PULMONER TROMBOEMBOLİLİ OLGULARIMIZIN DEĞERLENDİRİLMESİ

Year 2009, Volume: 23 Issue: 2, 59 - 65, 01.10.2009

Esin Yentürk Dilek Kanmaz Firdevs Atabey Esin Tuncay

Abstract

Günümüzde ciddi sağlık sorunlarından biri olan pulmoner tromboemboli de (PTE) hızlı tanı ve tedavi ile mortalite oldukça azalmaktadır. Kliniği özgül olmayan bu hastalığın tanısında klinik, radyolojik ve laboratuvar bulgularının birlikte değerlendirilmesi gereklidir. Çalışmamızda PTE nedeni ile kliniğimizde interne edilen 65 hastanın klinik, radyolojik ve laboratuar bulguları incelendi. Tüm olgularda PA akciğer grafisi, arter kan gazları (AKG) ve D-dimer, ventilasyon perfüzyon (V/Q) sintigrafisi 61 (%93), alt ekstremite venöz Doppler ultrasonografi (USG) 39 (%60), toraks bilgisayarlı tomografisi (BT) 28 (%43) olguda bakıldı. Yaş ortalaması 51.4±14.5 (27-78) yıl olan, 65 (41 erkek, 24 kadın) hastanın semptom süresi 9.4±9.2 (1-35) gündü. En sık görülen semptom ani başlayan nefes darlığı (%92) idi. PTE için risk faktörü %83 (54/65) oranında görüldü. En sık radyolojik bulgular; lineer atalektazi %81 (53/65), diafragma elevasyonu %75 (49/65) iken, V/Q sintigrafisi %75 (46/61) yüksek, %12 (7/61) orta, %13 (8/61) düşük olasılıklı değerlendirildi. Doppler USG de; %64 (25/39) olguda akut ve subakut trombüs saptandı. Düşük ve orta olasılıklı V/Q sintigrafisi olan olguların hepsinde yüksek klinik olasılık ve yüksek D-dimer düzeyi mevcuttu. Olgularımız invazif olmayan yöntemlere dayalı algoritma ile PTE tanısı konularak tedavi edilmiştir.

Keywords

Pulmoner tromboemboli, klinik bulgular, risk faktörleri

EVALUATION OF OUR PATIENTS WITH PULMONARY THROMBOEMBOLISM

Abstract

The mortality a nd the morbidity of the pulmonary thromboembolism (PTE), which is an important health problem, decreases significantly by early diagnoses and treatment. Because its clinical signs are not so specific the diagnosis must be based on the evaluation of clinical, radiological and biochemical findings together. Clinical, radiological and biochemical findings of 65 patients, hospitalized in our clinic with the diagnosis of PTE, were recorded. Chest radiograph, arterial blood gas (ABG) analyses and D-Dimer in all cases, V/Q scintigraphy in 61 (93%) cases, lower limb venous Doopler ultrasonography (USG) in 39 (60%) cases and thorax computed tomography (CT) in 28 (43%) cases were obtained. The duration of the symptoms of the 65 cases (M/W: 41/24) aged between 27 to 78 (51.4±14.5) was 9.4±9.2 (1-35) days. The most frequent symptom was acute onset dyspnea (92%). An 54 of the 65 cases (83%) there was one or more risk factors. The most frequent radiological findings were elevation of hemidiaphragm 75% (49/65), linear atelectasis 81% (53/65). In V/P scintigraphy 75% (46/61) high, 12% (7/61) moderate and 13% (8/61) of the cases were interpreted as low risk group. There was acute or subacute venous thrombosis in 64% (25/39) of the cases detected by Doopler USG. There were high clinical suspect and high blood D-Dimer levels in all the cases who have low or moderate risk according to V/P scintigraphy. In conclusion our cases were diagnosed by an algorithm based on noninvasive procedure.

Keywords

Pulmonary thromboembolism, clinic presentation, predisposing factors

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