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

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

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.

References

  • 1. Metintafl S. Venöz trombüs ve pulmoner tromboemboli epidemiyolojisi. ‹çinde: Metintafl M, (ed). Pulmoner Tromboemboli. Eskiflehir, ASD Toraks Yay›nlar›, 2001: 3-20.
  • 2. Guintini C, Di Ricco G, Marini C, Melillo E, Palla A. Epidemiology. Chest 1995; 107: 3-9.
  • 3. Masotti L, Ray P, Righini M, LeGal G, Antonelli F, Landini G, Capelli R, Prisco D, Rottoli P. Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation. Vasc Health Risk Manag 2008;4(3): 629-36.
  • 4. Oflaz H, Dereli fi, Çakan A. Pulmoner emboli olgular›m›z›n analizi. ‹zmir Gö¤üs Hastanesi Dergisi 1998; 12: 40-4.
  • 5. Quinn DA, Thompson BT, Terrin ML, Thrall JH, Athanasoulis CA, McKusick KA, Stein PD, Hales CA. A prospective investigation of pulmonary embolism in women end men. JAMA 1992; 268: 1689-96.
  • 6. Dursuno¤lu N, Bafler S, Dursuno¤lu D, Moray A, Kiter G, Öztürk S, Evyapan F, Karabulut N. Differences between men and women in the clinical and laboratory findings of patients diagnosed with pulmonary embolism Tuberk Toraks 2007; 55(3): 246-52.
  • 7. Savafl Özsu, Y›lmaz Bülbül, Funda Öztuna, Tevfik Özlü. Pulmoner Tromboemboli: Baflvuru Klini¤i ve Radyografik Özelliklerinin Karfl›- laflt›r›lmas›. Akci¤er Arflivi 2006; 7: 6-10.
  • 8. Yüksel EG, Turan F, Özyard›mc› N. Pulmoner emboliye retrospektif bak›fl. Akci¤er Arflivi 2001; 2: 79-84.
  • 9. Dursun AB, Güven SF, Saka D, Sar›o¤lu N, fiipit T. Klinik pratikte pulmoner tromboemboliye yaklafl›m. Tuberk Toraks 2001; 49: 464-70.
  • 10. Rizkallah J, Man SF, Sin DD. Prevalence of Pulmonary Embolism in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis. Chest 2008; Sep 23. [Epub ahead of print]
  • 11. K›ral N, Salepçi B, Özdo¤an S, Teveto¤lu ‹, Ça¤layan B. Klinik Olarak Yüksek Olas›l›kl› Pulmoner Embolili Olgular›m›z›n Retrospektif Analizi. Solunum Hastal›klar› 2002; 13: 172-6.
  • 12. Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997; 112: 974-9.
  • 13. Stein PD, Beemath A, Matta F. Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV Jr, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK. Clinical characteristics of patients with acute pulmonary embolism: Data from PIOPED II. Am J Med 2007; 120(10): 871-9.
  • 14. Afzal A, Noor HA, Gill SA, Brawner C, Stein PD. Leukocytosis in acute pulmonary embolism. Chest 1999; 115(5): 1329-32.
  • 15. Kokturk N, Demir N, Oguzulgen IK, Demirel K, Ekim N. Fever in pulmonary embolism. Blood Coagul Fibrinolysis 2005; 16(5): 341-7.
  • 16. Lewczuk J, Drozdz D. Hypoxemia in pulmonary embolism--the occurrence, patomechanism and significance. Pol Merkur Lekarski 2008; 24(139): 42-4.
  • 17. Uresandi F, Blanquer J, Conget F, de Gregorio MA, Lobo JL, Otero R, Pérez Rodríguez E, Monreal M, Morales P. Guidelines for the diagnosis, treatment, and follow-up of pulmonary embolism. Arch Bronconeumol 2004; 40: 580-94.
  • 18. Schoepf UJ, Costello P. CT angiography for diagnosis of pulmonary embolism: state of the art. Radiology 2004; 230: 329-37.
  • 19. Winer-Muram HT, Rydberg J, Johnson MS, Tarver RD, Williams MD, Shah H, Namyslowski J, Conces D, Jennings SG, Ying J, Trerotola SO, Kopecky KK. Suspected acute pulmonary embolism: evaluation with multi-detector row CT versus digital subtraction pulmonary arteriography. Radiology 2004; 233: 806-15.
  • 20. Patel S, Kazerooni EA, Cascade PN. Pulmonary embolism: optimization of small pulmonary artery visualization at multi-detector row CT. Radiology 2003; 227: 455-60.
  • 21. Erbaycu AE, Tuksavul F, Uçar H, Güçlü SZ. K›rkdokuz Pulmoner Emboli Olgusunun Retrospektif De¤erlendirilmesi. ‹zmir Gö¤üs Hastanesi Dergisi 2004, 18(3): 113-118.
  • 22. Karab›y›ko¤lu G. Pulmoner tromboemboli. ‹çinde: Numano¤lu N (ed.). Klinik Solunum Sistemi ve Hastal›klar›. Ankara: Ant›p A.fi, 1997: 454-67.
  • 23. Perrier A. Deep vein thrombosis and pulmonary embolism. A single disease entity with different risk factors. Chest 2000; 118: 1234-6.
  • 24. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003; 58: 470-84.
  • 25. Demirkaz›k FB. Akci¤er embolisi tan›s›nda spiral BT anjiyografisi. Toraks Derg 2001; 2: 69-73.
  • 26. Yentürk E, Kanmaz D, Atabey F, Tuncay E, Pulmoner Tromboembolili Olgular›m›z›n De¤erlendirilmesi. ‹zmir Gö¤üs Hastanesi Dergisi 2009, 23(2): 59-65.
  • 27. Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med 2002; 136: 691-700.

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

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

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.

References

  • 1. Metintafl S. Venöz trombüs ve pulmoner tromboemboli epidemiyolojisi. ‹çinde: Metintafl M, (ed). Pulmoner Tromboemboli. Eskiflehir, ASD Toraks Yay›nlar›, 2001: 3-20.
  • 2. Guintini C, Di Ricco G, Marini C, Melillo E, Palla A. Epidemiology. Chest 1995; 107: 3-9.
  • 3. Masotti L, Ray P, Righini M, LeGal G, Antonelli F, Landini G, Capelli R, Prisco D, Rottoli P. Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation. Vasc Health Risk Manag 2008;4(3): 629-36.
  • 4. Oflaz H, Dereli fi, Çakan A. Pulmoner emboli olgular›m›z›n analizi. ‹zmir Gö¤üs Hastanesi Dergisi 1998; 12: 40-4.
  • 5. Quinn DA, Thompson BT, Terrin ML, Thrall JH, Athanasoulis CA, McKusick KA, Stein PD, Hales CA. A prospective investigation of pulmonary embolism in women end men. JAMA 1992; 268: 1689-96.
  • 6. Dursuno¤lu N, Bafler S, Dursuno¤lu D, Moray A, Kiter G, Öztürk S, Evyapan F, Karabulut N. Differences between men and women in the clinical and laboratory findings of patients diagnosed with pulmonary embolism Tuberk Toraks 2007; 55(3): 246-52.
  • 7. Savafl Özsu, Y›lmaz Bülbül, Funda Öztuna, Tevfik Özlü. Pulmoner Tromboemboli: Baflvuru Klini¤i ve Radyografik Özelliklerinin Karfl›- laflt›r›lmas›. Akci¤er Arflivi 2006; 7: 6-10.
  • 8. Yüksel EG, Turan F, Özyard›mc› N. Pulmoner emboliye retrospektif bak›fl. Akci¤er Arflivi 2001; 2: 79-84.
  • 9. Dursun AB, Güven SF, Saka D, Sar›o¤lu N, fiipit T. Klinik pratikte pulmoner tromboemboliye yaklafl›m. Tuberk Toraks 2001; 49: 464-70.
  • 10. Rizkallah J, Man SF, Sin DD. Prevalence of Pulmonary Embolism in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis. Chest 2008; Sep 23. [Epub ahead of print]
  • 11. K›ral N, Salepçi B, Özdo¤an S, Teveto¤lu ‹, Ça¤layan B. Klinik Olarak Yüksek Olas›l›kl› Pulmoner Embolili Olgular›m›z›n Retrospektif Analizi. Solunum Hastal›klar› 2002; 13: 172-6.
  • 12. Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997; 112: 974-9.
  • 13. Stein PD, Beemath A, Matta F. Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV Jr, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK. Clinical characteristics of patients with acute pulmonary embolism: Data from PIOPED II. Am J Med 2007; 120(10): 871-9.
  • 14. Afzal A, Noor HA, Gill SA, Brawner C, Stein PD. Leukocytosis in acute pulmonary embolism. Chest 1999; 115(5): 1329-32.
  • 15. Kokturk N, Demir N, Oguzulgen IK, Demirel K, Ekim N. Fever in pulmonary embolism. Blood Coagul Fibrinolysis 2005; 16(5): 341-7.
  • 16. Lewczuk J, Drozdz D. Hypoxemia in pulmonary embolism--the occurrence, patomechanism and significance. Pol Merkur Lekarski 2008; 24(139): 42-4.
  • 17. Uresandi F, Blanquer J, Conget F, de Gregorio MA, Lobo JL, Otero R, Pérez Rodríguez E, Monreal M, Morales P. Guidelines for the diagnosis, treatment, and follow-up of pulmonary embolism. Arch Bronconeumol 2004; 40: 580-94.
  • 18. Schoepf UJ, Costello P. CT angiography for diagnosis of pulmonary embolism: state of the art. Radiology 2004; 230: 329-37.
  • 19. Winer-Muram HT, Rydberg J, Johnson MS, Tarver RD, Williams MD, Shah H, Namyslowski J, Conces D, Jennings SG, Ying J, Trerotola SO, Kopecky KK. Suspected acute pulmonary embolism: evaluation with multi-detector row CT versus digital subtraction pulmonary arteriography. Radiology 2004; 233: 806-15.
  • 20. Patel S, Kazerooni EA, Cascade PN. Pulmonary embolism: optimization of small pulmonary artery visualization at multi-detector row CT. Radiology 2003; 227: 455-60.
  • 21. Erbaycu AE, Tuksavul F, Uçar H, Güçlü SZ. K›rkdokuz Pulmoner Emboli Olgusunun Retrospektif De¤erlendirilmesi. ‹zmir Gö¤üs Hastanesi Dergisi 2004, 18(3): 113-118.
  • 22. Karab›y›ko¤lu G. Pulmoner tromboemboli. ‹çinde: Numano¤lu N (ed.). Klinik Solunum Sistemi ve Hastal›klar›. Ankara: Ant›p A.fi, 1997: 454-67.
  • 23. Perrier A. Deep vein thrombosis and pulmonary embolism. A single disease entity with different risk factors. Chest 2000; 118: 1234-6.
  • 24. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003; 58: 470-84.
  • 25. Demirkaz›k FB. Akci¤er embolisi tan›s›nda spiral BT anjiyografisi. Toraks Derg 2001; 2: 69-73.
  • 26. Yentürk E, Kanmaz D, Atabey F, Tuncay E, Pulmoner Tromboembolili Olgular›m›z›n De¤erlendirilmesi. ‹zmir Gö¤üs Hastanesi Dergisi 2009, 23(2): 59-65.
  • 27. Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med 2002; 136: 691-700.
There are 27 citations in total.

Details

Other ID JA83CT92RP
Journal Section Research Article
Authors

Emel Tellioğlu This is me

Özlem Şengören This is me

Rıfat Özacar This is me

Publication Date May 1, 2010
Published in Issue Year 2010 Volume: 24 Issue: 1

Cite

APA Tellioğlu, E., Şengören, Ö., & Özacar, R. (2010). PULMONER TROMBOEMBOLİ OLGULARININ KLİNİK, KAN GAZI, RADYOLOJİK, SİNTİGRAFİK VE ULTRASONOGRAFİK ÖZELLİKLERİNİN RETROSPEKTİF İNCELEMESİ. İzmir Göğüs Hastanesi Dergisi, 24(1), 21-28.