title: The role of thoracic ultrasonography in the diagnosis of pulmonary embolism.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Pulmonary Diseases, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
authors.forename: Sevda Sener
authors.initials: SS
authors.lastname: Comert
authors.forename: Benan
authors.initials: B
authors.lastname: Caglayan
authors.forename: Ulku
authors.initials: U
authors.lastname: Akturk
authors.forename: Ali
authors.initials: A
authors.lastname: Fidan
authors.forename: Nesrin
authors.initials: N
authors.lastname: Kıral
authors.forename: Elif
authors.initials: E
authors.lastname: Parmaksız
authors.forename: Banu
authors.initials: B
authors.lastname: Salepci
authors.forename: Betul Ayca Ozdere
authors.initials: BA
authors.lastname: Kurtulus
keywords: Chest ultrasonography; diagnosis; pulmonary embolism