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Makowska A, Treumann T, Venturini S, Christ M. Pulmonary Embolism in Pregnancy: A Review for Clinical Practitioners. J Clin Med 2024; 13:2863. [PMID: 38792409 PMCID: PMC11121909 DOI: 10.3390/jcm13102863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Diagnostic and therapeutic decision-making in pregnancy with suspected pulmonary embolism (PE) is challenging. European and other international professional societies have proposed various recommendations that are ambiguous, probably due to the unavailability of randomized controlled trials. In the following sections, we discuss the supporting diagnostic steps and treatments. We suggest a standardized diagnostic work-up in pregnant patients presenting with symptoms of PE to make evidence-based diagnostic and therapeutic decisions. We strongly recommend that clinical decisions on treatment in pregnant patients with intermediate- or high-risk pulmonary embolism should include a multidisciplinary team approach involving emergency physicians, pulmonologists, angiologist, cardiologists, thoracic and/or cardiovascular surgeons, radiologists, and obstetricians to choose a tailored management option including an interventional treatment. It is important to be aware of the differences among guidelines and to assess each case individually, considering the specific views of the different specialties. This review summarizes key concepts of the diagnostics and acute management of pregnant women with suspected PE that are supportive for the clinician on duty.
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Affiliation(s)
- Agata Makowska
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
- Cardiology, Hospital Centre of Biel, 2501 Biel, Switzerland
| | - Thomas Treumann
- Radiology, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland;
| | - Stefan Venturini
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
| | - Michael Christ
- Emergency Department, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland; (S.V.); (M.C.)
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Boccatonda A, Andreetto L, Vicari S, Campello E, Simioni P, Ageno W. The Diagnostic Role of Lung Ultrasound and Contrast-Enhanced Ultrasound in Pulmonary Embolism. Semin Thromb Hemost 2023. [PMID: 37832584 DOI: 10.1055/s-0043-1776006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
The diagnosis of pulmonary embolism (PE) relies essentially on a probabilistic approach that requires careful clinical assessments, targeted laboratory tests, and the use of appropriate imaging tools. Nowadays, the diagnostic gold standard is computed tomographic pulmonary angiography. Lung ultrasound (LUS) can play a role in the diagnosis of PE mainly by allowing the visualization of peripheral lung infarctions. Hypoechoic, pleural-based parenchymal consolidation is the most typical and common finding of pulmonary infarction. More than 85% of infarct lesions are wedge-shaped, extending to the pleural surface and are localized to where the patient complains of pleuritic chest pain. Contrast-enhanced ultrasound can be performed in addition to basic ultrasound examination to ascertain nonvascularization of the consolidation, thus confirming that the lesion is an infarct. The aim of this narrative review is to summarize the latest evidence on the application of LUS to the diagnosis of PE, focusing purely on thoracic/lung signs.
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Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO), Italy
| | - Lorenzo Andreetto
- Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy
| | - Susanna Vicari
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO), Italy
| | - Elena Campello
- General Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, University Hospital of Padova, Padova, Italy
| | - Paolo Simioni
- General Medicine and Thrombotic and Hemorrhagic Diseases Unit, Department of Medicine, University Hospital of Padova, Padova, Italy
| | - Walter Ageno
- Research Center on Thromboembolic Diseases and Antithrombotic Therapies, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Falster C, Egholm G, Jacobsen N, Poulsen MK, Posth S, Møller JE, Brabrand M, Laursen CB. Multiorgan ultrasonographic findings in patients with pulmonary embolism at diagnosis and clinical follow-up: a proof of concept study. J Ultrasound 2023; 26:663-672. [PMID: 36114986 PMCID: PMC10468447 DOI: 10.1007/s40477-022-00716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this descriptive feasibility study was to assess the clinical impact and feasibility of conducting a multiorgan ultrasound examination of patients with pulmonary embolism at both time of diagnosis and at clinical follow-up. METHODS Hemodynamically stable patients with pulmonary embolism verified by CT pulmonary angiography or ventilation perfusion scintigraphy were eligible for inclusion. Enrolled patients underwent multiorgan ultrasound investigation encompassing echocardiography supplemented with focused lung and deep venous ultrasound emphasizing right ventricular strain, subpleural consolidations and presence of deep venous thrombi. Identical investigations were conducted at 3 months follow-up. The presence of ultrasonographic findings at diagnosis and follow-up was compared and the clinical impact of any remaining pathology or strain was described. RESULTS Twenty-one patients were enrolled in the study of whom 20 survived to attend follow-up. Mean age was 62 ± 15 years and 48% were female. At diagnosis, the most prevalent ultrasonographic findings were subpleural consolidations in 11 patients and right ventricular dilation in eight. At follow-up, signs of right ventricular strain had resolved in all patients. However, in one patient, no resolution was seen in a subpleural consolidation observed at the time of pulmonary embolism diagnosis, resulting in referral to a chest CT. Additionally, one patient exhibited residual deep venous thrombotic material, leading to prolongation of anticoagulative treatment. CONCLUSION In patients with pulmonary embolism, multiorgan ultrasound is feasible in follow-up and adequately powered studies should determine the clinical utility of such an approach.
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Affiliation(s)
- Casper Falster
- Department of Respiratory Medicine, Odense University Hospital, Entrance 122, 5000, Odense C, Denmark.
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Region of Southern Denmark, Denmark.
| | - Gro Egholm
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Niels Jacobsen
- Department of Respiratory Medicine, Odense University Hospital, Entrance 122, 5000, Odense C, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mikael K Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Stefan Posth
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Entrance 122, 5000, Odense C, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Incidence and Prognostic Role of Pleural Effusion in Patients with Pulmonary Embolism: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12062315. [PMID: 36983315 PMCID: PMC10058137 DOI: 10.3390/jcm12062315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Background: Pleural effusion is a common pulmonary embolism (PE) complication, which has been documented to increase the risk of death in PE and relate to disease progression. However, the incidence of pleural effusion varies among studies and its association with PE outcome is still unclear. This study sought to determine the pooled incidence and prognostic value of pleural effusion events in patients with PE. Methods: We systematically searched the PubMed, EMBASE, SCOPE, Web of Science, Cochrane, LILACS, CINAHL, EBSCO, AMED, and OVID databases from the inception of each database to 7 September 2022 with a restriction on human studies, to identify studies assessing the association between pleural effusion and PE including all prospective and retrospective clinical studies. An exploratory meta-analysis was performed using a random-effects model. We evaluated the heterogeneity and performed subgroup analyses. Results: The final meta-analysis included 29 studies involving 13,430 PE patients. The pooled incidence of pleural effusion in PE patients was 41.2% (95% CI: 35.7–46.6%), which tended to be unilateral (pooled incidence: 60.8%, 95% CI: 45.7–75.8%) and small (pooled incidence: 85.9%, 95% CI: 82.6–89.1%). Pooled analysis using a random-effects model (I2 = 53.2%) showed that pleural effusion was associated with an increased risk of 30-day mortality (RR 2.19, 95% CI: 1.53–3.15, p < 0.001, I2 = 67.1%) and in-hospital mortality (RR 2.39, 95% CI: 1.85–3.09, p < 0.001, I2 = 37.1%) in patients with PE. Conclusions: Our meta-analysis found that PE patients had a high incidence of pleural effusion, which was usually unilateral and small. Pleural effusion generally increases 30-day and in-hospital mortality in patients with PE, and it is recommended that physicians be aware of the risk of death from PE, especially when patients have pleural effusion. Further investigations focusing on PE with pleural effusion are warranted.
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Accuracy of Critical Care Ultrasonography Plus Arterial Blood Gas Analysis Based Algorithm in Diagnosing Aetiology of Acute Respiratory Failure. J Crit Care Med (Targu Mures) 2023; 9:20-29. [PMID: 36890971 PMCID: PMC9987272 DOI: 10.2478/jccm-2023-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction Lung ultrasound when used in isolation, usually misses out metabolic causes of dyspnoea and differentiating acute exacerbation of COPD from pneumonia and pulmonary embolism is difficult, hence we thought of combining critical care ultrasonography (CCUS) with arterial blood gas analysis (ABG). Aim of the study The objective of this study was to estimate accuracy of Critical Care Ultrasonography (CCUS) plus Arterial blood gas (ABG) based algorithm in diagnosing aetiology of dyspnoea. Accuracy of traditional Chest X-ray (CxR) based algorithm was also validated in the following setting. Methods It was a facility based comparative study, where 174 dyspneic patients were subjected to CCUS plus ABG and CxR based algorithms on admission to ICU. The patients were classified into one of five pathophysiological diagnosis 1) Alveolar( Lung-pneumonia)disorder ; 2) Alveolar (Cardiac-pulmonary edema) disorder; 3) Ventilation with Alveolar defect (COPD) disorder ;4) Perfusion disorder; and 5) Metabolic disorder. We calculated diagnostic test properties of CCUS plus ABG and CXR based algorithm in relation to composite diagnosis and correlated these algorithms for each of the defined pathophysiological diagnosis. Results The sensitivity of CCUS and ABG based algorithm was 0.85 (95% CI-75.03-92.03) for alveolar (lung) ; 0.94 (95% CI-85.15-98.13) for alveolar (cardiac); 0.83 (95% CI-60.78-94.16) for ventilation with alveolar defect; 0.66 (95% CI-30-90.32) for perfusion defect; 0.63 (95% CI-45.25-77.07) for metabolic disorders.Cohn's kappa correlation coefficient of CCUS plus ABG based algorithm in relation to composite diagnosis was 0.7 for alveolar (lung), 0.85 for alveolar (cardiac), 0.78 for ventilation with alveolar defect, 0.79 for perfusion defect and 0.69 for metabolic disorders. Conclusion CCUS plus ABG algorithm is highly sensitive and it's agreement with composite diagnosis is far superior. It is a first of it's kind study, where authors have attempted combining two point of care tests and creating an algorithmic approach for timely diagnosis and intervention.
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Falster C, Jacobsen N, Coman KE, Højlund M, Gaist TA, Posth S, Møller JE, Brabrand M, Laursen CB. Diagnostic accuracy of focused deep venous, lung, cardiac and multiorgan ultrasound in suspected pulmonary embolism: a systematic review and meta-analysis. Thorax 2021; 77:679-689. [PMID: 34497138 DOI: 10.1136/thoraxjnl-2021-216838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 08/12/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of point-of-care ultrasound in suspected pulmonary embolism. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, CINAHL and Cochrane library were searched on 2 July 2020 with no restrictions on the date of publication. Subject headings or subheadings combined with text words for the concepts of pulmonary embolism, ultrasound and diagnosis were used. ELIGIBILITY CRITERIA AND DATA ANALYSIS Eligible studies reported sensitivity and specificity of deep venous, lung, cardiac or multiorgan ultrasound in patients with suspected pulmonary embolism, using an adequate reference-test. Prospective, cross-sectional and retrospective studies were considered for eligibility. No restrictions were made on language. Studies were excluded if a control group consisted of healthy volunteers or if transesophageal or endobronchial ultrasound was used. Risk of bias was assessed using quality assessment of diagnostic accuracy studies-2. Meta-analysis of sensitivity and specificity was performed by construction of hierarchical summary receiver operator curves. I2 was used to assess the study heterogeneity. MAIN OUTCOME MEASURES The primary outcome was overall sensitivity and specificity of reported ultrasound signs, stratified by organ approach (deep venous, lung, cardiac and multiorgan). Secondary outcomes were stratum-specific sensitivity and specificity within subgroups defined by pretest probability of pulmonary embolism. RESULTS 6378 references were identified, and 70 studies included. The study population comprised 9664 patients with a prevalence of pulmonary embolism of 39.9% (3852/9664). Risk of bias in at least one domain was found in 98.6% (69/70) of included studies. Most frequently, 72.8% (51/70) of studies reported >24 hours between ultrasound examination and reference test or did not disclose time interval at all. Level of heterogeneity ranged from 0% to 100%. Most notable ultrasound signs were bilateral compression of femoral and popliteal veins (22 studies; 4708 patients; sensitivity 43.7% (36.3% to 51.4%); specificity 96.7% (95.4% to 97.6%)), presence of at least one hypoechoic pleural-based lesion (19 studies; 2134 patients; sensitivity 81.4% (73.2% to 87.5%); specificity 87.4% (80.9% to 91.9%)), D-sign (13 studies; 1579 patients; sensitivity 29.7% (24.6% to 35.4%); specificity 96.2% (93.1% to 98.0%)), visible right ventricular thrombus (5 studies; 995 patients; sensitivity 4.7% (2.7% to 8.1%); specificity 100% (99.0% to 100%)) and McConnell's sign (11 studies; 1480 patients; sensitivity 29.1% (20.0% to 40.1%); specificity 98.6% (96.7% to 99.4%)). CONCLUSION Several ultrasound signs exhibit a high specificity for pulmonary embolism, suggesting that implementation of ultrasound in the initial assessment of patients with suspected pulmonary embolism may improve the selection of patients for radiation imaging. PROSPERO REGISTRATION NUMBER CRD42020184313.
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Affiliation(s)
- Casper Falster
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark .,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niels Jacobsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Mikkel Højlund
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Stefan Posth
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | | | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Silva Marques J, Correia R, Correia J, Ferreira G, Monteiro N. McConnell in Shock. Cureus 2021; 13:e15819. [PMID: 34327068 PMCID: PMC8301283 DOI: 10.7759/cureus.15819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/08/2022] Open
Abstract
The ideal approach to hemodynamically unstable patients requires the quick identification of the type of shock and its etiology. This can be a challenge in critically ill patients due to the limited information, the wide number of differential diagnosis and the need for fast intervention. Point-of-care ultrasound (POCUS) is a non-invasive, low-cost, real-time and reliable tool used to rapidly and accurately assess hemodynamically unstable patients at the bedside. It can support diagnosis, tailor therapy and guide further workup, especially in patients deemed too unstable to undergo other imaging studies. The authors describe the case of a patient in obstructive shock due to pulmonary embolism, in which McConnell sign was identified by bedside echocardiography, before lab tests and pulmonary computerized tomography angiogram results were obtained
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Affiliation(s)
| | - Rui Correia
- Internal Medicine, Centro Hospitalar Tondela-Viseu, Epe, Viseu, PRT
| | - Joana Correia
- Cardiology, Centro Hospitalar Tondela-Viseu, Epe, Viseu, PRT
| | | | - Nuno Monteiro
- Internal Medicine, Centro Hospitalar Tondela-Viseu, Epe, Viseu, PRT
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Abumossalam AM, El Mekkawy MMN, Eid REA, Salah M, Ehab A. Echopulmonography as a Surrogate Modality in Disclosure of Occult Pulmonary Consequences of Pulmonary Vascular Occlusion. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x17666210129123946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Diagnostic modalities of pulmonary embolism (PE) are still emerging day
after day with new tools and promising characteristic features.
Objective:
The aim of our work was to assess the diagnostic yield of echopulmonography in patients
with PE regarding pleural, parenchymal and vascular features of acute events and consequences.
Methods:
This is a prospective quasi-experimental study in which transthoracic echopulmonography
was adopted as a screening method for patients with clinical suspicion of PE in comparison to
Multi-Detector Computed Tomography Angiography of the chest, which is the best standard. This
study was conducted on 32 patients at the chest department in Mansoura University Hospital and a
Specialized Internal Medicine Hospital.
Results:
Echopulmonography was positive for pulmonary embolism at 68.75% but was of negative
value in 31.25%. On the other hand, CTPA was positive for pulmonary embolism in (71.78%) but
was of negative value in 28.12%. EPG confirm PE in 87% of patients diagnosed with PE by CTPA
with a false-negative result of 13%. EPG could exclude PE in 77.7% of patients who were negative
for PE by CTPA with a false-positive result of 22.2%.
Conclusion:
Echopulmonography might show promising features to be a substitute for computed
tomography angiography in the diagnosis of pulmonary embolism.
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Affiliation(s)
| | | | | | - Mohamed Salah
- Cardiology Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Ehab
- Chest Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Lei M, Liu C, Luo Z, Xu Z, Jiang Y, Lin J, Wang C, Jiang D. Diagnostic management of inpatients with a positive D-dimer test: developing a new clinical decision-making rule for pulmonary embolism. Pulm Circ 2021; 11:2045894020943378. [PMID: 33456753 PMCID: PMC7797584 DOI: 10.1177/2045894020943378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/26/2020] [Indexed: 11/16/2022] Open
Abstract
Background A positive D-dimer test has high sensitivity but relatively poor specificity
for the diagnosis of pulmonary embolism, causing difficulty for clinicians
unskilled in pulmonary embolism diagnosis in determining whether a patient
with a positive D-dimer test needs to undergo computed tomographic pulmonary
angiography. Objectives We sought to develop a new clinical decision-making rule based on a positive
D-dimer result to predict the probability of pulmonary embolism and to guide
clinicians in making decisions regarding the need for computed tomographic
pulmonary angiography. Methods We conducted a prospective, multicenter study in three hospitals in China. A
total of 3014 inpatients with positive D-dimer results were included. In the
derivation group, we built a multivariate logistic regression model and
deduced a regression equation from which our score was derived. Finally, we
validated the score in an independent cohort. Results Our score included nine variables (points): chest pain (1.4), chest tightness
(2.3), shortness of breath (3.6), hemoptysis (3.4), heart rate ≥100
beats/min (3.6), blood gas analysis (2.9), electrocardiogram presenting a
typical S1Q3T3 pattern (4.1), electrocardiogram findings (2.4), and
ultrasonic cardiogram findings (3.7). The sensitivities and specificities
were 100% and 86.94%, respectively, in the derivation group and 100% and
90.82%, respectively, in the validation group. Additionally, the observed
and predicted proportions of patients who underwent computed tomographic
pulmonary angiography were 16.82% and 10.76%, respectively, in the
derivation group and 18.72% and 11.40%, respectively, in the validation
group. Conclusions The new score can categorize inpatients with a positive D-dimer test as
pulmonary embolism-likely or pulmonary embolism-unlikely, thus reducing
unnecessary computed tomographic pulmonary angiography examinations.
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Affiliation(s)
- Min Lei
- Department of Geriatric Medicine, The Fuling Central Hospital of Chongqing, Chongqing, China
| | - Chang Liu
- Department of Respiratory medicine, The Second Clinical Hospital of Chongqing Medical University, Chongqing, China
| | - Zhuang Luo
- Department of Respiratory Medicine, The First Clinical Hospital of Kunming Medical College, Kunming, China
| | - Zhibo Xu
- Department of Respiratory Medicine, The Second People's Hospital of Chengdu City, Chengdu, China
| | - Youfan Jiang
- Department of Respiratory medicine, The Second Clinical Hospital of Chongqing Medical University, Chongqing, China
| | - Jiachen Lin
- Department of Respiratory Medicine, The Second People's Hospital of Chengdu City, Chengdu, China
| | - Chu Wang
- Department of Respiratory Medicine, The First Clinical Hospital of Kunming Medical College, Kunming, China
| | - Depeng Jiang
- Department of Respiratory medicine, The Second Clinical Hospital of Chongqing Medical University, Chongqing, China
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Recommendations for Lung Ultrasound in Internal Medicine. Diagnostics (Basel) 2020; 10:diagnostics10080597. [PMID: 32824302 PMCID: PMC7460159 DOI: 10.3390/diagnostics10080597] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022] Open
Abstract
A growing amount of evidence prompts us to update the first version of recommendations for lung ultrasound in internal medicine (POLLUS-IM) that was published in 2018. The recommendations were established in several stages, consisting of: literature review, assessment of literature data quality (with the application of QUADAS, QUADAS-2 and GRADE criteria) and expert evaluation carried out consistently with the modified Delphi method (three rounds of on-line discussions, followed by a secret ballot by the panel of experts after each completed discussion). Publications to be analyzed were selected from the following databases: Pubmed, Medline, OVID, and Embase. New reports published as of October 2019 were added to the existing POLLUS-IM database used for the original publication of 2018. Altogether, 528 publications were systematically reviewed, including 253 new reports published between September 2017 and October 2019. The new recommendations concern the following conditions and issues: pneumonia, heart failure, monitoring dialyzed patients' hydration status, assessment of pleural effusion, pulmonary embolism and diaphragm function assessment. POLLUS-IM 2020 recommendations were established primarily for clinicians who utilize lung ultrasound in their everyday clinical work.
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Severe massive pulmonary thromboembolism: a case reinforcing the crucial role of point-of-care ultrasound in emergency settings. J Ultrasound 2019; 24:323-329. [PMID: 31773637 DOI: 10.1007/s40477-019-00417-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/13/2019] [Indexed: 01/12/2023] Open
Abstract
Patients with high-risk pulmonary embolism (PE) have a significant mortality rate, and thus a timely diagnosis and early treatment are essential to improve outcomes. Since these groups of patients are often too ill to be transferred to the radiology department to perform a chest computed tomography angiography, offering a feasible, reliable and bedside diagnostic tool may be desirable in this setting. We report the case of a middle-aged woman presenting to the emergency department with shock who was diagnosed with massive pulmonary embolism based on point-of-care ultrasound (POCUS). We are hereby discussing the usefulness of POCUS in this subset of PE patients, highlighting the importance of considering ultrasound as a first-line diagnostic (and monitoring) tool for each patient with suspicion of massive PE.
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12
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Baz AA, Hamdy IM, Mohammed AS, Assal HH. Diagnostic validity of thoracic ultrasound in the assessment of pulmonary embolism. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0005-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Denault A, Canty D, Azzam M, Amir A, Gebhard CE. Whole body ultrasound in the operating room and intensive care unit. Korean J Anesthesiol 2019; 72:413-428. [PMID: 31159535 PMCID: PMC6781205 DOI: 10.4097/kja.19186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022] Open
Abstract
Whole body ultrasound can be used to improve the speed and accuracy of evaluation of an increasing number of organ systems in the critically ill. Cardiac and abdominal ultrasound can be used to identify the mechanisms and etiology of hemodynamic instability. In hypoxemia or hypercarbia, lung ultrasound can rapidly identify the etiology of the condition with an accuracy that is equivalent to that of computed tomography. For encephalopathy, ocular ultrasound and transcranial Doppler can identify elevated intracranial pressure and midline shift. Renal and bladder ultrasound can identify the mechanisms and etiology of renal failure. Ultrasound can also improve the accuracy and safety of percutaneous procedures and should be currently used routinely for central vein catheterization and percutaneous tracheostomy.
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Affiliation(s)
- André Denault
- Department of Anesthesiology and Critical Care Medicine, Faculté de Médecine, Université de Montréal, Institut de Cardiologie de Montréal, and Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - David Canty
- Department of Surgery, University of Melbourne, Australia.,Department of Medicine, Monash Medical Centre, Monash University, Clayton, Melbourne, and Department of Anesthesia, Monash Medical Centre and Royal Melbourne Hospital, Victoria, Australia
| | - Milène Azzam
- Department of Anesthesiology, Jewish General Hospital, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Alexander Amir
- Department of Anesthesiology, Montreal General Hospital, McGill University Faculty of Medicine, Montreal, QC, Canada
| | - Caroline E Gebhard
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
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Joshi G, Crawford KA, Hanna TN, Herr KD, Dahiya N, Menias CO. US of Right Upper Quadrant Pain in the Emergency Department: Diagnosing beyond Gallbladder and Biliary Disease. Radiographics 2018; 38:766-793. [DOI: 10.1148/rg.2018170149] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gayatri Joshi
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
| | - Kevin A. Crawford
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
| | - Tarek N. Hanna
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
| | - Keith D. Herr
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
| | - Nirvikar Dahiya
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
| | - Christine O. Menias
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
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15
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Acar H, Yılmaz S, Yaka E, Doğan NÖ, Özbek AE, Pekdemir M. Evaluation of the Diagnostic Role of Bedside Lung Ultrasonography in Patients with Suspected Pulmonary Embolism in the Emergency Department. Balkan Med J 2017; 34:356-361. [PMID: 28443595 PMCID: PMC5615969 DOI: 10.4274/balkanmedj.2016.1181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Despite the existence of detailed consensus guidelines, challenges remain regarding efficient, appropriate, and safe imaging methods for the diagnosis of suspected pulmonary embolism. Aims: To investigate the role of the wedge sign, B-lines, and pleural effusion seen on bedside lung ultrasound in the diagnosis of pulmonary embolism. Study Design: Diagnostic accuracy study. Methods: During the first evaluation of patients with suspected pulmonary embolism, bedside lung ultrasound was performed, and the B-lines, wedge sign, and pleural effusion were investigated. Computed tomography angiography was used as a confirmatory test and was compared with the lung ultrasound findings. Results: Pulmonary embolism was detected in 38 (38%) patients. In the comparison of bedside lung ultrasound results, statistically significant differences were found between the groups in terms of the B-lines and wedge sign (p=0.005 and p<0.001, respectively). There were no significant differences in terms of effusion (p=0.234). Comparison of these findings with computed tomography angiography of the chest showed weak negative correlations between the groups in terms of B-lines (r=-0297) and a moderately positive correlation in terms of the wedge sign (r=0.523). The sensitivity, specificity, and positive and negative predictive values of lung ultrasound findings alone were low. In the logistic regression analysis, the wedge sign (p<0.01, OR=69.45, 95% CI=6.94-695.17) and B-line (p=0.033, OR=1.96, 95% CI=0.41-8.40) were found to be effective in the diagnosis of pulmonary embolism. Conclusion: Although the role of lung ultrasound has been increasing in the management of critically ill patients, its value is limited and cannot replace the gold standard tests in the diagnosis of pulmonary embolism.
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Affiliation(s)
- Hüseyin Acar
- Clinic of Emergency, Tunceli State Hospital, Tunceli, Turkey
| | - Serkan Yılmaz
- Department of Emergency, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Elif Yaka
- Department of Emergency, Kocaeli University School of Medicine, Kocaeli, Turkey
| | | | - Asım Enes Özbek
- Clinic of Emergency, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Murat Pekdemir
- Department of Emergency, Kocaeli University School of Medicine, Kocaeli, Turkey
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16
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Ghanem MK, Makhlouf HA, Hasan AAA, Alkarn AA. Acute pulmonary thromboembolism in emergency room: gray-scale versus color doppler ultrasound evaluation. CLINICAL RESPIRATORY JOURNAL 2016; 12:474-482. [PMID: 27608416 DOI: 10.1111/crj.12547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/26/2016] [Accepted: 08/12/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary thromboembolism (PTE) remains under-diagnosed fatal disease at emergency units suggesting the need for alternative, easy, and noninvasive bedside diagnostic approaches. OBJECTIVES To determine the diagnostic role of gray-scale and color Doppler transthoracic ultrasonography (TUS) in patients with PTE. PATIENTS AND METHODS Blinded to 64 multi-detectors CT pulmonary angiography (MDCTPA) examination as a gold standard, 60 patients with clinically suspected PTE underwent gray-scale and then color Doppler TUS examination. Results were compared and diagnostic accuracy of TUS was assessed. RESULTS Forty patients proved to have PTE by MDCTPA. TUS showed typical lesions in 33 patients with the mean of 2 lesions per patient. Most lesions were hypoechoic, wedge- shaped, and pleural- based and the majority (80%) was located in the lower lobes. Consolidation with little perfusion was detected by Color Doppler ultrasound in 97% of lesions. Isolated central PTE was significantly higher in TUS negative patients. For gray -scale TUS, sensitivity, specificity, positive and negative predictive values and accuracy were 82%, 90%, 94%, 72%, and 85%. Meanwhile the sensitivity, specificity, positive and negative predictive values and accuracy of color Doppler TUS were 80%, 95%, 97%, 70% and 87%, respectively. CONCLUSION TUS is a reliable diagnostic bedside test for PTE in critically ill and immobile patients. Adding color Doppler to gray-scale TUS increases the specificity and accuracy and consequently the confidence in the diagnosis of peripheral pulmonary infarctions and differentiates them from other pulmonary lesions that allow initiation of anticoagulants.
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17
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Lee FCY. Lung ultrasound-a primary survey of the acutely dyspneic patient. J Intensive Care 2016; 4:57. [PMID: 27588206 PMCID: PMC5007698 DOI: 10.1186/s40560-016-0180-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 08/10/2016] [Indexed: 12/02/2022] Open
Abstract
There has been an explosion of knowledge and application of clinical lung ultrasound (LUS) in the last decade. LUS has important applications in the ambulatory, emergency, and critical care settings and its deployability for immediate bedside assessment allows many acute lung conditions to be diagnosed and early interventional decisions made in a matter of minutes. This review detailed the scientific basis of LUS, the examination techniques, and summarises the current applications in several acute lung conditions. It is to be hoped that clinicians, after reviewing the evidence within this article, would see LUS as an important first-line modality in the primary evaluation of an acutely dyspneic patient.
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Affiliation(s)
- Francis Chun Yue Lee
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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18
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Diagnostic performance of trans-thoracic sonography in patients of pneumonia and pulmonary embolism. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2016.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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19
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Abootalebi A, Golshani K, Karami M, Masoumi B, Aliasgharlou M. Diagnostic validity of ultrasonography in evaluation of pulmonary thromboembolism. Adv Biomed Res 2016; 5:4. [PMID: 26955625 PMCID: PMC4763566 DOI: 10.4103/2277-9175.174975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/15/2015] [Indexed: 11/07/2022] Open
Abstract
Background: Diagnosis of pulmonary embolism (PE) remains difficult due to its nonspecific symptoms and signs. Therefore, many patients die undiagnosed or untreated. We decided to study the sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of pulmonary thromboembolism. Materials and Methods: In this prospective study, 77 patients with clinically suspected PE in the emergency department of Isfahan Al-Zahra Hospital were enrolled from September 2011 to September 2012. At first, they were evaluated by thoracic ultrasonography (TUS) and then divided into four groups based on their TUS findings. Multi-slice computed tomography (MSCT) was the reference method in this study performed within 24 h from admission. MSCT scans were interpreted by a radiologist who was unaware of the TUS results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPVs) of thoracic ultrasonography were determined. Results: PE diagnosis was confirmed by MSCT in 25 patients and 54 hypoechoic lesions were detected by TUS with the average size of 16.4 mm × 11.1 mm. In our study, sensitivity, specificity, PPV, NPV, and accuracy of TUS for PE diagnosis were 84%, 94.2%, 87.5%, and 92.5%, respectively. Conclusion: TUS is an inexpensive, safe and easily available method for timely diagnosis and treatment of PE in emergency department and its NPV is high for cases with low scores for Wells criteria who had a normal or possible TUS findings. It is also specific in the diagnosis of PE in cases with high scores Wells criteria who have confirmed or probable TUS findings.
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Affiliation(s)
- Alireza Abootalebi
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Keihan Golshani
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Karami
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Masoumi
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Aliasgharlou
- Department of Pharmacology, Isfahan University of Medical Sciences, Isfahan, Iran
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20
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Validation of hand motion analysis as an objective assessment tool for the Focused Assessment with Sonography for Trauma examination. J Trauma Acute Care Surg 2015; 79:631-7. [PMID: 26402538 DOI: 10.1097/ta.0000000000000813] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Point-of-care ultrasonography is a standard part of trauma assessments, but there are no objective tools to assess proficiency and ensure high-quality examinations. Hand motion analysis (HMA) has been validated as a measure of surgical skill but has not previously been applied to ultrasonography. HMA was assessed for construct validity in Focused Assessment with Sonography for Trauma (FAST) performance. METHODS Two cohorts of 12 expert and 12 novice ultrasonographers performed a FAST examination on a healthy volunteer. Hand motions were recorded with the trakSTAR 3D electromagnetic motion-tracking device (Ascension Technology) and analyzed using our custom-designed Motion Analysis and Recording System (MARS) software. Data were recorded at 240 Hz. Outcomes included time of examination, number of movements, and path length. RESULTS Time of examination was not different between cohorts (expert, 345.9 seconds; novice, 475.7 seconds; p = 0.12). Total path length of travel was shorter, and the number of discreet movements was less in the expert cohort for the left-hand (18.52 m vs. 28.01 m, p = 0.03, and 109.5 vs. 193.9, p = 0.027, respectively) and the right-hand performance (14.25 m vs. 32.09 m, p < 0.01, and 153.5 vs. 258.5, p = 0.03, respectively) versus the novice cohort. Both total path length traveled and total number of discreet movements were associated with expertise level in logistic regression modeling with areas under the receiver operating characteristic curves of 0.8269 and 0.8205, respectively. CONCLUSION This is the first study in the medical literature showing HMA as an objective, valid measure of FAST imaging performance. These objective, automated metrics can function as an adjunct measure to assess FAST performance as well as follow progress of and provide feedback to learners to improve future performances. LEVEL OF EVIDENCE A "diagnostic criteria"-style test where the "diagnosis" is a determination of competence in a care provider, level II.
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21
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Jiang L, Ma Y, Zhao C, Shen W, Feng X, Xu Y, Zhang M. Role of Transthoracic Lung Ultrasonography in the Diagnosis of Pulmonary Embolism: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0129909. [PMID: 26076021 PMCID: PMC4468196 DOI: 10.1371/journal.pone.0129909] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 05/14/2015] [Indexed: 01/30/2023] Open
Abstract
Background Pulmonary embolism (PE) is a potentially life-threatening condition. Although computed tomography pulmonary angiography (CTPA) is the reference standard for diagnosis, its early diagnosis remains a challenge, and the concerns about the radiation exposures further limit the general use of CTPA. The primary aim of this meta-analysis was to evaluate the overall diagnostic accuracy of transthoracic lung ultrasound (TLS) in the diagnosis of PE. Methods PubMed, Web of science, OvidSP, ProQuest, EBSCO, Cochrane Library and Clinicaltrial.gov were searched systematically. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and hierarchical summary receiver operating characteristic (HSROC) curves were used to examine the TS performance. The Bayes analysis was used to calculate the post-test probability of PE. Publication bias was assessed with Deeks funnel plot. Results The results indicated that the sensitivity, specificity, PLR and NLR were 0.85 (95% confidence interval (CI), 0.78 to 0.90), and 0.83 (95% CI, 0.73 to 0.90). And the DOR and HSROC were 28.82 (95% CI, 17.60 to 47.21), 0.91(95% CI, 0.88, 0.93). Conclusions The present meta-analysis suggested that transthoracic lung ultrasonography is helpful in diagnosing pulmonary embolism. Although the application of transthoracic lung ultrasound may change some patients’ diagnostic processes, it is inappropriate to generally use transthoracic ultrasonography in diagnosing pulmonary embolism currently.
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Affiliation(s)
- Libing Jiang
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China
- China Emergency and Critical Care Evidence-based Group, Hangzhou, China
| | - Yuefeng Ma
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China
- China Emergency and Critical Care Evidence-based Group, Hangzhou, China
| | - Changwei Zhao
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China
| | - Weifeng Shen
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China
| | - Xia Feng
- China Emergency and Critical Care Evidence-based Group, Hangzhou, China
- Department of respiration, The Third People’s Hospital of Hangzhou,Hangzhou, China
| | - Yongan Xu
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China
| | - Mao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine &Institute of emergency Medicine, Zhejiang University, Hangzhou, China
- China Emergency and Critical Care Evidence-based Group, Hangzhou, China
- * E-mail:
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22
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Soni NJ, Lucas BP. Diagnostic point-of-care ultrasound for hospitalists. J Hosp Med 2015; 10:120-4. [PMID: 25408226 DOI: 10.1002/jhm.2285] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 10/21/2014] [Accepted: 10/28/2014] [Indexed: 11/11/2022]
Abstract
We review the literature on diagnostic point-of-care ultrasound applications most relevant to hospital medicine and highlight gaps in the evidence base. Diagnostic point-of-care applications most relevant to hospitalists include cardiac ultrasound for left ventricular systolic function, pericardial effusion, and severe mitral regurgitation; lung ultrasound for pneumonia, pleural effusion, pneumothorax, and pulmonary edema; abdominal ultrasound for ascites, aortic aneurysm, and hydronephrosis; and venous ultrasound for central venous volume assessment and lower extremity deep venous thrombosis. Hospitalists and other frontline providers, as well as physician trainees at various levels of training, have moderate to excellent diagnostic accuracy after brief training programs for most of these applications. Despite the evidence supporting the diagnostic accuracy of point-of-care ultrasound, experimental evidence supporting its clinical use by hospitalists is limited to cardiac ultrasound.
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Affiliation(s)
- Nilam J Soni
- Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
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23
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Eicken JJ, Billington M, Noble VE. Pulmonary ultrasound examination for edema, effusion, and thromboembolism. Glob Heart 2013; 8:313-21. [PMID: 25690632 DOI: 10.1016/j.gheart.2013.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 12/05/2013] [Indexed: 11/25/2022] Open
Abstract
Bedside, or point-of-care, ultrasound (US) has increasingly been used in various clinical settings to provide clinicians with rapid clinical information without the use of ionizing radiation. Lung US has been demonstrated as a valuable tool in the diagnosis and evaluation of pulmonary edema, pleural effusions, and pulmonary thromboembolism. Lung US enables the clinician to more quickly identify and initiate treatment for these potentially life-threatening conditions without the need for patient transportation to the radiology suite. Additionally, lung US can repeatedly be implemented to assess clinical changes without concern for repeated radiation exposure and is cost-effective given its ability to decrease the need for additional radiological and laboratory testing to confirm a suspected diagnosis. This review focuses on the application of lung US in the evaluation and management of pulmonary edema, pleural effusions, and pulmonary thromboembolism.
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Affiliation(s)
- John J Eicken
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Billington
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Vicki E Noble
- Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
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