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Thromb Haemost 2001; 86(05): 1156-1160
DOI: 10.1055/s-0037-1616044
Review Article
Schattauer GmbH

Prediction of Pulmonary Embolism Extent by Clinical Findings, D-dimer Level and Deep Vein Thrombosis Shown by Ultrasound

Cécile Galle
1   Division of Angiology and Hemostasis, Geneva, Switzerland
,
Jean-Pierre Papazyan
2   Division of Nuclear Medicine, Geneva, Switzerland
,
Marie-José Miron
1   Division of Angiology and Hemostasis, Geneva, Switzerland
,
Daniel Slosman
2   Division of Nuclear Medicine, Geneva, Switzerland
,
Henri Bounameaux
1   Division of Angiology and Hemostasis, Geneva, Switzerland
,
Arnaud Perrier
3   Medical Clinic 1, Geneva University Hospital, Geneva, Switzerland
› Author AffiliationsThe 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.
Further Information

Publication History

Received 04 January 2001

Accepted after revision 28 June 2001

Publication Date:
13 December 2017 (online)

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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.

Keywords

Pulmonary embolism - lung scan - prognosis
 

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