Eflatun YÜCEDAĞ, AYHAN UYSAL, Oktay BURMA, İBRAHİM MURAT ÖZGÜLER, Mehmet Cengiz ÇOLAK, TANSEL ANSAL BALCI

Derin ven trombozu sonrası asemptomatik pulmoner emboli tanısında ventilasyon/ perfüzyon sintigrafisi ve multidedektör bilgisayarlı tomografinin karşılaştırılması

Amaç: Pulmoner tromboemboli (PTE) sistemik venöz sistemde oluşan pıhtıların pulmoner vasküler yatağa göçü ile ortaya çıkan klinik tabloya verilen isimdir. Akut derin ven trombozu (DVT) sonrası ortalama %40-60 oranında asemptomatik PTE görülmekte ve bu durum sessiz klinik seyir nedeniyle fark edilmemektedir. Bu çalışmamızda akut alt ekstremite DVTsine bağlı gelişen asemptomatik PTE tanısında hala günümüzde önemli bir yer tutan ventilasyon-perfüzyon (V/P) sintigrafisi ile son yıllarda kullanılmaya başlanan multi-detektor bilgisayarlı tomografinin (MDBT) sensitivite ve spesifitesini karşılaştırmayı amaçladık. Yöntemler: Çalışma alt ekstremite akut DVT nedeniyle kliniğimize yatırılarak tedavisi planlanan 25 hastada ger- çekleştirildi. Gebeler, nüks DVT vakaları, müracaat esnasında semptomatik PTE tablosu olanlar, vena kavaya uzanım gösteren trombüsü olanlar, önceden geçirilmiş PTE öyküsü olanlar çalışmaya dahil edilmedi. Hastalarda DVT tanısı renkli doppler USG ile konulup, D-dimer testiyle teyit edildi. Hastalara yatışının 1.ve 8. günlerinde V/P sintigrafisi ve MDBT yapılarak asemptomatik PTE varlığı araştırıldı. Bulgular: Pulmoner tromboemboli açısından asemptomatik olan 25 DVT hastasının 24ünde D-dimer normalin üstünde ölçüldü. MDBT ile 10 hastaya PTE tanısı konuldu. Akut DVTye bağlı %40 oranında asemptomatik PTE geliştiği tespit edildi. Sonuç: Multi-detektor bilgisayarlı tomografi tanı değeri açısından V/P sintigrafisinden daha faydalı bulundu.

Comparison of ventilation/perfusion scintigraphy and multi-detector computerized tomography in diagnosis of asymptomatic pulmonary embolism after deep vein thrombosis

Objective: Pulmonary thromboembolism (PTE) named due to migration of clots formed in systemic venous system to pulmonary vascular bed is a serious clinical table. After acute DVT, asymptomatic PTE is seen about 40- 60% and this situation can not be discovered because of silent clinical course. In this study, we aimed to compare sensivity and spesifity of multi detector computerized tomography (MDCT), which is used extensively in recent years, with ventilation-perfusion (V/P) scintigraphy which is used formerly for diagnosis of asymptomatic PTE developed after acute lower extremity DVT. Methods: The study was carried out 25 patients who were admitted to our clinic and treated for lower extremity acute DVT. Pregnants, and cases with recurrent DVT, presence of symptomatic PTE during admission, thrombosis extending to vena cava, and history of passed PTE were excluded from the study. DVTs in patients were diagnosed by color doppler, and confirmed by D-dimer test. After patientss admission, V/P scintigraphy and MDCT were used to detects asymptomatic PTE at 1st and 8th day of the admission. Results: D-dimer was measured as higher in 24 of 25 patients with asymptomatic PTE. Ten patients were diagnosed by MDCT. Development of asymptomatic PTE related to acute DVT was determined as 40%. Conclusion: In terms of diagnostic value, MDCT was found more useful than V/P scintigraphy.

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