Differenzialdiagnostik der akuten Lungenembolie, welche Rolle spielt die Bildgebung?

Abstract

By combining score based clinical pretest probability with D-Dimer testing and appropriate imaging protocols pulmonary embolism (PE) can be accurately detected. Early risk adapted therapies helped to significantly reduce mortality and morbidity of pulmonary embolism.

CT has been established as gold standard in the diagnostic algorithm of the 2014 ESC guideline. In case of hemodynamically instable patients echocardiography is the modality of choice to rule in or rule out PE and identify other entities which critically compromise the cardiovascular system.

In some cases CUS can support the diagnostic algorithm, where CT alone is not sufficient to make the diagnosis.

V/Q might still be warranted in some clinical scenarios like pregnancy or renal failure.

• Literatur

• 1 Cohen AT, Agnelli G, Anderson FA et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98: 756-764
• 2 Konstantinides SV, Torbicki A, Agnelli G et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35: 3033-3069 , 69a–69k
• 3 Dogan H, de Roos A, Geleijins J et al. The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism. Diagn Interv Radiol 2015; 21: 307-316
• 4 Reissig A, Kroegel C. Therapeutic approaches to acute pulmonary embolism. Internist (Berl) 2004; 45: 540-548
• 5 Kim NH, Delcroix M, Jenkins DP et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol 2013; 62: D92-99
• 6 Ceriani E, Combescure C, Le Gal G et al. Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis. J Thromb Haemost 2010; 8: 957-970
• 7 Stein PD, Fowler SE, Goodman LR et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006; 354: 2317-2327
• 8 Anderson DR, Kahn SR, Rodger MA et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA 2007; 298: 2743-2753
• 9 Moores L, Kline J, Portillo AK et al. Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism. J Thromb Haemost 2016; 14: 114-120
• 10 Ayaram D, Bellolio MF, Murad MH et al. Triple rule-out computed tomographic angiography for chest pain: a diagnostic systematic review and meta-analysis. Acad Emerg Med 2013; 20: 861-871
• 11 Zhang LJ, Lu GM, Meinel FG et al. Computed tomography of acute pulmonary embolism: state-of-the-art. Eur Radiol 2015; 25: 2547-2557
• 12 Roy PM, Colombet I, Durieux P et al. Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ 2005; 331: 259
• 13 Patra S, Math RS, Shankarappa RK et al. McConnell’s sign: an early and specific indicator of acute pulmonary embolism. BMJ Case Rep 2014; 2014
• 14 Rudski LG, Lai WW, Afilalo J et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23: 685-713 ; quiz 86–88
• 15 Marti C, John G, Konstantinides S et al. Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis. Eur Heart J 2015; 36: 605-614
• 16 Cooper J. Improving the diagnosis of pulmonary embolism in the emergency department. BMJ Qual Improv Rep 2015; 4 (1)