Comprehensive Ultrasound Diagnosis Of Pulmonary Thromboembolism And Efficacy Evaluation

Objectives: To assess the value of echocardiography combined with venous ultrasonography for the diagnosis of pulmonary thromboembolism(PTE) and the assessment of the effect of thrombolytic and anticoagulated treatments. Methods: one hundred and thirty patients with suspected PTE were investigated via echocardiography and ultrasonic examination in deep veins of lower limbs. Sixty-one were diagnosed as PTE clinically and forty-five were normal. Thirty-five patients accept thrombolytic and anticoagulated treatment. Compared the change of heart and venous thrombus of patients before treatment with the 24h,2w,3m,6m after treatment. Results: (1) 29 of 61 patients were found thrombus in right heart. One is in right ventricle and others in main, left or right pulmonary artery. The indirect sign including the right heart dilatation, right ventricular hypokinesia, the right ventricle ejective fraction(RVEF) decrease, pulmonary artery dilatation, reduction of the inspiratory collapse of the inferior vena cava, The parameters has significant changes from normal. There were 21 patients displayed double-peak of pulmonary artery blood wave and 31 patients displayed right-angled triangle. The accelerating time and decelerating time were significant shorter. Tricuspid regurgitation were found. The velocity was about(332.7±135.7)cm/s and the pressure(51.1±27.5)mmHg. The pulmonary artery pressure heightened, about(67.1 ±25.7)mmHg. So according to echocardiography, 29 were surely diagnosed, 17 were probably and 8 were suspect. (2) Thrombuses in deep veins of lower limbs were discovered by venous ultrasonography in 286 veins of 54 cases, including acute thrombi of 121,subacute of 67,old of 98. (3) The sensitivity, specificity and accuracy of echocardiography combined with venous ultrasonography diagnosing PTE were 93.3%, 71.1%, 81.5%, respectively. (4) In 24h after treatment, the right heart became smaller. In 2w,the parameters continued to improve. In 3m, only the right ventricle slight dilatation had been found. In 6m,the parameters had no differences with normal. The acute and subacute thrombuses in deep veins of lower limbs decreased partly in 24h after treatment and mostly disappeared in 2w.There were no obviously changes in old thrombuses. Conclusions: (1) As a diagnosed method, synthetical ultrasonography is safe, noninvasive. It is help for diagnosis and differentiated diagnosis. (2) Synthetical ultrasonography can be the first choice for evaluate the effects of thrombolytic treatment.