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。

Transthoracic Echocardiography in the Diagnosis of Acute Pulmonary Embolism

Objective To evaluate the applied value of the transthoracic echocardiography(TTE) in patients with acute pulmonary embolism(APE) Methods A total of 16 patients with acute pulmonary embolism were examined with TTE,which were compared with the results of pulmonary angiography,nuclide scintiscanning and computed tomography (CT) Results Six cases with thromboembolism in the major pulmonary artery were detected by TTE and were testified by pulmonary angiography or CT Among these cases,3 cases with right ventricular embolism and 1 cases with right atrial embolism were directly detected by TTE Twelve cases with typical right ventricular pressure overload in echocardiogram were found to have multiple and wide areas pulmonary embolism by ventilation/perfusion scintigraphy or CT 4 cases who revealed normal echocardiogram were identified as segmental or subsegmental pulmonary embolism by scintigraphy or CT Conclusions TTE could directly diagnose pulmonary embolism according to the presence of embolus in the major pulmonary artery,as well as could indirectly suggest the probability of pulmonary embolism in accordance with the sign of right ventricular pressure overload However,TTE could not diagnose and exclude the pulmonary segmental or subsegmental embolism