The role of diagnostic criteria, isotopic perfusion defect and alveolar-arterial oxygen difference in the differential diagnosis of pulmonary thromboembolism and the evaluation of fibrinolytic therapy.
We have previously adopted tentative diagnostic criteria for pulmonary thromboembolism (PTE) based on the scoring system concerning clinical signs. In the present study, using 26 patients with PTE, we examined the effectiveness of these criteria to diagnose PTE and to evaluate fibrinolytic effects of urokinase (UK) with the combination of isotopic perfusion defect (IPD) and alveolar-arterial oxygen difference (A-aDO2). All patients obtained more than 20 scoring points and satisfied the levels of "highly probable". The values of scoring points, A-aDO2 and IPD demonstrated significant difference according to the type of PTE but they could not predict the fibrinolytic effects of UK beforehand. However, they revealed significant improvement in effective cases compared to ineffective cases after UK therapy. So, it is suggested that these criteria are sensitive to differential diagnosis of PTE and useful to evaluate fibrinolytic effects of UK objectively with the combination of IPD and A-aDO2.
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010477:Perfusion; D011651:Pulmonary Artery; D011652:Pulmonary Circulation; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000628:therapy; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D014568:Urokinase-Type Plasminogen Activator; D010100:Oxygen