Aygül GÜZEL, Mesut ÖZTÜRK, Kerim ASLAN, Ahmet Veysel POLAT

Akut pulmoner emboli hastalarında tedavi öncesi ve sonrası sol atriyum boyutu ve hastalığın şiddeti arasındaki ilişkinin bilgisayarlı tomografi pulmoner anjiyografi ile değerlendirilmesi

Giriş: Bildiğimiz kadarıyla literatürde tedavi öncesi ve sonrası nonmasif, submasif ve masif akut pulmoner emboli (APE)’nin sol atriyum (LA) görüntüleme bulguları raporlanmadı. Bu çalışmanın amacı nonmasif, submasif ve masif APE’nin tedavi öncesi ve sonrası bilgisayarlı tomografi pulmoner anjiyografi (BTPA) ile LA boyutlarını değerlendirmek ve gruplar arasında farklılık olup olmadığını araştırmaktır. Materyal ve Metod: BTPA ile tanı alan, tedavi sonrası takip görüntülere ve kayıtlı klinik bilgiye sahip 62 erişkin APE hastası (21 nonmasif, 31 submasif ve 10 masif) çalışmaya dahil edildi. Tüm grupların tedavi öncesi ve sonrası LA boyutları iki radyolog tarafından birbirinden bağımsız ölçüldü. Bulgular: Tedavi öncesi tüm grupta LA boyutu en düşük masif APE'de olup bu farklılık istatistiksel olarak submasif (p= 0.001) ve nonmasif (p< 0.001) gruplara göre anlamlıydı. Ayrıca submasif APE hastaları nonmasif APE hastalarına göre daha düşük LA boyutuna sahipti (p= 0.006). Masif ve submasif APE'de tedavi sonrası LA boyutları tedavi öncesine göre istatistiksel olarak anlamlı yüksekti (her iki grup için p< 0.001). Fakat nonmasif APE hastalarında tedavi öncesi ve sonrası LA boyut farklılığı istatistiksel olarak anlamlı değildi (p= 0.082). Sonuç: APE'nin şiddeti arttıkça LA boyutu azalmaktadır. Bu yüzden APE sırasında azalmış bir LA boyutu artan APE şiddetini gösterebilir. Bu çalışma tedavi sonrası masif ve submasif APE hastalarında tedavi öncesine göre LA boyutunun istatistiksel olarak arttığını raporladı. Bu sonuçlar LA boyutunun APE’li hastalarda tedaviye yanıt olarak kardiyak morfolojideki değişiklikleri yansıtan ek bir parametre olabileceğini düşündürmektedir.

Assessment of the association between pre-treatment and post-treatment left atrium size and severity of disease in patients with acute pulmonary embolism by using computed tomography pulmonary angiography

Introduction: As far as we know, left atrium (LA) imaging findings ofpre-treatment and post-treatment nonmassive, submassive and massive acutepulmonary embolism (APE) have not been reported in literature. The aim ofthis study is to assess LA sizes of nonmassive, submassive and massive APEbefore and after treatment with computed tomography pulmonary angiography(CTPA) and to research whether there are differences between groups.Materials and Methods: Sixty two adult APE patients (21 nonmassive, 31submassive and 10 massive) who were diagnosed with CTPA and who hadpost-treatment follow-up images and recorded clinical information wereincluded in the study. Pre-treatment and post-treatment LA sizes of all groupswere measured by two radiologists independently.Results: The lowest pre-treatment LA size was found in massive APE and thisdifference was found to be statistically significant when compared withsubmassive (p= 0.001) and nonmassive (p< 0.001) groups. In addition,submassive APE patients were found to have lower LA size when comparedwith nonmassive APE patients (p= 0.006). In massive and submassive APE,post-treatment LA sizes were found to be statistically significantly higher whencompared with pre-treatment (p< 0.001 for both groups). However, innonmassive APE patients, pre-treatment and post-treatment LA size differencewas not found to be statistically significant (p= 0.082).Conclusion: As the severity of APE increases, LA size decreases. Thus, a decrease LA size during APE can show increased APE severity.This study reported that LA size increased statistically in post-treatment massive and submassive APE patients when compared withpre-treatment. These results suggest that in APE patients, as a response to treatment, LA size can be an additional parameter reflectingthe changes in cardiac morphology.

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