Ultraschall Med 2007; 28 - V_12_5
DOI: 10.1055/s-2007-989100

Central pulmonary embolism diagnosed by real-time endobronchial ultrasound

J Aumiller 1, F Herth 2, M Krasnik 3, R Eberhardt 2
  • 1Marienkrankenhaus Hamburg, Zentrum Innere Medizin, Hamburg, Germany
  • 2Thoraxklinik Heidelberg, Pneumologie und Intensivmedizin, Heidelberg, Germany
  • 3Gentofte University Hospital, Departement of Cardiothoracic Surgery, Copenhagen, Denmark

Introduction: Life threatening central pulmonary embolism (PE) is defined as thrombotic occlusion of the main pulmonary trunk or of main or lobar pulmonary artery. These vessels accompany the trachea, the main and lobar bronchi at a distance of less than 5mm. Chest-CT enhanced with iv contrast (Angio-CT) has become the principal imaging modality to evaluate suspected, central PE. Here we report imaging of central PE using real-time endobronchial ultrasound (rtEBUS).

Aim: Feasibility of diagnosing central PE by rtEBUS in an imaging quality comparable with Angio-CT.

Methods: In 20 case-reports we compared the visualization of central PE via rtEBUS and Angio-CT.

Results: Fortuitously PE was discovered via rtEBUS in 7 patients, who were checked for hilar and mediastinal lymphnodes in staging lung-cancer. In 12 patients with documented PE (Angio-CT) we could demonstrate, that it is feasible to visualize all central pulmonary emboli by rtEBUS. 2 additional patients were explored for PE via rtEBUS as initial dignostic procedure, because of obesity and renal failure. The first case was confirmed by autopsy, the second by Angio-CT after 4 days with normalized renal function.

In all patients we could visualize the pulmonary trunk, both main pulmonary arteries and the lobe arteries at the entrance for at least 10mm by rtEBUS. All central PE were confirmed by Angio-CT, demonstrating a valid congruence.

Conclusions: rtEBUS of central pulmonary arteries may represent a valuable alternative in the diagnosis of PE, especially in patients with renal impairment, anaphylaxis to intravenous contrast, pregnancy, cardiogenic shock or right ventricular failure.