Göðüs Hastanesi Dergisi. 2009; 23(2): 59-65

PULMONER TROMBOEMBOLÝLÝ OLGULARIMIZIN DEÐERLENDÝRÝLMESÝ

Esin YENTÜRK¹, Dilek KANMAZ¹, Firdevs ATABEY¹, Esin TUNCAY¹
Yedikule Göðüs Hastalýklarý ve Göðüs Cerrahisi Eðitim ve Araþtýrma Hastanesi, 8 Klinik, Ýstanbul

Günümüzde ciddi saðlýk sorunlarýndan biri olan pulmoner tromboemboli de (PTE) hýzlý taný ve tedavi ile mortalite oldukça azalmaktadýr. Kliniði özgül olmayan bu hastalýðýn tanýsýnda klinik, radyolojik ve laboratuvar bulgularýnýn birlikte deðerlendirilmesi gereklidir. Çalýþmamýzda PTE nedeni ile kliniðimizde interne edilen 65 hastanýn klinik, radyolojik ve laboratuar bulgularý incelendi. Tüm olgularda PA akciðer grafisi, arter kan gazlarý (AKG) ve D-dimer, ventilasyon perfüzyon (V/Q) sintigrafisi 61 (%93), alt ekstremite venöz Doppler ultrasonografi (USG) 39 (%60), toraks bilgisayarlý tomografisi (BT) 28 (%43) olguda bakýldý. Yaþ ortalamasý 51.4±14.5 (27-78) yýl olan, 65 (41 erkek, 24 kadýn) hastanýn semptom süresi 9.4±9.2 (1-35) gündü. En sýk görülen semptom ani baþlayan nefes darlýðý (%92) idi. PTE için risk faktörü %83 (54/65) oranýnda görüldü. En sýk radyolojik bulgular; lineer atalektazi %81 (53/65), diafragma elevasyonu %75 (49/65) iken, V/Q sintigrafisi %75 (46/61) yüksek, %12 (7/61) orta, %13 (8/61) düþük olasýlýklý deðerlendirildi. Doppler USG de; %64 (25/39) olguda akut ve subakut trombüs saptandý. Düþük ve orta olasýlýklý V/Q sintigrafisi olan olgularýn hepsinde yüksek klinik olasýlýk ve yüksek D-dimer düzeyi mevcuttu. Olgularýmýz invazif olmayan yöntemlere dayalý algoritma ile PTE tanýsý konularak tedavi edilmiþtir.

Anahtar Kelimeler: Pulmoner tromboemboli, klinik bulgular, risk faktörleri

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EVALUATION OF OUR PATIENTS WITH PULMONARY THROMBOEMBOLISM

Esin YENTÜRK¹, Dilek KANMAZ¹, Firdevs ATABEY¹, Esin TUNCAY¹
Yedikule Göðüs Hastalýklarý ve Göðüs Cerrahisi Eðitim ve Araþtýrma Hastanesi, 8 Klinik, Ýstanbul

The mortality a nd the morbidity of the pulmonary thromboembolism (PTE), which is an important health problem, decreases significantly by early diagnoses and treatment. Because its clinical signs are not so specific the diagnosis must be based on the evaluation of clinical, radiological and biochemical findings together. Clinical, radiological and biochemical findings of 65 patients, hospitalized in our clinic with the diagnosis of PTE, were recorded. Chest radiograph, arterial blood gas (ABG) analyses and D-Dimer in all cases, V/Q scintigraphy in 61 (93%) cases, lower limb venous Doopler ultrasonography (USG) in 39 (60%) cases and thorax computed tomography (CT) in 28 (43%) cases were obtained. The duration of the symptoms of the 65 cases (M/W: 41/24) aged between 27 to 78 (51.4±14.5) was 9.4±9.2 (1-35) days. The most frequent symptom was acute onset dyspnea (92%). An 54 of the 65 cases (83%) there was one or more risk factors. The most frequent radiological findings were elevation of hemidiaphragm 75% (49/65), linear atelectasis 81% (53/65). In V/P scintigraphy 75% (46/61) high, 12% (7/61) moderate and 13% (8/61) of the cases were interpreted as low risk group. There was acute or subacute venous thrombosis in 64% (25/39) of the cases detected by Doopler USG. There were high clinical suspect and high blood D-Dimer levels in all the cases who have low or moderate risk according to V/P scintigraphy. In conclusion our cases were diagnosed by an algorithm based on noninvasive procedure.

Keywords: Pulmonary thromboembolism, clinic presentation, predisposing factors

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