Pulmoner Embolide Yardımcı Tanı Yöntemlerinin Karşılaştırılması

Öz

Amaç: Mortalite oranı yüksek pulmoner embolide (PE) bilgisayarlı tomografi pulmoner anjiyografinin (BTPA) kullanılamadığı durumlarda yardımcı tanı yöntemlerinin önemini araştırdık.
Materyal Metod: Hastalar tek merkezden oluşturulan bir örneklemde dışlama kriterleri uygulandıktan sonra toplanmış oldu. Çalışmamıza dahil edilen toplam 86 hasta BTPA’da PE’nin masif ya da segmental tutulumuna göre klinik özellikleri, yardımcı tanı yöntemleri, antikoagülan kullanımı ve yatış taburculuk durumuna göre incelendi.
Bulgular: Hastaların yaş ortalaması 52.29±14.14 yıl idi. BTPA sonucuna göre masif tutulumu olan 46 (%53.5) ve segmental tutulumu olan toplam 40 (%46.5) hasta vardı. Masif tutulumlarda ekokardiyografi (EKO) sonucunda sağ kalp boşlukları dilate olan 38 (%82.6) hasta varken; segmental tutulumlarda ise 19 (%47.5) hasta vardı. BTPA’nin masif tutulumu ile EKO sonucu arasında istatistiksel bir anlamlılık vardı (p=0,001).
Sonuç: Acil servislerde PE tanısında özelikle de masif embolilerde yardımcı radyolojik yöntem olarak EKO tercih edilebilir. 

Comparison of Auxiliary Diagnostic Methods in Pulmonary Embolism

Öz

Aim: We investigated the importance of auxiliary diagnostic methods in cases when computed tomography pulmonary angiography (CTPA) cannot be used in pulmonary embolism (PE) with a high mortality rate.
Materials and Methods: Patients were selected after the exclusion criteria were applied in a sample created from a single center. A total of 86 patients included in our study were examined in terms of clinical features, auxiliary diagnostic methods, anticoagulant use, and hospitalization and discharge status according to the massive or segmental involvement of PE in CTPA.
Results: The mean age of the patients was 52.29±14.14 years. According to the CTPA results, there were 46 (53.5%) patients with massive involvement and 40 (46.5%) patients with segmental involvement. While there were 38 (82.6%) patients with massive involvement whose right chambers of the heart were dilated in echocardiography (ECHO) results, there were 19 (47.5%) patients with segmental involvement. There was a statistical significance between the massive involvement of CTPA and ECHO result (p=0.001).
Conclusion: ECHO may be preferred as an auxiliary radiological method in the diagnosis of PE in emergency departments (ED), especially in massive embolisms.

Anahtar Kelimeler

• Pulmonary embolism
• massive
• segmental
• echocardiography

Kaynakça

1. Beckman MG, Hooper WC, Critchley SE, et al. Venous thromboembolism: a public health concern. Am J PrevMed 2010;38:S495-501.
2. Özsu S, Özlü T, Bülbül Y. Pulmonary thromboembolism based on the Turkish national data. Tuberculosis and Thorax Journal 2009; 57(4): 466-82.
3. White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107 (Suppl1):14-8.
4. Elias A, Colombier D, Victor G, et al. Diagnostic performance of complete lower limb venous ultrasound in patients with clinically suspected acute pulmonary embolism. Thromb Haemost 2004; 91: 187–95.
5. Kearon C, Ginsberg JS, Hirsh J. The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism. Ann Intern Med 1998;129:1044-9.
6. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. EurHeart J 2014;35:3033-69.
7. van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017;390(10091):289-297.
8. Oz I.I, Serifoglu I, Altınsoy B, et al. (2014). Diagnostic Imaging in Acute Pulmonary Embolism. Journal of Chest Diseasesand Critical Care 2014; 1(4): 151-156.

9. Sebih A.L.P, Özyurt S, Kara B.Y, et al. Determination of Factors Affecting the Survival in Patients with Pulmonary Thromboembolism. Journal of Harran University Medical Faculty 2019; 16(3): 470-477.
10. Doolittle RF, Pandi L. Probingthe beta-chain hole of fibrinogen with synthetic peptides that differ at their amino termini. Biochemistry. 2007;46:10033-10038.
11. Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res 2016;118:1340-1347.
12. Doğan C, Comert S.S, Caglayan B, et al. Retrospective Evaluation of Pulmonary Thromboembolism Cases. Journal of Izmir Chest Hospital 2016; 30 (1): 15-21.
13. Yan C, Wang X, Su H, et al.. Recent Progress in Research on the Pathogenesis of Pulmonary Thromboembolism: An Old Story with New Perspectives. Hindawi Bio Med Research International Volume 2017, Article ID 6516791, 10 pagesdoi: 10.1155/2017/6516791.
14. Kobberøe Søgaard K, Schmidt M, Pedersen L, et al. 30-year mortality after venous thromboembolism: a population-based cohort study. Circulation 2014: 2;130(10):829-36.
15. Welsh JD, Hoofnagle MH, Bameza S, et al. Hemodynamic regulation of perivalvular endothelial gene expression prevents deep venous thrombosis. J Clin Invest. 2019; 129(12): 5489–5500.
16. Ipekci A. Pulmonary Embolism. Phnx Med J 2019: 1; 51-63.
17. Becattini C, Agnelli G. Risk stratification and management of acute pulmonary embolism. Hematology Am Soc Hematol Educ Program 2016; 1: 404-412.
18. Ishaaya E, Tapson VF. Advances in the diagnosis of acute pulmonary embolism. Version 1. F1000Res. 2020; 9: F1000 Faculty Rev-44. Published online 2020 Jan 24. doi: 10.12688/f1000research.21347.1.
19. Yurtseven A, Tatlı M, Altintop I. Pulmonary Embolism is Enigmatic Problem in Emergency Service: Performance of Wells Score, Geneva Score and Other Test for PE. Journal of Anatolian Medical Research 2017; 2(1): 36-44.
20. Barrios D, Morillo R, Lobo JL, et al. Assessment of right ventricular function in acute pulmonary embolism. AmHeart J 2017; 185: 123–129.
21. Albaghdadi MS, Dudzinski DM, Giordano N, et al. Cardiopulmonary Exercise Testing in Patients Following Massive and Submassive Pulmonary Embolism. J Am Hear Assoc 2018; 7(5): e006841. Publishedonline 2018 Mar 3. doi: 10.1161/JAHA.117.006841.
22. In E, Turgut T, Kalkan M, et al. The Relationship Between Computed Tomography Pulmonary Angiography Findings and Right Ventricular Dysfunction in Patients with Pulmonary Embolism. Turkish Thoracic Journal 2014; 15: 117-21.
23. Selimoglu Sen H, Abakay O. Current diagnosis and treatment in pulmonary thromboembolism. J Clin ExpInvest 2013; 4 (3): 405-410.
24. Sin D, Lennan GM, Rengier F, et al. Acute pulmonary embolism multimodality imaging prior to endovascular therapy. Int J Cardiovasc Imaging 2021; 37(1): 343-358.
25. Winer-Muram HT, Rydberg J, Johnson MS, et al. Suspected acute pulmonary embolism: evaluation with multi-detectorrow CT versus digital subtraction pulmonary arteriography. Radiology 2004:233:806–815.
26. Burgan H, Akdeniz, Y.S, Ipekci A, et al. The Effectiveness of YEARS and Wells Diagnostic Criteria in the Emergency Department with Suspected Pulmonary Thromboembolism. Phoenix Medical Journal 2021: 3(1); 35-39.
27. Moutzouris JP, Chwan Ng AC, Chow V, et al. Acute pulmonary embolism during warfarin therapy and long-term risk of recurrent fatal pulmonary embolism. Thromb Haemost 2013; 110: 523–533.
28. Meyer G, Planquette B, Sanchez O. Long-term outcome of pulmonary embolism. Curr Opin Hematol 2008; 15: 499-503.
29. Douketis JD, Kearon C, Bates S, et al. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. J Am Med Assoc 1998; 279: 458-462.
30. Koc B, Karatepe O, Unal O, et al. Post-Hospital Pulmonary Embolism Study in Patients Undergoing Prophylaxis: A Retrospective Clinical Study. Medical Journal of Bakırkoy 2011: 7 (1); 17-19.
31. Baydin A, Yardan T, Eden A.O, et al. The Evaluatıon Of Cases Dıagnosed As Acute Pulmonary Embolısm In Emergency Department. Eurasian J Emerg Med 2008;7(1):20-23.