Chest
Volume 120, Issue 6, December 2001, Pages 1977-1983
Journal home page for Chest

Clinical Investigations
CLOTTING
Sonography of Lung and Pleura in Pulmonary Embolism: Sonomorphologic Characterization and Comparison With Spiral CT Scanning

https://doi.org/10.1378/chest.120.6.1977Get rights and content

Study objectives

Despite the widespread use of lung scanning and angiography, pulmonary embolisms (PEs) remain undiagnosed in the majority of patients, suggesting the need for alternative diagnostic approaches. The present study investigates the clinical utility of transthoracic sonography (TS) for the diagnosis of PE and compares the data obtained with the technique to those obtained by spiral CT (sCT) scanning.

Design

This prospective study was performed using 69 patients with suspected PEs. TS was performed in all patients. In addition, sCT scanning was carried out in 62 patients. Other diagnostic procedures included the estimation of d-dimers, echocardiography, venous duplex sonography of the legs, pulmonary angiography, and ventilation/perfusion scanning. The diagnosis of PE was accepted when there was a conclusive result of these investigations or when an embolus could be visualized on a CT scan.

Setting

The Department of Pneumology in Friedrich-Schiller-University Hospital (Jena, Germany).

Patients

Sixty-nine patients (27 women and 42 men) with suspected PEs.

Results

A diagnosis of PE was established in 44 patients. Ninety-one peripheral parenchymal lesions (mean, 2.6 lesions per patient; range 1 to 9 lesions per patient) that are associated with PE were detected by TS in 35 patients (80%). Multiple, triangular, hypoechoic, and pleural-based parenchymal lesions with a localized and/or basal effusion were typical of the PEs as shown by TS. In nine patients with central PEs that had been diagnosed by CT scanning, no peripheral lesions could be detected by sonography. One patient with sonographic signs of PEs had a diffuse bronchogenic adenocarcinoma that was diagnosed at autopsy. In another patient with parenchymal lesions, pneumonia was diagnosed by CT scanning. The sensitivity of TS for detecting PEs was 80% (sensitivity of CT scanning, 82%), and the specificity of TS for detecting pulmonary lesions was 92% (specificity of CT scanning, 100%). The positive and negative predictive values of TS for the detection of PEs were 95% and 72%, respectively (positive predictive value for CT scanning, 100%; negative predictive value for CT scanning, 77%). The accuracy of TS was 84% (accuracy of CT scanning, 89%).

Conclusions

TS is a noninvasive technique that is used for diagnosing parenchymal alterations, and it may serve as an additional method in the strategy for diagnosing PE.

Section snippets

Patients

Between February 1998 and March 2000, a total of 69 consecutive patients (27 women and 42 men; mean age, 62.8 years; age range, 24 to 88 years) with clinical signs of PE were enrolled in the study. Only those patients were included on whom TS as well as CT scans had been performed within 24 h. During the study period, 138 patients with suspected PEs were investigated with sCT scanning but did not undergo TS.

All patients had a typical history of PE with the acute onset of complaints that

TS

Of the 69 patients enrolled in this study, 44 (63.8%) had experienced PEs. Among the 44 patients, 35 (80.0%) showed sonographic changes involving the lung parenchyma (Table 1). The parenchymal lesions were assessed according to their shape, number, size, demarcation, movement during respiration, and the detection of a single central echo. Lesions also were analyzed using color Doppler imaging. In addition, the pleura were analyzed with respect to the continuity of the visceral pleural line and

Discussion

Despite the advent of new techniques such as contrast-enhanced sCT scanning, diagnosing PEs still remains a significant medical problem, accounting for a considerable number of deaths each year. Moreover, only one third of PEs confirmed at autopsy are diagnosed before death2356725 suggesting that a high percentage of PEs continue to remain undiagnosed. On the other hand, the early accurate diagnosis of PE is important and potentially life-saving.26 The reasons for this discrepancy between the

References (31)

  • PIOPED Investigators

    Value of the ventilation/perfusion scan in acute pulmonary embolism: results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)

    JAMA

    (1990)
  • RD Hull et al.

    A non-invasive strategy for the treatment of patients with suspected pulmonary embolism

    Arch Intern Med

    (1994)
  • M Remy-Jardin et al.

    Spiral CT angiography of the pulmonary circulation

    Radiology

    (1999)
  • VF Tapson et al.

    The diagnostic approach to acute venous thromboembolism: clinical practice guideline

    Am J Respir Crit Care Med

    (1999)
  • AB van Rossum et al.

    Role of spiral volumetric computed tomographic scanning in the assessment of patients with clinical suspicion of pulmonary embolism and an abnormal ventilation/perfusion lung scan

    Thorax

    (1996)
  • Cited by (118)

    • Multi-organ point-of-care ultrasound for detection of pulmonary embolism in critically ill COVID-19 patients – A diagnostic accuracy study

      2022, Journal of Critical Care
      Citation Excerpt :

      Studies using a diagnostic threshold of at least two subpleural consolidations had a worse sensitivity 44.2%, but better specificity 96.5% [33]. Most included studies were conducted in ambulatory patients [14,15,33,39,40], and the authors noted a high potential of selection bias, limiting generalization of those results to critically ill COVID-19 patients. Our results might be less remarkable when we revisit the pathophysiology of subpleural consolidations.

    • Lung Ultrasound Fundamentals, “Wet Versus Dry” Lung, Signs of Consolidation in Dogs and Cats

      2021, Veterinary Clinics of North America - Small Animal Practice
    View all citing articles on Scopus
    View full text