肺动脉栓塞的螺旋CT增强表现的探讨

目的 探讨肺栓塞螺旋CT增强扫描的影像表现，提高肺栓塞的诊断水平。方法 对14例肺栓塞患者行螺旋CT增强扫描，观察血栓累及部位及影像学表现。结果 14例患者共累及51处肺动脉及其分支，其中右肺动脉主干栓塞5例，左肺动脉弓3例，右上肺动脉6例，右中肺动脉4例，右下肺动脉13，左上肺动脉8例，左下肺动脉12例。肺栓塞的CT表现：①直接征象：肺动脉内充盈缺损，表现为中心型充盈缺损、锐角附壁型血栓、钝角附壁型血栓、完全阻塞型充盈缺损4种形式；②间接征象：肺动脉栓塞的间接征象有受累部分肺野透亮度增高、肺纹理细小稀疏、“马赛克”征、肺实变、主肺动脉增宽、右心室增大、胸腔积液、心包积液等。结论 螺旋CT增强扫描是诊断肺动脉栓塞的一种无创、快速的影像检查方法。     

经胸超声心动图诊断急性肺动脉栓塞的价值

目的　探讨经胸超声心动图 (transthoracic echocardiography,TTE)对急性肺动脉栓塞 (acute pulmonary embolism,APE)的诊断价值。方法　分析 16例确诊为 APE患者的 TTE表现 ,与肺动脉造影、肺核素扫描及计算机体层摄影对照。结果　超声直接检出主肺动脉及左、右肺动脉主干近段血栓者 6例 ,均被 CT或肺动脉造影证实 ,其中超声还直接检出右室内血栓 3例、右房内血栓 1例 ;本组资料具有右心负荷过重超声征象者 12例 (其中包括超声直接检出血栓的 6例 ) ,CT或核素肺灌注 /通气扫描提示为双肺多发性大面积栓塞 ;TTE检查大致正常者 4例 ,但核素肺灌注 /通气扫描或者 CT均提示为肺段或亚段栓塞。结论　经胸超声心动图可发现主肺动脉、左右肺动脉干内血栓直接提示肺动脉栓塞 ,或根据右心负荷过重表现并结合临床表现间接提示肺栓塞的可能 ,但对肺段或亚段栓塞者超声不能作出或排除诊断。     

双源CT在评价肺栓塞中的价值

目的 探讨双源CT在诊断肺栓塞中的价值.方法 2008年5月-2010年12月纳入50例可疑肺栓塞患者,使用双源CT进行肺动脉血管增强扫描,对图像行三维重建,分析栓塞部位、栓子形态、肺内、心脏及胸腔改变等.结果 44例确殄肺栓塞,发现肺栓塞共260处,最常见于右肺下叶动脉28例(63.0%),其次于右肺动脉22例(50...     

MSCTPA诊断肺栓塞的探讨

目的：探讨多层螺旋CT肺血管成像（MSCTPA）对于肺动脉栓塞的临床应用价值。材料与方法：对40例肺栓塞患者的临床及CT资料进行回顾性分析。结果：全部患者均进行了胸部CT平扫和增强检查。40例肺栓塞病例中,位于右侧肺动脉主干者6例,位于左侧肺动脉主干者4例,位于右下肺动脉及其分支者15例,位于左下肺动脉及其分支者5例,两侧或单侧多部位者10例。MSCTPA上均表现为肺动脉内充盈缺损影,病灶呈圆形、卵圆形、条带状、杯口状。有时伴肺梗死、肺不张、肺部浸润、胸腔积液等改变。CT扫描两上肺动脉未见栓塞灶。结论：MSCTPA是目前诊断肺栓塞的无创伤性的最佳影像学手段,其对正确及时诊断和治疗本病具有非常重要的临床应用价值。     

肺动脉栓塞的腔内旋切消融术介入治疗

目的 :探讨经导管肺动脉腔内旋切消融术介入治疗肺动脉栓塞的临床疗效。方法 :经右侧股静脉穿刺 ,行选择性左、右肺动脉插管造影的右侧肺动脉栓塞 4例 ,其中右肺动脉主干不规则充盈缺损 1例 ,右肺动脉主干及右下肺动脉不规则充盈缺损 2例 ,右上、下肺动脉均不规则充盈缺损 1例 ;双侧肺动脉多发性栓塞 1例 ,造影见右肺动脉主干及左下肺动脉不规则充盈缺损。 5例病人均行肺动脉血栓旋切消融术并于下腔静脉内肾静脉以下各放置滤器 1只。结果 :本组病例经导管行血栓旋切消融术后 ,肺动脉栓塞明显好转 ,各栓塞肺动脉及其分支重新显示 ,患者术中临床症状即刻明显减轻 ,血气明显改善 ,血氧饱和度及PaO2 明显回升 ,基本恢复正常。有 3例患者出现轻微胸痛。结论 :对肺动脉栓塞病人实施经导管肺动脉腔内旋切消融术疗效肯定、安全、有效 ,能延长患者生命 ,提高患者的生活质量     

超声心动图急性肺栓塞溶栓治疗的评估

目的应用超声心动图技术观察急性肺栓塞患者溶栓抗凝治疗前后肺动脉栓子、右心结构及收缩功能的改变。方法前瞻性非随机对照研究,对2002年12月至2006年4月间经肺动脉CT或肺血管造影证实的30例急性肺栓塞患者行溶栓治疗,应用经胸超声心动图观察治疗前、治疗后24～30h、1个月的肺动脉栓子、主肺动脉及其分支内径、右房室内径,右室前壁运动幅度、右室舒张末期容积、右室射血分数,三尖瓣返流、肺动脉收缩压等指标。结果30例急性肺动脉栓塞患者溶栓治疗24～30h后右房室结构明显改善,表现为右房长径及横径、右室前后径及横径、主肺及右肺动脉内径、右室舒张末期容积与治疗前比较明显回缩(P<0.01),右室前壁运动幅度、右室射血分数有所增加(P<0.01),肺动脉收缩压明显下降(P<0.01);治疗后1个月后右房室大小、主肺及右肺动脉内径、右室舒张末期容积、右室前壁运动幅度及肺动脉收缩压等仍有恢复(P<0.05或P<0.01)。5例患者主肺动脉和/或右、左肺动脉内检出栓子,溶栓后栓子逐渐消失。结论超声心动图可动态、实时、无创评价急性肺动脉栓塞溶栓治疗效果,尤对血栓的溶解、右房室结构、右室超负荷及肺动脉高压的变化有独到的价值。     

超声在诊断肺动脉栓塞中的应用研究

目的 探讨无创心血管超声在肺动脉栓塞诊断中的应用价值。方法 对临床综合诊断的35例肺动脉栓塞患者进行经胸超声心动图和下肢深静脉超声检查。结果 超声心动图发现11例肺动脉内血栓直接征象，29例右心系统形态改变，29例肺动脉收缩压升高。周围血管超声检出合并下肢静脉血栓20例。结论 综合运用超声在肺动脉栓塞诊断中的各种检查方法，以提高其敏感性和特异性，对肺动脉栓塞的诊断具有重要的意义。     

Conséquences hémodynamiques de l’embolie pulmonaire

Acute pulmonary embolism is defined by the occurrence of right ventricular failure secondary to an increase in ventricular afterload. The existence of hypotension, peripheral signs of shock and/or right ventricular dysfunction are associated with a mortality excess. The interactions between the pulmonary vascular anomalies, the function of the left and right ventricles and the coronary circulation reflect the haemodynamic changes seen at the different stages of acute pulmonary embolism. Echocardiography allows the haemodynamic consequences of pulmonary embolism to be determined, as well as certain other scan indicators. Over the last few years, research has been focused on patients at intermediate risk, i.e. not hypotensive but presenting with echocardiographic signs of right ventricular dysfunction, as well as an increase in myocardial markers (proBNP [brain natriuretic peptide], BNP and troponin). The place for different symptomatic or etiological therapeutic treatments are discussed.     

A novel regional right ventricular wall-motion abnormality observed in a case of acute pulmonary embolism (reverse McConnell sign).

Among various echocardiographic parameters for diagnosis of pulmonary embolism, an abnormal regional contraction pattern of the right ventricular free wall consisting of normokinesia of the apical segment and akinesia of the midfree wall with persistence of abnormal wall motion at the base has proved to be fairly specific for pulmonary embolism. This echocardiographic abnormality has been termed "McConnell sign." We describe the case of a patient with acute pulmonary embolism who developed reversible akinesia of the apex and right ventricular midfree wall, a finding we would like to term "reverse McConnell sign."     

Electrocardiographic findings in Emergency Department patients with pulmonary embolism

To assess the pre-study, null hypothesis that there is no difference in the electrocardiogram (EKG) findings for Emergency Department (ED) patients who rule in vs. rule out for suspected pulmonary embolism, a retrospective review of a cohort of patients with pulmonary embolism and their controls was conducted in an academic, suburban ED. Patients who were evaluated in the ED during a one-year study period for symptoms suggestive of pulmonary embolism were eligible for inclusion. All patients with pulmonary embolism and sex- and age-matched controls comprised the final study groups. Two board-certified cardiologists reviewed each patient's EKG. There were 350 eligible patients identified; 49 patients with pulmonary embolism and 49 controls were entered into the study. The most common rhythm observed in both groups was normal sinus rhythm (67.3% cases vs. 68.6 % controls; p = 1.0). Abnormalities believed to be associated with pulmonary embolism occurred with similar frequency in both case and control groups (sinus tachycardia [18.8 % vs. 11.8%, respectively; p = 0.40]), incomplete right bundle branch block (4.2% vs. 0.0%, respectively; p = 0.24), complete right bundle branch block (4.2% vs. 6.0, respectively; p = 1.0), S1Q3T3 pattern (2.1 vs. 0.0, respectively; p = 0.49), S1Q3 pattern (0.0 vs. 0.0), and extreme right axis (0.0 vs. 0.0). New EKG changes were identified more frequently for patients with pulmonary embolism (33.3% vs. 12.5% controls; p = 0.03), but specific findings were rarely different between cases and controls. In our cohort of ED patients, we did not identify EKG features that are likely to help distinguish patients with pulmonary embolism from those who rule out for the disease.     

双能量CT肺灌注在肺栓塞诊断及危险分层中的价值

目的  探讨双能量CT肺灌注的灌注缺陷对肺栓塞诊断及危险分层。方法  选取我院2018年1月~2020年12月157例临床疑诊为肺栓塞的患者为研究对象,最终120例患者确诊肺栓塞,所有患者均行双能量CT肺灌注成像(DEPI)及肺动脉CT血管造影成像(CTPA),根据临床生物学标志及影像学改变,将患者分为肺栓塞低危组(n=30)、中危组(n=35)、高危组(n=55)。比较患者肺栓塞数量,肺动脉灌注缺失面积分数、右/左心室短轴最大径比值及心脏生物学标志物。所有患者随访3月并记录结局。结果  DEPI与CTPA对肺栓塞的诊断相符,诊断符合率为86.1%; CTPA和DEPI联合诊断的曲线下面积为0.95,特异性为89.20%,敏感度为95.80%,Youden指数为0.85,较CTPA和DEPI单独诊断肺栓塞更好。肺栓塞低危组、中危组、高危组的灌注缺损面积、心脏生物学标志物及右/左心室短轴最大径比值经两两比较差异有统计学意义(P < 0.05)。结论  DEPI可作为CTPA的诊断肺栓塞的补充,并通过肺动脉灌注缺失面积分数危险分层,是一种新的临床诊疗方案的选择。     

Is thrombolytic therapy effective for pulmonary embolism?

Pulmonary embolism is a disorder that is associated with significant morbidity and mortality. Right-sided heart failure and recurrent pulmonary embolism are the main causes of death associated with pulmonary embolism in the first two weeks after the embolic event. Thrombolysis is a potentially lifesaving therapy when used in conjunction with standard anticoagulation. However, it has significant side effects and must therefore be used with caution. Indications for thrombolysis are not well defined and are thus controversial. The only current absolute indication is massive pulmonary embolism with hypotension. Other potential indications include right heart dysfunction, recurrent pulmonary embolism and the prevention of pulmonary hypertension. However, no evidence exists to show benefit of thrombolytic therapy over standard anticoagulation therapy for recurrent pulmonary embolism, mortality or chronic complications. Bleeding is the most common complication of thrombolysis and may be fatal.     

64层螺旋CTPA对肺动脉栓塞的诊断价值(附25例分析)

目的评价64层螺旋CTPA及三维成像技术对肺动脉栓塞的诊断价值。方法收集25例经64层SCTPA检查确诊的肺动脉栓塞;回顾性分析其成像条件及薄层容积图像,MPR、MIP、SSD、VR等后处理方法对肺动脉及其栓子的显示情况,并观察肺动脉栓塞征象。结果25例SCTPA图像质量均满足诊断需要;薄层容积图像可清晰显示肺动脉及其各级分支,显示率为100%;MPR、MIP、SSD、CR等后处理法有助于多角度、多方位显示栓子。PE主要累及左右肺动脉等大分支,占90%,其中中央型栓塞18,周围型栓塞7例。栓塞直接征象为栓子形成充盈缺损;间接征象包括肺梗死、胸腔积液、心包积液、膈肌抬高和右心增大等。结论64层螺旋CT极大提高了SCTPA这一技术的临床应用价值,是目前诊断肺动脉栓塞最为快捷、安全、可靠的影像方法。     

超声检查在急性肺栓塞诊断中的价值

目的 探讨超声检查在急性肺栓塞诊断中的价值。方法 对临床综合诊断为肺栓塞的82例患者行经胸超声心动图和周围血管超声检查。结果 超声心动图发现右房内血栓1例，肺动脉干或左、右肺动脉栓塞7例，典型右心负荷过重和肺动脉高压25例。周围血管超声发现下肢深静脉和（或）髂静脉内血栓39例。结论 超声检查是急性肺栓塞影像学诊断的首选，是急诊情况下重要、实用、及时的诊断方法，对临床决策有较大帮助。     

Inhaled nitric oxide as salvage therapy in massive pulmonary embolism: a case series

Inhaled nitric oxide (INO) has been shown to preferentially lower resistance in the pulmonary vasculature. The relative selectiveness of INO in accomplishing this effect makes it an attractive drug to administer as salvage therapy in patients with acute right ventricular failure secondary to pulmonary embolism. We describe 4 cases in which INO was used as a temporizing agent to decrease right ventricular after-load following massive near-fatal pulmonary embolism. All 4 patients survived to hospital discharge.     

Facteurs pronostiques de l’embolie pulmonaire

Risk stratification of patients with pulmonary embolism represents an important step and may help to guide initial therapeutic management. Pulmonary embolism can be stratified into several levels of risk of early death or complications based on the presence of several risk factors. High-risk pulmonary embolism is defined by shock or peripheral signs of hypoperfusion. It is a life-threatening emergency with high short-term mortality (> 25%) requiring specific therapeutic strategy with inotropic agents and fibrinolysis. In patients with normotensive pulmonary embolism, the presence of right ventricular dysfunction on echocardiography and/or myocardial injury, as attested by elevated levels of biomarkers, is associated with an intermediate risk of early death. These patients need close monitoring, while evaluation of fibrinolysis efficacy is currently underway. Patients with normotensive pulmonary embolism and without right ventricular dysfunction or myocardial injury have low risk of death. These patients may be candidates for home treatment. Several scores combining these risk factors have been described.     

Effects of levosimendan on acute pulmonary embolism-induced right ventricular failure

OBJECTIVE: Repeated episodes of pulmonary embolism can persistently increase pulmonary arterial pressure and depress right ventricular contractility. We investigated the effects of levosimendan on right ventricular-pulmonary arterial coupling in this model of right ventricular failure. DESIGN: Prospective, controlled, randomized animal study. SETTING: University research laboratory. SUBJECTS: Fourteen anesthetized piglets. INTERVENTIONS: Repeated acute pulmonary embolisms were induced with autologous blood clots to induce persistent right ventricular failure. Animals were randomly assigned to a control or levosimendan group. Levosimendan 20 microg/kg was administered in 10 mins followed by 0.2 microg/kg/min or same volumes of isotonic saline. MEASUREMENTS AND MAIN RESULTS: Pulmonary artery distal resistance and proximal elastance by pressure-flow relationships and vascular impedance were measured. We noted right ventricle contractility by the end-systolic pressure-volume relationship (Ees), pulmonary artery effective elastance by the end-diastolic to end-systolic relationship (Ea), and right ventricular-pulmonary arterial coupling efficiency by the Ees/Ea ratio. The gradual pulmonary artery embolism increased pulmonary artery resistance and elastance, increased Ea from 1.01 +/- 0.17 to 5.58 +/- 0.37 mm Hg/mL, decreased Ees from 1.75 +/- 0.12 to 1.29 +/- 0.20 mm Hg/mL, and decreased Ees/Ea from 1.74 +/- 0.20 to 0.24 +/- 0.09. Compared with placebo, levosimendan decreased pulmonary arterial elastance and characteristic impedance. Right ventricular-pulmonary arterial coupling was restored by both an increase in right ventricular contractility and a decrease in right ventricular afterload. CONCLUSIONS: A gradual increase in pulmonary artery pressure induced by pulmonary embolism persistently worsens pulmonary artery hemodynamics, right ventricular contractility, right ventricular-pulmonary arterial coupling, and cardiac output. Levosimendan restores right ventricular-pulmonary arterial coupling better than placebo, because of combined pulmonary vasodilation and increased right ventricular contractility.     

Diagnosis and prognosis of acute pulmonary embolism: focus on serum troponins

Pulmonary embolism is a common disease associated with high mortality. Death due to pulmonary embolism occurs mainly before hospital admission or in the first hours of the hospital stay. Prompt diagnosis and prognostic stratification and more intensive treatment in patients with estimated high risk for adverse outcomes have the potential to reduce mortality due to pulmonary embolism. Significant advances have recently been made in the risk stratification for adverse outcomes in patients with pulmonary embolism and normal blood pressure. In these patients, right ventricle overload assessed by echocardiography and probably by helical computerized tomography is a predictor of in-hospital mortality. Serum troponin is rapidly available in the emergency room, and has a critical role in the management of patients with acute coronary syndromes. The role of serum troponin in patients with pulmonary embolism has been explored recently: it seems to be marginal in diagnosis while it can significantly contribute to prognostic stratification. Elevated serum levels of troponins are associated with right ventricular overload and adverse in-hospital outcomes in patients with pulmonary embolism and normal blood pressure.     

肺栓塞的多层螺旋CT诊断和溶栓治疗效果评价

目的探讨多层螺旋CT在肺动脉栓塞诊断和溶栓治疗效果评估中的作用。方法对52例临床拟诊肺动脉栓塞的患者行16层螺旋CT肺动脉成像(CTPA)检查,并对其中20例经溶栓治疗2周后的患者进行同机同条件复查。结果52例中8例肺动脉成像未见异常,1例为动静脉瘘,5例诊断为肺动脉高压,38例诊断肺动脉栓塞。38例肺栓塞中共累及各级肺动脉236处,其中肺动脉干5支,左右肺动脉30支,叶动脉81支,肺段动脉103支,亚段动脉17支。20例经溶栓治疗后复查,病灶均不同程度缩小或消失。结论16层螺旋CT能及时发现和诊断肺栓塞,也可指导溶栓治疗及评价疗效。     

家兔急性肺栓塞影像模型的制备

目的:通过家兔急性肺栓塞影像模型的制备并与DSA和MRPA及病理对照研究,验证用明胶海绵制作家兔肺栓塞影像模型的可行性和准确性。方法:在DSA下经家兔颈静脉插管至右心房,将明胶海绵自导管注入,栓塞前后分别做肺动脉造影和增强磁共振肺动脉成像,最后经病理解剖来验证肺栓塞模型的可靠性。结果:在MRPA和DSAPA图像上,肺栓塞表现为肺动脉分支截断?熏 病理镜下可见肺动脉管腔内有明胶海绵栓塞物。结论:此方法制备肺栓塞模型是客观有效的,为肺栓塞的影像学研究提供了一种较好的方法。