Chest
Clinical Investigations: Pulmonary VasculatureNoninvasive Diagnosis of Suspected Severe Pulmonary Embolism: Transesophageal Echocardiography vs Spiral CT
Section snippets
Materials and Methods
In the period from November 1994 to May 1996, 211 patients with clinical suspicion of acute or chronic PE were referred to our echocardiographic laboratory for standard transthoracic echocardiography (TTE). This group was formed by consecutive patients seen by the staff of our department for suspected PE in this period, with the exception of a few moribund patients with disseminated neoplasmatic disease who were not considered candidates for further diagnostic management. Patients with signs of
Results
TEE reported the presence of at least one pulmonary arterial thromboembolus in 32 of 49 investigated patients. Emboli were revealed in 17 of 23 patients with suspected acute PE and in 15 of 26 patients with suspected chronic PE (Table 1 and Figs 1 and 2). Emboli were found bilaterally in 15 cases; in 9 of them the clinical picture indicated acute PE. Unilateral right-sided, intrapulmonary thromboemboli were reported in 12 subjects, and the left-sided thromboemboli were reported in five others.
Discussion
Diagnostic strategies for PE are being modified because of the successful introduction of venous ultrasound to the clinical practice.16, 17 Another breakthrough in the management of PE may be expected with more frequent application of imaging techniques permitting direct visualization of thromboemboli in the pulmonary arteries. This study is focused on the relative value of two such methods in the diagnosis of suspected PE in patients with signs of the right ventricular pressure overload
Conclusions
Due to the high prevalence of bilateral central pulmonary arterial thrombi in patients with hemodynamically significant PE, the diagnosis may be reliably confirmed in most cases with TEE despite its topographic limitations.
sCT has an excellent diagnostic power for centrally located thrombi. However, when sCT detects thrombi limited to the segmental or subsegmental pulmonary arteries, the diagnosis of PE should be made with caution.
When compared with sCT, the limitations of TEE are not
Acknowledgments
We would like to thank Mrs. K. Borek for her excellent technical assistance during TEE examinations.
References (23)
- et al.
Intravascular ultrasound imaging of pulmonary arteries: methodology, clinical applications, and future potential
Chest
(1994) - et al.
Rapid visualization of massive pulmonary emboli utilizing intravascular ultrasound
Chest
(1994) - et al.
Pulmonary MR angiography at 1.0 T: early results with K-space segmented and post-contrast turboflash two-dimensional time-of-flight sequences
Eur J Radiol
(1995) - et al.
Spiral-computed tomography versus pulmonary angiography in the diagnosis of acute massive pulmonary embolism
Am J Cardiol
(1994) - et al.
Detection of central pulmonary artery thromboemboli by transesophageal echocardiography in patients with severe pulmonary embolism
J Am Soc Echocardiogr
(1992) Venous and pulmonary thromboembolism: an algorithmic approach to diagnosis and management
Mayo Clin Proc
(1995)- et al.
Noninvasive diagnosis and treatment of a saddle pulmonary embolism: a case report in support of new trends in management of pulmonary embolism
Chest
(1996) - et al.
Reduced dose bolus alteplase vs conventional alteplase infusion for pulmonary embolism thrombolysis: an international multicenter randomized trial
Chest
(1994) - et al.
Prognostic significance of right ventricular hypokinesis and perfusion lung defects in pulmonary embolism
Am Heart J
(1994) - et al.
Paucity of angiographic findings despite extensive organized thrombus in chronic thromboembolic pulmonary hypertension
J Vasc Interv Radiol
(1992)
Detection of pulmonary embolism: comparison of contrast-enhanced spiral CT and time-of-flight MR techniques
J Thorac Imaging
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The echocardiographic part of this study was supported by grant KBN 4P05B06610.