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2017, Number 1

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Acta Med 2017; 15 (1)

Diagnostic approach to pulmonary thromboembolism

Machado VL, Dimakis RDA

Language: Spanish
References: 86
Page: 36-46
PDF size: 187.85 Kb.


ABSTRACT

Pulmonary embolism is a pathology of frequent presentation associated with high mortality rates; it is clinically characterized by highly unspecific signs and symptoms. Several modalities for its diagnosis exist: clinical prediction scores (revised Wells and Geneva scores), D-dimer, computed tomography pulmonary angiography, magnetic resonance angiography, X-rays, pulmonary ventilation/perfusion scan, helical computed tomography, electrocardiogram, echocardiogram and venous ultrasonography. Other tests, such as impedance plethysmography and phlebography were previously useful in the diagnostic protocol of deep vein thrombosis, and thus, pulmonary embolism; nevertheless, nowadays they have been displaced by tests with higher sensitivity and specificity. Several laboratory tests that measure biological markers useful in diagnosing pulmonary embolism have been developed; among them are brain natriuretic peptide, heart fatty acid binding protein, neutrophil gelatinase-associated lipocalin and cystatin C.


REFERENCES

  1. Li F, Wang X, Huang W, Ren W, Cheng J, Zhang M et al. Risk factors associated with the occurrence of silent pulmonary embolism in patients with deep venous thrombosis of the lower limb. Phlebology. 2014; 29 (7): 442-446.

  2. Guijarro R, Trujillo-Santos J, Bernal-Lopez MR, de Miguel-Díez J, Villalobos A, Salazar C et al. Trend and seasonality in hospitalizations for pulmonary embolism: a time-series analysis. J Thromb Haemost. 2015; 13: 23-30.

  3. Bach AG, Taute BM, Baasai N, Wienke A, Meyer HJ, Schramm D et al. 30-day mortality in acute pulmonary embolism: prognostic value of clinical scores and anamnestic features. PLoS One. 2016; 11 (2): e0148728.

  4. Goncharova EA, Gladwin MT, Kawut SM. Update in pulmonary vascular diseases 2014. Am J Respir Crit Care Med. 2015; 192 (5): 544-550.

  5. Donadini MP, Dentali F, Squizzato A, Guasti L, Ageno W. Unsuspected pulmonary embolism in cancer patients: a narrative review with pooled data. Intern Emerg Med. 2014; 9 (4): 375-384.

  6. Ali N, Ayyub M, Khan SA. High prevalence of protein C, protein S, antithrombin deficiency, and factor V Leiden mutation as a cause of hereditary thrombophilia in patients of venous thromboembolism and cerebrovascular accident. Pak J Med Sci. 2014; 30 (6): 1323-1326.

  7. Jun ZJ, Ping T, Lei Y, Li L, Ming SY, Jing W. Prevalence of factor V Leiden and prothrombin G20210A mutations in Chinese patients with deep venous thrombosis and pulmonary embolism. Clin Lab Haematol. 2006; 28 (2): 111-116.

  8. Stojanovich L, Kontic M, Djokovic A, Ilijevski N, Stanisavljevic N, Marisavljevic D. Pulmonary events in antiphospholipid syndrome: influence of antiphospholipid antibody type and levels. Scand J Rheumatol. 2012; 41 (3): 223-226.

  9. Aito S, Pieri A, D’Andrea M, Marcelli F, Cominelli E. Primary prevention of deep venous thrombosis and pulmonary embolism in acute spinal cord injured patients. Spinal Cord. 2002; 40 (6): 300-303.

  10. Sawant SP, Banumathy S, Daddi A, Dhir AA. Pulmonary embolism in cancer patients. Indian J Cancer. 2012; 49 (1): 119-124.

  11. Mraovic B, Hipszer BR, Epstein RH, Parvizi J, Pequignot EC, Chervoneva I et al. Metabolic syndrome increases risk for pulmonary embolism after hip and knee arthroplasty. Croat Med J. 2013; 54 (4): 355-361.

  12. Zahir U, Sterling RS, Pellegrini VD, Forte ML. Inpatient pulmonary embolism after elective primary total hip and knee arthroplasty in the United States. J Bone Joint Surg Am. 2013; 95 (22): e175.

  13. Jing ZC. China’s guidelines on the diagnosis and treatment of pulmonary hypertension. Chin J Frontiers Med Sci. 2011; 2: 62-81.

  14. Liu YY, Li XC, Duan Z, Yuan YD. Correlation between the embolism area and pulmonary arterial systolic pressure as an indicator of pulmonary arterial hypertension in patients with acute pulmonary thromboembolism. Eur Rev Med Pharmacol Sci. 2014; 18 (17): 2551-2555.

  15. Smulders YM. Pathophysiology and treatment of haemodynamic instability in acute pulmonary embolism: the pivotal role of pulmonary vasoconstriction. Cardiovasc Res. 2000; 48 (1): 23-33.

  16. Deng X, Li Y, Zhou L, Liu C, Liu M, Ding N et al. Gender differences in the symptoms, signs, disease history, lesion position and pathophysiology in patients with pulmonary embolism. PLoS One. 2015; 10 (7): e0133993.

  17. Cho JH, Kutti Sridharan G, Kim SH, Kaw R, Abburi T, Irfan A et al. Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis. BMC Cardiovasc Disor. 2014; 14: 64.

  18. Montagnana M, Cervellin G, Franchini M, Lippi G. Pathophysiology, clinics and diagnostics of non-thrombotic pulmonary embolism. J Thromb Thrombolysis. 2011; 31 (4): 436-444.

  19. Banks DA, Pretorius GV, Kerr KM, Manecke GR. Pulmonary endarterectomy: Part I. Pathophysiology, clinical manifestations, and diagnostic evaluation of chronic thromboembolic pulmonary hypertension. Semin Cardiothorac Vasc Anesth. 2014; 18 (4): 319-330.

  20. Sinha N, Padegal V, Satyanarayana S, Santosh HK. Pulmonary cement embolization after vertebroplasty, an uncommon presentation of pulmonary embolism: a case report and literature review. Lung India. 2015; 32 (6): 602-605.

  21. Pollack CV, Schreiber D, Goldhaber SZ, Slattery D, Fanikos J, O’Neil BJ et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol. 2011; 57 (6): 700-706.

  22. Abdalla A, Kelly F. “STEMI-like” acute pulmonary embolism, an unusual presentation. BMJ Case Rep. 2014; 2014. pii: bcr2014206517. doi: 10.1136/bcr-2014-206517.

  23. Modi S, Deisler R, Gozel K, Reicks P, Irwin E, Brunsvold M et al. Wells criteria for DVT is a reliable clinical tool to assess the risk of deep venous thrombosis in trauma patient. World J Emerg Surg. 2016; 11: 24.

  24. Bertoletti L, Le Gal G, Aujesky D, Roy PM, Sánchez O, Verschuren F et al. Prognostic value of the Geneva prediction rule in patients in whom pulmonary embolism is ruled out. J Intern Med. 2011; 269 (4): 433-440.

  25. Angriman F, Ferreyro BL, Posadas-Martínez ML, Giunta D, Vázquez FJ, Vollmer WM. Wells score and poor outcomes among adult patients with subsegmental pulmonary embolism: a cohort study. Clin Appl Thromb Hemost. 2015; 21 (6): 539-545.

  26. Di Marca S, Cilia C, Campagna A, D’Arrigo G, Abd ElHafeez S, Tripepi G et al. Comparison of Wells and revised Geneva rule to assess pretest probability of pulmonary embolism in high-risk hospitalized elderly adults. J Am Geriatr Soc. 2015; 63 (6): 1091-1097.

  27. Nemenqani D, Fayek MH, Ahmad SA, Elnashar H, Asaad H. Validation of new D-dimer cutoff values to increase its diagnostic utility as biochemical marker in acute venous thromboembolic disease. Egypt J Hosp Med. 2015; 61: 363-370.

  28. Lippi G, Cervellin G, Casagranda I, Morelli B, Testa S, Tripodi A. D-dimer testing for suspected venous thromboembolism in the emergency department. Consensus document of AcEMC, CISMEL, SIBioC, and SIMeL. Clin Chem Lab Med. 2014; 52 (5): 621-628.

  29. Michiels JJ, Maasland H, Moossdorff W, Lao M, Gadiseur A, Schroyens W. Safe exclusion of deep vein thrombosis by a rapid sensitive ELISA D-dimer and compression ultrasonography in 1,330 outpatients with suspected DVT. Angiology. 2016; 67 (8): 781-787.

  30. Kearon C, Spencer FA, O’Keeffe D, Parpia S, Schulman S, Baglin T et al. D-dimer testing to select patients with a first unprovoked venous thromboembolism who can stop anticoagulant therapy: a cohort study. Ann Intern Med. 2015; 162: 27-34.

  31. Stein PD, Matta F, Sabra MJ, Tana C, Gough A, Chabala S et al. Specificity of quantitative latex agglutination assay for D-dimer in exclusion of pulmonary embolism in the emergency department. Clin Appl Thromb Hemost. 2014; 20 (8): 807-812.

  32. Halaby R, Popma CJ, Cohen A, Chi G, Zacarkim MR, Romero G et al. D-dimer elevation and adverse outcomes. J Thromb Thrombolysis. 2015; 39: 55-59.

  33. Shah K, Quaas J, Rolston D, Bansal S, Banja T, Newman D et al. Magnitude of D-dimer matters for diagnosing pulmonary embolus. Am J Emerg Med. 2013; 31: 942-945.

  34. Crop MJ, Siemes C, Berendes P, van der Straaten F, Willemsen S, Levin MD. Influence of C-reactive protein levels and age on the value of D-dimer in diagnosing pulmonary embolism. Eur J Haematol. 2013; 92 (2): 147-155.

  35. Le Gal G, Righini M, Wells PS. D-dimer for pulmonary embolism. JAMA. 2015; 313 (16): 1668-1669.

  36. Cohen AT, Spiro TE, Spyropoulos AC, DeSanctis YH, Homering M, Büller HR et al. D-dimer as a predictor of venous thromboembolism in acutely ill, hospitalized patients: a subanalysis of the randomized controlled MAGELLAN trial. J Thromb Haemost. 2014; 12 (4): 479-487.

  37. Cini M, Legnani C, Frascaro M, Sartori M, Cosmi B, Palareti G. D-dimer use for deep venous thrombosis exclusion in elderly patients: a comparative analysis of three different approaches to establish cut-off values for an assay with results expressed in D-dimer units. Int J Lab Hematol. 2014; 36 (5): 541-547.

  38. Le Gal G, Righini M, Wells PS. Computed tomographic pulmonary angiography for pulmonary embolism. J Am Med Assoc. 2015; 314 (1): 74-75.

  39. Javadrashid R, Mozayan M, Tarzamni MK, Ghaffari MR, Fouladi DF. Spiral computed tomographic pulmonary angiography in patients with acute pulmonary emboli and no pre-existing comorbidity: a prospective prognostic panel study. Eur Radiol. 2015; 25: 147-154.

  40. Perelas A, Dimou A, Saenz A, Rhee JH, Teerapuncharoen K, Rowden A et al. Incidental findings on computed tomography angiography in patients evaluated for pulmonary embolism. Ann Am Thorac Soc. 2015; 12 (5): 689-695.

  41. Allen C, Seinge R, Maxwell R, Thind D. CT pulmonary angiography and pulmonary embolism following 5,809 primary joint arthroplasties. N Z Med J. 2015; 128 (1413): 41-49.

  42. Morales-Borrero WJ, Maldonado-Vargas JA. Diagnostic yield of pulmonary CT angiography in the evaluation of pulmonary embolisms treated at the Puerto Rico Medical Center from 2008 to 2012. P R Health Sci J. 2016; 35 (1): 16-19.

  43. Minshall CT, Doben AR, Leon SM, Fakhry SM, Eriksson EA. Computed tomography pulmonary angiography: more than a screening tool for pulmonary embolus. J Crit Care. 2015; 30 (1): 196-200.

  44. İn E, Turgut T, Kalkan M, Karadağ MO, Dağlı MN. The relationship between computed tomography pulmonary angiography findings and right ventricular dysfunction in patients with pulmonary embolism. Turk Thorac J. 2014; 15: 117-121.

  45. Scarsbrook A, Bradley K, Gleeson F, Groves AM, Yates SJ, Win T et al. Perfusion scintigraphy still has important role in evaluation of majority of pregnant patients with suspicion of pulmonary embolism. Radiology. 2007; 244 (2): 623-624.

  46. Vedovati MC, Germini F, Agnelli G, Becattini C. Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis. J Thromb Haemost. 2013; 11 (12): 2092-2102.

  47. Schissler AJ, Rozenshtein A, Kulon ME, Pearson GD, Green RA, Stetson PD et al. CT pulmonary angiography: increasingly diagnosing less severe pulmonary emboli. PLoS One. 2013; 8 (6): e65669.

  48. Cok G, Tasbakan MS, Ceylan M, Bayraktaroglu S, Duman S. Can we use CT pulmonary angiography as an alternative to echocardiography in determining right ventricular dysfunction and its severity in patients with acute pulmonary thromboembolism? Jpn J Radiol. 2013; 31 (3): 172-178.

  49. Revel MP, Sánchez O, Couchon S, Planquette B, Hernigou A, Niarra R et al. Diagnostic accuracy of magnetic resonance imaging for an acute pulmonary embolism: results of the “IRM-EP” study. J Thromb Haemost. 2012; 10 (5): 743-750.

  50. Hosch W, Schlieter M, Ley S, Heye T, Kauczor HU, Libicher M. Detection of acute pulmonary embolism: feasibility of diagnostic accuracy of MRI using a stepwise protocol. Emerg Radiol. 2014; 21 (2): 151-158.

  51. Jackowski C, Grabherr S, Schwendener N. Pulmonary thrombembolism as cause of death on unenhanced postmortem 3T MRI. Eur Radiol. 2013; 23 (5): 1266-1270.

  52. Hochhegger B, Ley-Zaporozhan J, Marchiori E, Irion K, Soares Souza Jr. A, Moreira J et al. Magnetic resonance imaging findings in acute pulmonary embolism. B J Radiol. 2011; 84: 282-287.

  53. Sinzinger H, Rodrigues M, Kummer F. Ventilation/perfusion lung scintigraphy. Multiple applications besides pulmonary embolism. Hell J Nucl Med. 2013; 16 (1): 50-55.

  54. Le Roux PY, Pelletier-Galarneau M, De Laroche R, Hofman MS, Zuckier LS, Roach P et al. Pulmonary scintigraphy for the diagnosis of acute pulmonary embolism: a survey of current practices in Australia, Canada, and France. J Nucl Med. 2015; 56: 1212-1217.

  55. Perisinakis K, Seimenis I, Tzedakis A, Damilakis J. Perfusion scintigraphy versus 256-Slice CT angiography in pregnant patients suspected of pulmonary embolism: comparison of radiation risks. J Nucl Med. 2014; 55:1273-1280.

  56. He J, Wang F, Dai HJ, Li M, Wang Q, Yao Z et al. Chinese multi-center study of lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism. Int J Cardiovasc Imaging. 2012; 28: 1799-1805.

  57. Wang L, Kang W, Zu M, Zhang Q, Shen J, Wu L et al. Application of 128‑slice spiral CT combination scanning in the diagnosis of embolisms in pulmonary arteries and lower extremity veins. Exp Ther Med. 2014; 7 (2): 401-404.

  58. Brunot S, Corneloup O, Latrabe V, Montaudon M, Laurent F. Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism. Eur Radiol. 2005; 15: 2057-2063.

  59. Hiorns MP, Mayo JR. Spiral computed tomography for acute pulmonary embolism. Can Assoc Radiol J. 2002; 53 (5): 258-268.

  60. Kamphuisen PW, Agnelli G. Spiral computed tomography is the first-line chest imaging test for acute pulmonary embolism: no. J Thromb Haemost. 2005; 3: 11-13.

  61. Van Strijen MJ, De Monye W, Kieft GJ, Pattynama PM, Prins MH, Huisman MV. Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: a prospective multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy. J Thromb Haemost. 2005; 3 (1): 17-25.

  62. Patel UB, Ward TJ, Kadoch MA, Cham MD. Radiographic features of pulmonary embolism: Hampton’s hump. Postgrad Med J. 2014; 90 (1065): 420-421.

  63. Abbas A, St Joseph EV, Mansour OMA, Peebles CR. Radiographic features of pulmonary embolism: Westermark and Palla signs. Postgrad Med J. 2014; 90: 422-423.

  64. Stein PD, Matta F. Noninvasive imaging in pulmonary embolism according to age and gender. Clin Appl Thromb Hemost. 2014; 20 (2): 143-146.

  65. Zhan ZQ, Wang CQ, Nikus KC, He CR, Wang J, Mao S et al. Electrocardiogram patterns during hemodynamic instability in patients with acute pulmonary embolism. Ann Noninvasive Electrocardiol. 2014; 19 (6): 543-551.

  66. Icli A, Kayrak M, Akilli H, Aribas A, Coskun M, Ozer SF et al. Prognostic value of Tpeak-Tend interval in patients with acute pulmonary embolism. BMC Cardiovasc Disord. 2015; 15: 99.

  67. Zhan ZQ, Wang CQ, Wang ZX, Nikus KC, Baranchuk A, Yuan RX et al. Significance of ST-segment deviation in patients with acute pulmonary embolism and negative T waves. Cardiol J. 2015; 22 (5): 583-589.

  68. Aujesky D, Roy PM, Verschuren F, Righini M, Osterwalder J, Egloff M et al. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet. 2011; 378 (9785): 41-48.

  69. Spirk D, Willenberg T, Aujesky D, Husmann M, Hayoz D, Baldi T et al. Use of biomarkers or echocardiography in pulmonary embolism: the Swiss venous thromboembolism registry. Q J Med. 2012; 105 (12): 1163-1169.

  70. Rodrigues AC, Guimaraes L, Guimaraes JF, Monaco C, Cordovil A, Lira E et al. Relationship of clot burden and echocardiographic severity of right ventricular dysfunction after acute pulmonary embolism. Int J Cardiovasc Imaging. 2015; 31: 509-515.

  71. Rodrigues AC, Cordovil A, Mônaco CG, Guimarães LA, Oliveira WA, Fischer CH et al. Assessing prognosis of pulmonary embolism using tissue-Doppler echocardiography and brain natriuretic peptide. Einstein (Sao Paulo). 2013; 11 (3): 338-344.

  72. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014; 35: 3033-3069.

  73. Gordon NT, Schreiber MA. Pulmonary emboli and deep vein thromboses: are they always part of the same disease spectrum? Mil Med. 2016; 181 (5 Suppl): 104-110.

  74. Hogg K, Dawson D, Mackway-Jones K. Investigating pulmonary embolism in the emergency department with lower limb plethysmography: the Manchester Investigation of Pulmonary Embolism Diagnosis (MIOPED) study. Emerg Med J. 2006; 23: 94-98.

  75. Sundaram PS, Padma S. Combined radionuclide phlebography and V/Q scan in the assessment of iliac vein thrombosis and pulmonary embolism - A case report establishing a cause and effect relationship. Iran J Nucl Med. 2013; 21 (1): 36-39.

  76. DeBakey ME, Schroeder GF, Ochsner A. Significance of phlebography in phlebothrombosis. JAMA. 2014; 311 (7): 741.

  77. Lauque D, Maupas-Schwalm F, Bounes V, Juchet H, Bongard V, Roshdy A et al. Predictive value of the heart-type fatty acid-binding protein and the pulmonary embolism severity index in patients with acute pulmonary embolism in the emergency department. Acad Emerg Med. 2014; 21: 1143-1150.

  78. Jo JY, Lee MY, Li JW, Rho BH, Choi WI. Leukocytes and systemic inflammatory response syndrome as prognostic factors in pulmonary embolism patients. BMC Pulm Med. 2013; 13: 74.

  79. Ozsu S, Abul Y, Yilmaz I, Ozsu A, Oztuna F, Bulbul Y et al. Prognostic significance of PaO2/PaCO2 ratio in normotensive patients with pulmonary embolism. Clin Respir J. 2012; 6 (2): 104-111.

  80. Drent M, Cobben NA, Henderson RF, Wouters EF, van Dieijen-Visser M. Usefulness of lactate dehydrogenase and its isoenzymes as indicators of lung damage or inflammation. Eur Respir J. 1996; 9: 1736-1742.

  81. Dursunoğlu N, Dursunoğlu D, Yıldız AI, Rota S. Evaluation of cardiac biomarkers and right ventricular dysfunction in patients with acute pulmonary embolism. Anatol J Cardiol. 2016; 16: 276-282.

  82. Gutte H, Mortensen J, Jensen CV, von der Recke P, Petersen CL, Kristoffersen US et al. ANP, BNP and D-dimer predict right ventricular dysfunction in patients with acute pulmonary embolism. Clin Physiol Funct Imaging. 2010; 30: 466-472.

  83. Bulj N, Potočnjak I, Sharma M, Pintarić H, Degoricija V. Timing of troponin T measurements in triage of pulmonary embolism patients. Croat Med J. 2013; 54: 561-568.

  84. Khor YH, Smith R, McDonald CF. Suboptimal management of unfractionated heparin compared with low-molecular-weight heparin in the management of pulmonary embolism. Intern Med J. 2014; 44 (4): 339-344.

  85. Hohner EM, Kruer RM, Gilmore VT, Streiff M, Gibbs H. Unfractionated heparin dosing for therapeutic anticoagulation in critically ill obese adults. J Crit Care. 2015; 30: 395-399.

  86. Kostrubiec M, Łabyk A, Pedowska-Włoszek J, Dzikowska-Diduch O, Wojciechowski A, Garli n´ ska M et al. Neutrophil gelatinase-associated lipocalin, cystatin C and eGFR indicate acute kidney injury and predict prognosis of patients with acute pulmonary embolism. Heart. 2012; 98: 1221-1228.




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