Lung ultrasound improves diagnosis of pulmonary embolism

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Incorporating transthoracic lung ultrasonography could avoid CT pulmonary angiography in 50 per cent of suspected cases of pulmonary embolism.

A new study suggests pre-test risk stratification enhanced with lung and venous ultrasound, performs better than Well’s score alone in the early diagnosis of pulmonary embolism (PE).

In the study, the findings of which are published in Academic Emergency Medicine , the Italian Ultrasound Well’s Study Group explored the possibility of improving conventional risk stratification for PE by integrating ultrasound.
Ultrasound and Well’s score performed significantly better than Well’s score, with sensitivity of 69.6 per cent vs 57.6 per cent and specificity of 88.2 per cent vs 68.2 per cent. In combination with d-dimer, the combination showed a failure rate of 0.8% per cent and significantly superior efficiency.
Although CT pulmonary angiography (CTPA) is the reference standard for diagnosing PE, early diagnosis remains a challenge; only 13-33 per cent of patients with suspected acute PE test positive for acute PE on CTPA. Concerns about radiation exposure limits the general use of CTPA.

The current study found that a strategy based on lung and venous ultrasound combined with d-dimer and Well’s score could avoid CTPA in 50.5 per cent of patients with suspected PE, compared to 27.2 per cent with Wells score alone.

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