Document Detail


Thoracic ultrasound for diagnosing pulmonary embolism: a prospective multicenter study of 352 patients.
MedLine Citation:
PMID:  16162754     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulmonary embolism (PE) continues to be a major challenge in terms of diagnosis, as evidenced by the fact that many patients die undiagnosed and/or untreated. The aim of this multicenter study was to determine the accuracy of thorax ultrasound (TUS) in the diagnosis of PE (TUSPE). METHODS: From January 2002 through September 2003, 352 patients with suspected PE were examined in seven clinics. The patients were investigated prospectively by TUS according to the following criteria: (1) PE confirmed: two or more typical triangular or rounded pleural-based lesions; (2) PE probable: one typical lesion with pleural effusion; (3) PE possible: small (< 5 mm) subpleural lesions or a single pleural effusion alone; or (4) normal TUS findings. In all cases, CT pulmonary angiography (CTPA) was used as the reference method. In the event of discrepant findings, a combination of duplex sonography of the leg veins, echocardiography, ventilation/perfusion scintigraphy, and a quantitative enzyme-linked immunosorbent assay or latex d-dimer, or a biopsy/autopsy was performed. FINDINGS: PE was diagnosed in 194 patients. On TUS, 144 patients had a total of 333 subpleural lesions (mean, 2.3 lesions per patient) averaging 15.5 x 12.4 mm in size. Additionally, a narrow pleural effusion was found in 49% of the patients. TUS yielded the following results under application of the strict criteria 1 and 2: PE true-positive, n = 144; PE false-positive, n = 8; PE true-negative, n = 150; and PE false-negative, n = 50. The sensitivity was 74%, specificity was 95%, positive predictive value was 95%, negative predictive was value 75%, and accuracy was 84%, at a prevalence of 55%. The sensitivity in patients with criterion 1 was 43% and a specificity of 99%. INTERPRETATION: TUS is a noninvasive method to diagnose peripheral PE. In the absence of CTPA, TUS is a suitable tool to demonstrate a PE at the bedside and in the emergency setting.
Authors:
Gebhard Mathis; Wolfgang Blank; Angelika Reissig; Peter Lechleitner; Joachim Reuss; Andreas Schuler; Sonja Beckh
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study    
Journal Detail:
Title:  Chest     Volume:  128     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-09-15     Completed Date:  2005-11-08     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1531-8     Citation Subset:  AIM; IM    
Affiliation:
Innere Medizin, Landeskrankenhaus Hohenems, Bahnhofstrasse 31, A-6845 Hohenems, Austria. gebhard.mathis@cable.vol.at
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Child
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Pulmonary Embolism / ultrasonography*
Thorax / ultrasonography*
Ultrasonography / methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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