Ultrasound in the diagnosis of pulmonary embolism

Venska tromboembolija hitno je stanje koje, ako se rano ne prepozna, rezultira visokim mortalitetom. Plućna embolija treći je najčešći uzrok smrti povezan s kardiovaskularnim bolestima. 90% embolusa potječe od tromba iz dubokog venskog sustava nogu. Zlatni standard za dijagnostiku plućne embolije trenutno je MSCT angiografija. Glavni nedostatci ove metode su zračenje i nefrotoksičnost kontrasta. Zlatni standard za slikovnu dijagnostiku DVT-a je CD UZV dubokih vena nogu. VTE kod hemodinamski stabilnih bolesnika liječimo antikoagulantnim lijekovima. Cilj istraživanja bio je pokazati u kojem je postotku bolesnika s MSCT angiografijom verificiranom PE moguće CD UZV-om dokazati prisutnost DVT-a. Ovo retrospektivno presječno istraživanje obuhvatilo je 114 bolesnika hospitaliziranih u Zavodu za intenzivnu medicinu Kliničkog bolničkog centra Zagreb i Medicinskog fakulteta Sveučilišta u Zagrebu, kod kojih je MSCT angiografijom verificirana masivna ili submasivna PE. Svim bolesnicima je, uz MSCT angiografiju, učinjen i UZV pluća, te CD UZV dubokih vena nogu. Svim bolesnicima, koristeći podatke iz otpusnih pisama, izračunali smo Wells score za PE i za DVT. Potom je učinjena deskriptivna statistika. Rezultati našeg istraživanja pokazali su da 66 od 114 bolesnika (57,9%) ima CD UZV-om dokaziv DVT. Obzirom da se za liječenje i DVT-a i PE koriste jednaki lijekovi u jednakim dozama, nameće se pitanje potrebitosti MSCT angiografije.Venous thromboembolism is an emergency condition that, if not recognized early, results in high mortality. Pulmonary embolism is the third most common cause of death associated with cardiovascular disease. 90% of emboli originate from a thrombus from the deep venous system of the legs. The gold standard for the diagnosis of pulmonary embolism is the MSCT angiography. The main disadvantages of this method are radiation and contrast nephrotoxicity. The gold standard for DVT imaging is CD ultrasound of the deep veins of the legs. VTE in hemodynamically stable patients is treated with anticoagulant drugs. The aim of the study was to show in what percentage of patients with MSCT angiography- verified PE is possible to prove the presence of DVT by CD ultrasound. This retrospective cross-sectional study included 114 patients hospitalized in the Department of Intensive Care Medicine of the Clinical Hospital Center Zagreb and the Medical Faculty of the University of Zagreb, in whom the massive or submassive PE was verified by MSCT angiography. In addition to MSCT angiography, all patients underwent lung ultrasound and CD ultrasound of the deep veins of the legs. For all patients, using data from discharge letters, we calculated the Wells score for PE and DVT. We performed the descriptive statistical analysis. The results of our study showed that 66 of 114 patients (57.9%) had CD ultrasound-detectable DVT. Since the same drugs in equal doses are administered to treat both DVT and PE, the question of the need for MSCT angiography in those patients arises