[Diagnosis of pulmonary embolism by transthoracic sonography. Sono-morphologic characterization of pulmonary lesions and comparison with spiral computed tomography].
OBJECTIVE
Pulmonary embolism often extends to pleural surfaces, resulting in pleural-based parenchymal lesions. This study was carried out in order to evaluate the clinical value of transthoracic sonography (TS) for the diagnosis of pulmonary embolism.


METHODS
A prospective study was performed in 45 patients (27 men, 18 women; mean age: 63.4 years; range: 24-88 years) with suspected pulmonary embolism. Transthoracic sonography was performed in all patients. In addition, helical computed tomography (CT) was carried out in 40 patients. Other diagnostic procedures included the estimation of D-dimeres, echocardiography, venous duplex sonography of the legs and ventilation/perfusion scanning. The diagnosis of pulmonary embolism was accepted when an embolus was detected on CT or as a conclusive result of the other investigations.


RESULTS
Pulmonary embolism was established in 33 patients. Peripheral parenchymal lesions suspicious of pulmonary embolism were detected by transthoracic sonography in 26 patients (79%). In seven patients with central pulmonary embolism diagnosed by CT, no peripheral lesions could be detected by sonography. One patient with sonographic signs of pulmonary embolism had a diffuse bronchogenic adenocarcinoma which was diagnosed on autopsy. The sensitivity of transthoracic sonography (computed tomography) for pulmonary embolism was 79% (76%) and the specificity 92% (100%). The positive and negative predictive values of transthoracic sonography for the detection of pulmonary embolism were 96% and 61% (100% and 61%), respectively. The accuracy was 82% (82%).


CONCLUSIONS
A substantial number of pulmonary emboli involve the peripheral lung areas. Transthoracic sonography is a non-invasive technique for diagnosing such parenchymal alterations and may serve as an alternative method in the diagnosis of pulmonary embolism.
Reissig
A
A
Abteilung für Pneumologie, Friedrich-Schiller-Universität, Jena. Angelika.Reissig@med.uni-jena.de
Heyne
J P
JP
Kroegel
C
C
D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000473:pathology; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods