Çisel YAZGAN, Hakan ERTÜRK, Ayşenaz TAŞKIN

PULMONER TROMBOEMBOLİ ŞÜPHESİNDE BT ANJİOGRAFİNİN VERİMLİLİĞİ VE PULMONER TROMBOEMBOLİ DIŞI RADYOLOJİK BULGULARIN ANALİZİ

Amaç Bu çalışmada amacımız pulmoner tromboemboli (PTE) şüphesiyle pulmoner BT anjiografi yapılan has talarda PTE pozitiflik oranını araştırmaktı. Ayrıca BT anjiografide saptanan alternatif tanıların sıklığını ve alternatif tanıların saptanmasında akciğer grafisinin rolünü belirlemekti. Gereç ve Yöntem Çalışmaya Ocak 2018- Mayıs 2018 tarihleri arasında acil servise başvuran ve PTE şüphesiyle pulmoner BT anjiografi yapılan hastalar dahil edildi. Radyolojik ra por bazında PTE negatif, PTE pozitif ve şüpheli olmak üzere hastalar üç gruba ayrıldı. PTE negatif grupta BT anjiografi incelemeleri alternatif tanılar yönünden iki radyolog tarafından gözden geçirildi. Alternatif ta nılar konsolidasyon, kitle ve amfizem gibi hastaların klinik ve semptomlarını açıklayan bulgular olarak ta nımlandı. Akciğer grafileri alternatif tanıların saptana bilirliği yönünden değerlendirildi. Başvuru anındaki semptomlar, klinik bulgular ve laboratuar bulguları kaydedildi. Bulgular Ocak 2018-Mayıs 2018 tarihleri arasında toplam 683 hastaya PTE şüphesiyle pulmoner BT anjiografi ya pılmıştı. Hastaların %6,4’ünde PTE pozitifti. PTE saptanmayan hastaların %65’inde klinik bulgular ve semptomları açıklayabilecek alternatif tanılar mev cuttu. En sık alternatif tanılar konsolidasyon, atelek tazi, amfizem ve bronşektaziydi. Bu alternatif tanıla rın %72’si hastaların akciğer grafilerinde de izlendi. Hastaların %15’inde semptomlarla ilişkisiz insidental bulgular saptandı. Sonuç Çalışmamızın sonucunda PTE şüphesiyle uygulanan pulmoner BT anjiografi incelemelerinde alternatif ta nıların PTE tanısından çok daha yüksek bir oranda saptandığını ve bu alternatif tanıların büyük çoğun luğunun ise BT’ye gerek kalmadan akciğer grafisi ile tespit edilebileceğini ortaya koyduk.

DIAGNOSTIC YIELD OF CT ANGIOGRAPHY AND ANALYSIS OF ALTERNATIVE RADIOLOGIC FINDINGS IN PATIENTS WITH SUSPECTED PULMONARY EMBOLISM

Objective The aim of this study was to assess diagnostic yield of pulmonary CT angiography and analyze alternative diagnoses in patients who underwent CT angiography with suspected pulmonary thromboembolism (PTE). It was also to determine the role of chest X-ray in the detection of alternative diagnoses. Materials and Methods Patients who underwent pulmonary CT angiography with suspicion PTE between January 2018-May 2018 were included in this study. On the basis of radiologi cal report, patients were divided into three groups as PTE negative, PTE positive and suspicious. Pulmo nary CT angiography images in the PTE negative group were reviewed by two radiologists for alternati ve diagnoses. Alternative diagnoses were defined as findings related to the clinical and symptoms of pa tients such as consolidation, tumor, and emphysema. Chest X-rays were evaluated for the detectability of alternative diagnoses. Symptoms, clinical, and labo ratory findings were recorded. Results A total of 683 patients underwent pulmonary CT angi ography. PTE was detected 6,4% of our patients. Of the patients without PTE, 65% had alternative diagno ses based on imaging. The most common alternative diagnoses were consolidation, atelectasis, emphyse ma, and bronchiectasis. 72% of these alternative di agnoses were also observed in patients' chest X-rays. Incidental findings unrelated to symptoms were dete cted in 15% of the patients. Conclusion As a result of our study, we revealed that alternative diagnoses in patients with suspected PTE were de tected at a much higher rate than PTE in pulmonary CT angiography, and the majority of these alternative diagnoses could be detected by chest X-ray without the need for CT.

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