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. 2013 Apr;8(2):99-104.
doi: 10.4103/1817-1737.109822.

The role of thoracic ultrasonography in the diagnosis of pulmonary embolism

Sevda Sener Comert  1 , Benan Caglayan, Ulku Akturk, Ali Fidan, Nesrin Kıral, Elif Parmaksız, Banu Salepci, Betul Ayca Ozdere Kurtulus
Affiliations

The role of thoracic ultrasonography in the diagnosis of pulmonary embolism

Sevda Sener Comert et al. Ann Thorac Med. 2013 Apr.

Abstract

Objectives: The diagnosis of pulmonary embolism (PE) is still a problem especially at emergency units. The purpose of study was to determine the diagnostic accuracy of thoracic ultrasonography (TUS) in patients with PE.

Methods: In this prospective study, 50 patients with suspected PE were evaluated in Department of Pulmonary Diseases of a Training and Reasearch Hospital between January 2010 and July 2011. At the begining, TUS was performed by a chest physician, subsequently for definitive diagnosis computed tomography pulmonary angiography were performed in all cases as a reference method. Other diagnostic procedures were examination of serum d-dimer levels, echocardiography, and venous doppler ultrasonography of the legs. Both chest physician and radiologist were blinded to the results of other diagnostic method. Diagnosis of PE was suggested if at least one typical pleural-based/subpleural wedge-shaped or round hypoechoic lesion with or without pleural effusion was reported by TUS. Presence of pure pleural effusion or normal sonographic findings were accepted as negative TUS for PE.

Results: PE was diagnosed in 30 patients. It was shown that TUS was true positive in 27 patients and false positive in eight and true negative in 12 and false negative in three. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of TUS in diagnosis of PE for clinically suspected patients were 90%, 60%, 77.1%, 80%, and 78%, respectively.

Conclusions: TUS with a high sensitivity and diagnostic accuracy, is a noninvasive, widely available, cost-effective method which can be rapidly performed. A negative TUS study cannot rule out PE with certainty, but positive TUS findings with moderate/high suspicion for PE may prove a valuable tool in diagnosis of PE at bedside especially at emergency setting, for critically ill and immobile patients, facilitating immediate treatment decision.

Keywords: Chest ultrasonography; diagnosis; pulmonary embolism.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Pleural-based, wedge-shaped, hypoechoic infarct area with central hyperechoic bronchiolar pattern in the sonographic examination of a pulmonary embolism case
Figure 2
Figure 2
Distribution of lesions detected by transthoracic ultrasound
Figure 3
Figure 3
(a and b) Parenchymal window of thoracic computed tomography and sonographic examinations of pulmonary embolism case. Pleural-based, irregular-circumscribed, hypoechoic lesion with local pleural effusion at sonographic examination
Figure 4
Figure 4
Distribution of groups based on sonographic findings in pulmonary embolism and nonpulmonary embolismcases
See this image and copyright information in PMC

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