close attention objectives: Despite the widespread use of lung scanning and angiography.

close attention objectives: Despite the widespread use of lung scanning and angiography, pulmonary embolisms (PEs) remain undiagnosed in the majority of patients, suggesting the ne for alternative diagnostic approaches. The existing 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 according to spiral CT (sCT) scanning.

Design: This prospective close attention was performed using 69 patients with suspected PE T was performed in all patients. In addition, sCT scanning was carried revealed in 62 patients. Other diagnostic courses included the estimation of d-dimers, echocardiography, venous duplex sonography of the leg pulmonary angiography, and ventilation/perfusion scanning. The diagnosis of PE was accepted when there was a conclusive conclusion of these investigations or when an embolus could be visualized forward 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, 26 lesions by patient; range 1 to 9 lesions by patient) that are associated with PE were bring to lighted 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 PE as shown by means of TS. In nine patients with central PE that had been diagnosed by way of CT scanning, no peripheral lesions could be discovered by sonography. One patient with sonographic signs of PE had a diffuse bronchogenic adenocarcinoma that was diagnosed at autopsy. In another patient with parenchymal lesions, pneumonia was diagnosed by means of CT scanning. The sensitivity of T for detecting PE was 80% (sensitivity of CT scanning, 82%) and the specificity of T for detecting pulmonary lesions was 92% (specificity of CT scanning, 100%) The positive and negative predictive values of T for the detection of PE were 95% and 72% respectively (positive predictive value for CT scanning, 100%; negative predictive value for CT scanning, 77%) The accuracy of T was 84% (accuracy of CT scanning, 89%)

Conclusions: T is a noninvasive technique that is used for diagnosing parenchymal alterations, and it may wait on as an additional method in the strategy for diagnosing PE (CHEST 2001; 120:1977-1983)

key-note words: pulmonary embolism; transthoracic sonography of lung and pleura; spiral CT scanning

Abbreviations: PE = pulmonary embolism; sCT = spiral CT; T = transthoracic sonography

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Pulmonary embolism (PE) is an many times underestimated, underdiagnosed, and undertreated disease. It is estimated to be the third most numerous common cause of death in the United States, accounting for up to 250000 hospitalizations and 50000 deaths each year. (1) and nothing else one third of PEs that are confirmed by the agency of autopsy are diagnosed before death, (2-7) reflecting the difficulty in establishing the diagnosis. In addition, despite the widespread use of lung scanning and angiography, (89) there has been no significant reduction in mortality from PE over the past 40 years. (10)

Since the signs and symptoms of PE may be silent or nonspecific, diagnosis still remains a challenge to the attending physician and requires a high index of clinical suspicion as well as a rational approach to testing. More specific investigations in the same state [i]or[/i] condition as imaging techniques, however, differ significantly with revere to sensitivity and specificity, and, in the majority of cases, a negative eventuate to testing does not full exclude PE. Ventilation/perfusion scanning, for instance, has a high sensitivity for PE unless lacks anatomic resolution and sufficient specificity. In addition, transthoracic echocardiography can easily and rapidly point out to the presence and the measure of right ventricular pressure overload, and may directly demonstrate thrombotic masses in the main pulmonary arteries, although sensitivity and specificity are soft (11) MRI offers both morphologic and functional information onward lung perfusion and right heart function, on the other hand its image quality still urgencys improvement. Finally, pulmonary angiography, (12) albeit accurate, is an invasive manner of proceeding associated with low but still not negligible morbidity and mortality. In addition, the availability is limited, and nondiagnostic springs may be obtained. (13)

In the past 10 years, spiral CT (sCT) scanning has been introduced for the diagnosis of acute and chronic PE and it provides a noninvasive means of detecting acute PE and organized thrombi, as well as perfusion abnormalities and other concomitant findings. (14) However, since PE in subsegmental pulmonary arteries are not reliably visualized, CT imaging is les accurate than angiography for detecting a minor embolism or an embolism in the stages in which central emboli have been dissolved from endogenous fibrolysis. (15-17) Thus, although sCT scanning furnishs a high sensitivity and specificity for central or segmental PE more peripheral thromboembolic lesions confined to the subsegmental even may be overlooked. Moreover, CT imaging is dear and usually requires time-consuming organization prior to the investigation. Thus, the growth of alternative, easily accessible modes for diagnosis that are immediately available to the physician at the bedside, and that as well-as; not only-but also; not only-but; not alone-but facilitate recognition and reduce the time lag until diagnosis of PE can be established, is warranted.

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