Value Of Multiorgan Ultrasongraphy For The Diagnosis Of Pulmonary Embolism

Objective: The objective of this study was to investigate the value of the multi-parameter echocardiography and multiorgans(heart,leg vein and lung)ultrasonography for the diagnosis of pulmonary embolism(PE).Methods: Adult patients suspected of PE were prospectively enrolled and the final diagnosis was obtained with computed tomography pulmonary angiography(CTPA),treated in our hospital from January 2017 to November 2017.Patients received a echocardiography looking for right heart strain(right ventricular enlargement,McConnell's sign,tricuspid annular plane systolic ejection(TAPSE)<17mm or septal flattening,lower limb compressive venous ultrasonography(CUS)looking for deep venous thrombosis(DVT),and lung ultrasonography(LUS)looking for subpleural infarcts.Multiorgan ultrasonography considered diagnostic for PE if one or more right heart strain,DVT,or subpleural infarcts was detected.Results: There were 196 patients enrolled in the study,with 53/196(27.0%)positive for a diagnosis of PE.Of these,29/53(54.7%)PE's were located centrally.Of those with a PE,29/53(54.7%)had evidence of right heart strain,40/53(75.5%)had an associated DVT identified on bedside ultrasound and 25/53(47.2%)had evidence of subpleural infarcts.Multi-parameter heart ultrasonography yielded a sensitivity of 54.72% and a specificity of 91.61%,right ventricular dilatation 35.85% and 96.50%,McConnell's sign 30.19% and 98.60%,TAPSE<17mm 41.51% and 91.61%,septal flattening 13.21% and 100% respectively,proximal lower limb compressive venous ultrasonography 24.53% and 96.50%,the whole lower limb compressive venous ultrasonography 75.47% and 76.22%,lung ultrasonography 47.16% and 94.41%.The combination of echocardiography and lower limb compressive venous ultrasonography yielded a sensitivity of 81.13% and a specificity of 67.83%,multiorgan(heart,vein and lung)ultraonography yielded a sensitivity of 86.79% and a specificity of 63.64%.There was no significant difference in sensitivity between the two combination diagnostic methods(P=0.25),however,there was significant difference in specificity(P=0.031).Conclusion:1.Multi-parameter echocardiography can significantly improve the sensitivity of the diagnosis of PE,and the TAPSE is the most sensitive parameter.2.The sensitivity of distal lower limb compressive venous ultrasonography for the diagnosis of PE is higher than proximal vein,the whole lower limb compressive venous ultrasonography can improve the sensitivity of PE.3.Obviously,the combination of echocardiography and lower limb compressive venous ultrasonography can increase the sensitivity of diagnosis of PE.Also,multiorgans(heart,leg vein and lung)ultraonography can improve the sensitivity of the diagnosis of PE,lung ultraonography could be used as the supplement for the diagnosis of PE.