Chest sonography in the diagnosis of pulmonary embolism: a comparison with MRI angiography and ventilation perfusion scintigraphy.

AIM: To compare the diagnostic performance of chest sonography, MRI angiography and ventilation/perfusion intigraphy in pulmonary embolism (PE). METHOD: In a prospective clinical study, 55 patients (41 women, 14 men, age 23 - 91 years) with clinical signs of PE were investigated within 48 hours of the onset of symptoms. The final diagnosis was made by MRI angiography (reference method). RESULTS: PE was diagnosed in a total of 36 patients. Chest sonography revealed rounded or wedge-shaped hypoechoic lesions in 30 patients. On ventilation/perfusion (V/P) scintigraphy, 41 patients had positive V/P scans, but only 23 were of high probability. Chest ultrasound had a positive predictive value of 97 % to diagnose PE. The sensitivity, specificity, the negative predictive value and accuracy were 81 %, 84 %, 84 % and 82 %, respectively. As 18 patients had inconclusive scans, the diagnostic performance of ventilation/perfusion scintigraphy was poor. The positive predictive value, sensitivity and specificity were 58 %, 42 % and 91 %, respectively. Patients in whom PE was excluded mainly suffered from congestive heart failure, bronchopulmonary infections or pulmonary hypertension. CONCLUSION: A negative sonographic study cannot rule out PE with certainty. However, a chest sonography is of acceptable diagnostic value in patients with suspected PE and may be used as an adjunct or guide to more established methods.

Lung sonographic findings in patients with suspected pulmonary embolism.

PURPOSE: To assess the feasibility and diagnostic performance of lung transthoracic sonography in patients with suspected pulmonary embolism. METHOD: In a prospective clinical study we compared sonographic findings of the peripheral lung with various scintigraphic gradings and D-dimer plasma concentrations. One hundred and nineteen consecutive patients with clinical signs of pulmonary embolism were investigated within 24 hours of the onset of symptoms. RESULTS: Seventy patients with suspected pulmonary embolism (59%) had sonographic lesions, which were echo poor, homogeneous and rounded or wedge-shaped with a hyperechoic reflexion in the centre. Of the patients with high-probability scintigraphic scans 86% had such sonographic lesions as had 79% with intermediate, 64% with low-probability and 33% with normal scintigraphic scans. Of the patients with positive sonographic findings and normal or low-probability scans only a minority (14%) had negative D-dimer tests. CONCLUSION: We found a high rate of specific sonographic lesions in patients with suspected pulmonary embolism when investigating the peripheral lung with ultrasound.

[Accidental glycol poisoning]. / Akzidentelle Glykolvergiftung.

An acute ethylene glycol intoxication is reported. 100 to 130 ml monoethylene glycol which is used as antifreeze were taken by mistake. On admission to hospital the 41-year-old patient was not remarkable. Despite the lethal dose--according to literature--no renal failure developed by immediate intravenous ethanol therapy. While the patient was given 10 g of ethanol hourly, the serum glycol level decreased steadily (93 mg/dl). After a short oral treatment with 5 to 7 g of ethanol hourly, the serum glycol increased to 350 mg/dl, but could be lowered again--after the reinstitution of the intravenous therapy--to those values recorded before the oral therapy. The level of blood ethanol differed between 2.41 and 0.01 mg/l. The creatinine clearance was normal and the serum electrolytes could be kept in the normal range with adequate compensation despite of the polyuria of 13.81/24 h. It is known that even a low ethanol level inhibits the enzymic metabolism of ethylene glycol by ethanol dehydrogenase and prevents the formation of toxic metabolites. The patient luckily had already consumed about 40 g of alcohol (2 bottles of beer), so that an ethanol level existed already before this intoxication. From this case report one could conclude, that the parenterally given ethanol influences the serum glycol level far better than the orally given especially in case it is not more than 7 g/h. If glycol intoxication is sure, hemodialysis is--despite this especially good course of conservative treatment--the more efficient and quicker method because of its good ability of elimination.