PULMONER TROMBOEMBOLİ OLGULARININ KLİNİK, KAN GAZI, RADYOLOJİK, SİNTİGRAFİK VE ULTRASONOGRAFİK ÖZELLİKLERİNİN RETROSPEKTİF İNCELEMESİ

Year 2010, Volume: 24 Issue: 1, 21 - 28, 01.05.2010

Emel Tellioğlu Özlem Şengören Rıfat Özacar

Abstract

Pulmoner tromboemboli (PTE) olgularımızın klinik özellikleri, laboratuar, radyolojik bulgularının incelenmesi amaçlandı. Ocak 2007-Kasım 2008 tarihleri arasındaki PTE olguları retrospektif değerlendirildi. Kliniğimizde 26'sı kadın, 39'u erkek olmak üzere yaş ortalamaları 54.49±17.8 olan toplam 65 olgu takip edildi. En sık görülen belirti olan nefes darlığını (%70.8) göğüs ağrısı (%46.2) ve hemoptizi (%13.8) izliyordu. Kan gazı ölçümü yapılan 59 hastanın 49 (%75.4)'unda hipoksi, 33 (%50.8)' unda hipokapni, 23' ünde (%38.9) respiratuvar alkaloz ve 18'inde (%27.7) de solunum yetmezli ği saptandı. Pulmoner tromboemboli tanısı 15 hastada sadece toraks anjioBT ile ve 10 hastada da sadece ventilasyon perfüzyon sintigrafisi ile kondu. 14 hastada ise toraks anjioBT ile sintigrafi bulguları birbirini desteklemekteydi. AnjioBT çekilen 58 (%89.2) hastanın 20'\\\sinde ana pulmoner arterlerde (14'ünde unilateral, 6 hastada bilateral), 17 hastada lober/segmenter arterlerde, 7 hastada da hem ana pulmoner arterlerde hem de lober/segmenter arterlerde dolma defekti bulundu. Ventilasyon/perfüzyon sintigrafisi çekilen 32 hastanın (%49,2) 28\\\'inde segmenter ve/veya subsegmenter düzeyde perfüzyon defekti bulundu. Alt ekstremite venöz Doppler USG yapılan 50 hastanın 23ünde ultrasonografide patoloji saptandı DVT bulgularının dokuzu akut, 12'si subakut, biri de kronik aşamadaydı. Ekokardiyografi yapılan yedi hastanın sadece üçünde sağ kalp yüklenme bulguları ve pulmoner hipertansiyon bulundu. Önceki çalışmalardan daha küçük yaş ortalaması saptandı. Erkek hastalarımızın sayısı kadınlardan daha fazlaydı. Lökositozlu hasta oranı, önceki çalışmalardan daha fazlaydı. Hipoksi ve hipokarbi uyarıcı kan gazı bulguları idi. Toraks anjio- BT'nin tek başına PTE tanısında kullanılabildiği olgular genellikle ana pulmoner arterlerde ve/ veya ilk damarsal dallanma bölgesinde PTE meydana gelen hastalardı. Alt ekstremite venöz Doppler USG, PTE tanısında yararlı bir yöntemdi.

Keywords

Pulmoner tromboemboli, klinik özellikler

RETROSPECTIVE ANALYSIS OF CLINICAL, BLOOD GASSES, RADIOLOGIC, SCINTIGRAPHIC AND ULTRASONOGRAPHIC FEATURES OF PULMONARY THROMBOEMBOLISM PATIENTS

Abstract

Clinical, la boratory and radiological features of pulmonary thromboembolism (PTE) cases are presented. PTE cases in January 2007-November 2008 period were assessed retrospectively. In 65 patients (26 female, 39 male) (mean age 54.49±17.8), the most common symptom was dyspnea (70,8%). Chest pain (46.2%) and hemoptysis (13.8%) were other common syptoms. Among 59 patients, 49 (75.4%) had hypoxia, 33 (50.8%) hypocapnia, 23 (38.9%) respiratory alcalosis and 18 (27.7%) had respiratory insufficiency. 15 was diagnosed by only thorax CT and 19 were diagnosed by scanning. Thorax angioCT and scintigraphy supported each other in 14. AngioCT were performed in 58 (89.2%). 20 had defects in main pulmonary arteries(14 had unilateral and 6 had bilateral), 17 had defects in lobar/segmenter arteries and 7 had kardiodefects in both main and lobar/segmenter arteries. Segmentary and/or subsegmentary perfusion defects were detected in 28 (49.2%) of 32 patients assessed with lung scans. 23 of 50 patients assessed with lower extremity venous Doppler ultrasonography had pathological findings. Nine of DVT's were acute, 12 were subacute, one was in chronical state. Among seven patients with echocardiography, only three had right ventricular strain and pulmonary hypertension. Our patients were younger. Male patients were more than women. Leucocytosis ratio was more in our patients. Hypoxia and hypocarbia were alarming blood gas values. Thorax angioCT alone could be used in PTE patients with thrombosis in main pulmonary arteries and/or in first branching region of pulmonary arteries. Lower extremity venous Doppler USG was a useful method in PTE diagnosis.

Keywords

Pulmonary thromboembolism, clinical features

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