Point-of-care ultrasound

Point-of-care ultrasound in the diagnosis of pulmonary embolism

Abstract

The best diagnostic strategy to confirm or exclude pulmonary embolism (PE) suspicion needs an appropriate combination of clinical assessment, plasma D-dimer measurement, and computed tomographic pulmonary angiography (CTPA). CTPA should be used with caution in some patient groups, such as patients with known allergy to contrast media, those with severe renal insufficiency, and pregnant women, and could be not immediately available in case of unstable patients. In the emergency setting, alternative diagnostic strategies should be implemented to overcome CTPA limitations. Ultrasonography is certainly a valuable alternative diagnostic tool. In addition to echocardiography and lower limb compressive venous ultrasonography, lung ultrasound (US) may play an important role in selected patients’ subgroups. Recent data on the diagnostic performance of a triple point-of-care US (lung, heart, and leg vein US) are discussed in the present paper, and pros and cons of triple point-of-care US are compared with those of standard diagnostic approaches.

Introduction

Venous thromboembolism (VTE) is a major health problem, with an overall annual incidence between 100 and 200 per 100,000 inhabitants [1]. Acute pulmonary embolism (PE) is the most serious clinical presentation of VTE and may be life-threatening or lead to chronic pulmonary hypertension if not early diagnosed and treated [2]. Signs and symptoms of PE are non-specific, and several cardiopulmonary diseases should be taken into account in the differential diagnosis: no laboratory or imaging test has a sufficient accuracy to be used as a single test for this complex diagnostic workup [3]. The European Society of Cardiology (ESC) suggests, in the last edition of guidelines on the diagnosis and management of acute pulmonary embolism, that the best diagnostic strategy to confirm or exclude PE suspicion needs an appropriate combination of clinical assessment, plasma D-dimer measurement, and computed tomographic pulmonary angiography


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