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DOI: 10.1055/s-0037-1616044
Prediction of Pulmonary Embolism Extent by Clinical Findings, D-dimer Level and Deep Vein Thrombosis Shown by Ultrasound
The study was supported in part by grant 32-36064.92 from the Swiss National Research Foundation, Bern, Switzerland, to A.P. and H.B. C.G. was the recipient of travel grants from the Fonds National de la Recherche Scientifique, Brussels, Belgium, and from the Université Libre de Bruxelles, Brussels, Belgium.Publication History
Received
04 January 2001
Accepted after revision
28 June 2001
Publication Date:
13 December 2017 (online)
Summary
Pulmonary embolism (PE) may encompass a wide spectrum of severity. To determine whether clinical findings, D-dimer (DD) concentration, and deep vein thrombosis (DVT) shown by lower-limb venous compression ultrasonography (US) might predict the scintigraphic extent of PE, we studied 104 hemodynamically stable consecutive outpatients with acute PE diagnosed by a high-probability ventilation-perfusion lung scan. Scintigraphic extent of PE was classified into three categories: perfusion defects corresponding to <30%, 30–50%, or >50% of the total lung area. Median respiratory and heart rates were found to be significantly related to the extent of PE. Higher median alveolar-arterial oxygen difference values were observed as the proportion of lung perfusion defects increased (>50% vs. <30%, 6.3 vs. 3.6 kPa, P <.0001). Median plasma DD concentration was 7950 g/L in patients with >50% perfusion defects compared to 2731 g/L in those with <30% defects (P = .0001). DD levels above 4000 g/L were associated to more extensive perfusion defects (>50% vs. <30% defects, OR 30; 95% CI 5.8–155). Finally, a proximal DVT was more likely among patients with larger perfusion defects (>50% vs. <30% defects, OR 4.5; 95% CI 1.5–13.6). In conclusion, clinical signs such as tachypnea and tachycardia, alveolar-arterial oxygen difference, plasma DD concentration, and presence of DVT on US are predictors of a larger PE, as assessed by the extent of perfusion defects on high probability lung scans.
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