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PULMONER TROMBOEMBOLİ OLGULARIMIZIN RETROSPEKTİF TARANMASI

Year 2013, Volume: 27 Issue: 2, 89 - 94, 01.10.2013

Abstract

Pulmoner tromboemboli (PTE) zor tanı konulan morbidite ve mortalitesi yüksek bir hastalıktır. 2002 ve 2006 yılları arasında kliniğimizde takip edilen 68 PTE olgusu çalışmaya dahil edildi. 68 olgunun 30u erkek (%44.1), 38i kadın (%55,9) idi. Yaş ortalaması 48,9±17,48 (16-86). Olguların başvuru semptomlarından en sık dispne %72,1 izlenmiştir. Risk faktörleri incelendiğinde cerrahi müdahalenin ilk sırayı aldığı görüldü. 46 olguda hipoksemi, 45 olguda hipokapni, 42 olguda respiratuvar alkoloz vardı. Akciğer grafisinse %73,5 oranında birden fazla lezyona rastlandı. En sık rastlanan lezyonlar %57,4 parankimal konsolidasyon, %50 sinüs kapalılığı, % 44,1 diafrgma yüksekliği idi.Toraks BT bulgusu olarak 54 olguda lümen içi dolma defektine rastlandı. Ventilasyon Perfüzyon Sintigrafisi 32 olguya uygulandı. 39 olguya Doppler USG yapıldı. 14 olguda derin ven trombozu saptandı. 12 olguda ekokardiografi yapılmış olup yarısında pulmoner hipertansiyon saptandı. 52 (%76,47) olguya düşük molekül ağırlıklı heparin, 14 (%20,58) olguya standart heparin uygulandı. 2 olguya trombolitik tedavi uygulandı. Sonuç olarak PE olgularda en sık rastlanan semptom dispne, risk faktörü cerrahi müdale, akciğer grafi bulgusu parankimal konsolidasyondu. Toraks BT ile olguların çoğunda pulmner arter ve dallarında trombüs saptanarak tanı konmuştur. PE olgularda hastalığa spesifik bulgu olmadığı için uyumlu klinik ve laboratuar bulguları varlığında PE düşünülmesi ve acilen tedaviye başlanması ile morbidite ve mortalite oranlarının azalacağını düşünmekteyiz.

References

  • 1. Türk Toraks Dergisi. Pulmoner Tromboembolizm Tanı ve Tedavi Uzlaşı Raporu 2009
  • 2. Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism. N Engl J Med 1992;236:1240-5.
  • 3. Hirsh J, Bates SM. Prognosis in acute pulmonary embolism. Lancet 1999; 353: 1375-6.
  • 4. Lilienfeld DE. Decreasing mortality from pulmoner embolism in the United States, 1979- 1996. Int J Epidemiol 2000;29:465-9.
  • 5. Courtney DM, Kline JA, Kabrhel C,et all. Clinical features from the history and physical examination that predict the presence or absence of pulmonary embolism in symptomatic emergency department patients: results of a prospective, multicenter study. Ann Emerg Med. 2010 Apr;55(4):307-15.
  • 6. Stein PD, Huang HI, Afzal A, et all. Incidens of acute pulmonary embolismin a general hospital: relation age,sex and race. Chest 1999; 116:909-13.
  • 7. PIOPED investigators. The value of the ventilation/ perfusion scan in acute pulmonary embolism: Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). JAMA 1990; 263: 2753-9.
  • 8. Miniati M, Prediletto R, Formichi B, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 1999; 159: 864-71.
  • 9. Heit JA. Risk factors for venous tromboembolism. Clin Chest Med 2003;24:1-12.
  • 10. Çakmak F, Işık C, Gündoğdu C. 1987-1990 yılları arasında Atatürk Göğüs Hastalıkları ve Gö- ğüs Cerrahisi Merkezi’nde akciğer embolisi tanı- sı konan hastaların retrospektif incelenmesi. Solunum Hastalıkları 1992;3:53-62.
  • 11. Kadakal F, Çetinkaya E, Yıldız P ve ark. Klinik olarak yüksek olasılıklı pulmoner emboli olgularında tanı. Solunum Hastalıkları 2000;11:140-3.
  • 12. Atikcan Ş, Atalay F, Turgut D, Ünsal E. Pulmoner tromboemboli: 42 olgunun retrospektif değerlendirilmesi. Solunum Hastalıkları 2002;13:87- 93.
  • 13. Worsley DF, Alavi A, Aronchick JM, et al. Chest radiographic findings in patients with acute pulmonary embolism: Observations from the PIOPED study. Radiology 1993;189:133-6.
  • 14. Eliot G, Goldhaber SZ, Visani L, et al. Chest radiographs in acute pulmonary embolism. Chest 2002;118:33-8.
  • 15. Özkan R. Tanıda konvansiyonel radyoloji, tomografi, manyetik rezonans. In: Metintaş M, ed. Pulmoner tromboemboli. Eskişehir: ASD Toraks Yayınları, 2001;111-9.
  • 16. Wells PS, Rodger M. Diagnosis of pulmonary embolism: When is imaging needed? Clin Chest Med 2003;24:13-28.
  • 17. Lewczuk J, Drozdz D. Hypoxemia in pulmonary embolism-the occurrence, patomechanism and significance. Pol Merkur Lekarski 2008; 24(139): 42-4.
  • 18. Schoepf J, Costello P. CT angiography for diagnosis of pulmonary embolism. State of art. Radiology 2004; 230: 329-37.
  • 19. Wells PS, Ginsberg JS, Anderson DR, et al. Utility of ultrasound imaging of the lower extremities in the diagnostic approach in patients with suspected pulmonary embolism. J Intern Med 2001;250:262-4.

RETROSPECTIVE EVALUATION OF CASES WITH PULMONARY THROMBOEMBOLISM

Year 2013, Volume: 27 Issue: 2, 89 - 94, 01.10.2013

Abstract

Pulmonary thromboembolism (PTE) is common, diffucultly diagnosed disease that has high morbidity and mortality 68 PTE cases who were followed in our clinic between the years 2002 and 2006 were included in this study. Of 68 cases, 30 were male (%44,1) 38 were female (%55,9) with a mean age of 48,9 ±17,48 (16-86) The most comman admission symptom was dyspnea (%72,1). Surgery took first place among predisposing factor. In 46 cases hypoxemia, in 45 cases hypocapnia and in 42 cases respiratory alkolozis were detected.More than one lesion was encountered in X Ray (%75,3). The most common radiolojic signs in X Ray were parenchymal infiltrations (%57,4), small pleural effuion (%50), hemidiaphragm elevation (%44,1). İn 54 cases intraluminal filling defect was observed in spiral throcal CT. Ventilation Perfusion Syntigraphy applied in 32 cases. İn 39 cases doppler us performed.there was deep vein thrombosis in 14 cases.Ecocardiography was performed in 12 cases and half of them had pulmonary hipertension. In 52 cases LMWH, in 14 cases standart heparin and in 2 cases thrombolytic therapy was applied. In conclusion, in cases with PE, the most common symptom was dyspnea. Predisposing factor was surgery, radiolojic sign in XRay was parenchymal infiltration. The diagnosis was confirmed in most cases by detecting thrombus in main pulmonary artery for pulmonary arteries. We think that, because of the cases with PTE has no spesific finding, starting therapy immediately in PTE cases when we observed appropriate clinical and laboratuary findings may reduce the mortality and morbidity rates.

References

  • 1. Türk Toraks Dergisi. Pulmoner Tromboembolizm Tanı ve Tedavi Uzlaşı Raporu 2009
  • 2. Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism. N Engl J Med 1992;236:1240-5.
  • 3. Hirsh J, Bates SM. Prognosis in acute pulmonary embolism. Lancet 1999; 353: 1375-6.
  • 4. Lilienfeld DE. Decreasing mortality from pulmoner embolism in the United States, 1979- 1996. Int J Epidemiol 2000;29:465-9.
  • 5. Courtney DM, Kline JA, Kabrhel C,et all. Clinical features from the history and physical examination that predict the presence or absence of pulmonary embolism in symptomatic emergency department patients: results of a prospective, multicenter study. Ann Emerg Med. 2010 Apr;55(4):307-15.
  • 6. Stein PD, Huang HI, Afzal A, et all. Incidens of acute pulmonary embolismin a general hospital: relation age,sex and race. Chest 1999; 116:909-13.
  • 7. PIOPED investigators. The value of the ventilation/ perfusion scan in acute pulmonary embolism: Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). JAMA 1990; 263: 2753-9.
  • 8. Miniati M, Prediletto R, Formichi B, et al. Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 1999; 159: 864-71.
  • 9. Heit JA. Risk factors for venous tromboembolism. Clin Chest Med 2003;24:1-12.
  • 10. Çakmak F, Işık C, Gündoğdu C. 1987-1990 yılları arasında Atatürk Göğüs Hastalıkları ve Gö- ğüs Cerrahisi Merkezi’nde akciğer embolisi tanı- sı konan hastaların retrospektif incelenmesi. Solunum Hastalıkları 1992;3:53-62.
  • 11. Kadakal F, Çetinkaya E, Yıldız P ve ark. Klinik olarak yüksek olasılıklı pulmoner emboli olgularında tanı. Solunum Hastalıkları 2000;11:140-3.
  • 12. Atikcan Ş, Atalay F, Turgut D, Ünsal E. Pulmoner tromboemboli: 42 olgunun retrospektif değerlendirilmesi. Solunum Hastalıkları 2002;13:87- 93.
  • 13. Worsley DF, Alavi A, Aronchick JM, et al. Chest radiographic findings in patients with acute pulmonary embolism: Observations from the PIOPED study. Radiology 1993;189:133-6.
  • 14. Eliot G, Goldhaber SZ, Visani L, et al. Chest radiographs in acute pulmonary embolism. Chest 2002;118:33-8.
  • 15. Özkan R. Tanıda konvansiyonel radyoloji, tomografi, manyetik rezonans. In: Metintaş M, ed. Pulmoner tromboemboli. Eskişehir: ASD Toraks Yayınları, 2001;111-9.
  • 16. Wells PS, Rodger M. Diagnosis of pulmonary embolism: When is imaging needed? Clin Chest Med 2003;24:13-28.
  • 17. Lewczuk J, Drozdz D. Hypoxemia in pulmonary embolism-the occurrence, patomechanism and significance. Pol Merkur Lekarski 2008; 24(139): 42-4.
  • 18. Schoepf J, Costello P. CT angiography for diagnosis of pulmonary embolism. State of art. Radiology 2004; 230: 329-37.
  • 19. Wells PS, Ginsberg JS, Anderson DR, et al. Utility of ultrasound imaging of the lower extremities in the diagnostic approach in patients with suspected pulmonary embolism. J Intern Med 2001;250:262-4.
There are 19 citations in total.

Details

Other ID JA87AP88JR
Journal Section Research Article
Authors

Gülistan Karadeniz This is me

Melih Büyükşirin This is me

Gülru Polat This is me

Zehra Aşuk This is me

Fatma Üçsular This is me

Gülcan Ürpek This is me

Gültekin Tibet This is me

Publication Date October 1, 2013
Published in Issue Year 2013 Volume: 27 Issue: 2

Cite

APA Karadeniz, G., Büyükşirin, M., Polat, G., Aşuk, Z., et al. (2013). PULMONER TROMBOEMBOLİ OLGULARIMIZIN RETROSPEKTİF TARANMASI. İzmir Göğüs Hastanesi Dergisi, 27(2), 89-94.