COMPUTED TOMOGRAPHY IN DIAGNOSTICS OF PULMONARY THROMBOEMBOLISM

Plućna tromboembolija jest bolest koja nastaje opstrukcijom jedne ili više grana plućne arterije embolusima koji se najčešće stvaraju u velikim venama predjela zdjelice i donjih ekstremiteta. Ova bolest jest treća po učestalosti među kardiovaskularnim bolestima s visokim mortalitetom. Klinička prezentacija ove bolesti vrlo je varijabilna te ovisi o broju zahvaćenih ogranaka pulmonalne arterije i njihovoj veličini. Najčešći simptomi ove bolesti jesu: nagla pojava tahipneje i dispneje, bol u prsištu, kašalj i tahikardija. Danas osnovu dijagnostike ove bolesti čini kompjutorska tomografija plućne angiografije (CTPA). CTPA jest neinvazivna tehnika koja pomoću kontrastnog sredstva omogućuje vizualizaciju plućne arterije i njezinih grana. Ova metoda jest vrlo brza i relativno sigurna metoda koja se može izvesti 10ak sekundio odnosno jednom zadržavanju daha. Još jedna prednost ove tehnike jest što može prikazati postoji li i neka druga patologija odnosno sva patološka stanja koja se prezentiraju sličnim simptomima. Ostale metode koje se mogu koristiti za dijagnostiku plućne tromboembolije jesu angiografija magnetnom rezonancom (MRA), perfuzijska i ventilacijska scintigrafija pluća, angiografija plućne arterije pomoću fluoroskopije te ultrazvučni pregled vena zdjelice i nogu kao dodatna dijagnostička pretraga u evaluaciji pacijenata s plućnom tromboembolijom. Cilj ovog istraživanja bio jest utvrditi incidenciju plućne tromboembolije među bolesnicima koji su upućeni na CT plućnu angiografiju te također utvrditi koje su dobne skupine najviše zastupljenje u bolesnika s pozitivnim nalazom CT plućne angiografije. Također se utvrđivala incidencija plućne tromboembolije s obzirom na spol bolesnika. Retrospektivnom analizom 87 bolesnika podvrgnutih CT plućnoj angiografiji može se zaključiti da je od ukupnog broja pozitivnih nalaza bilo samo 17, odnosno 19.5%. Od sveukupnih podvrgnutih bolesnika CT plućnoj angiografiji bilo je 44 žene (50,5%) i 43 muškarca (49,5%), dok je od pozitivnih bolesnika na plućnu tromboemboliju bilo 6,9% žena i 12,6% muškaraca. Rezultati ove studije ukazuju na prekomjerno izvođenje CT plućnih angiografija što bi trebalo potaknuti zabinutost liječnika naše ustanove.Pulmonary thromboembolism is a disease caused by obstruction of one or more pulmonary arteries with the embolisms most commonly formed in the large veins of the pelvis and lower extremities. This disease is the third in frequency among cardiovascular diseases with high mortality. The clinical presentation of this disease is highly variable and depends on the number of affected branches of the pulmonary artery and their size. The most common symptoms of this disease are: sudden onset of tachypnea and dyspnoea, chest pain, cough and tachycardia. Today, the basis of the diagnosis of pulmonary thromboembolism is computed tomography pulmonary angiography (CTPA). CTPA is a non-invasive technique that allows visualization of the pulmonary artery and its branches using contrast. This method is a very fast and relatively safe method that can be carried out in 10 seconds or in one breath hold. Another advantage of this technique is its ability to show whether there is any other pathology that presents with similar symptoms. Other methods that can be used for the diagnosis of pulmonary thromboembolism are magnetic resonance angiography (MRA), perfusion and ventilation scintigraphy, pulmonary artery angiography by fluoroscopy and ultrasound examination of the pelvic and legs as an additional diagnostic scan in the evaluation of patients with pulmonary thromboembolism. The aim of this study was to determine the incidence of pulmonary thromboembolism among patients who are referred to CT pulmonary angiography and also to determine which age groups are most represented in patients with positive CT scan of pulmonary angiography. The incidence of pulmonary thromboembolism in relation to the sex of the patient was also determined. By retrospective analysis of 87 patients undergoing CT pulmonary angiography it can be concluded that out of the total number there was only 17 or 19.5% positive studies. Of the total subjects undergoing CT pulmonary angiography, there were 44 women (50.5%) and 43 males (49.5%), while patients with diagnosed pulmonary thromboembolism were 6.9% of women and 12.6% of men. The results of this study indicate the overuse of CT pulmonary angiography, which should be a cause of worry among our physicians