Ancillary findings assessed by ventilation/perfusiont omography

Summary

Ventilation/perfusion tomography (V/P SPECT) is a recommended method for diagnosing and follow-up of pulmonary embolism (PE). Moreover, it is possible to recognize other pathologies in addition to PE, such as pneumonia, COPD and left heart failure (LHF). The objective of this prospective study was to identify frequency of ancillary findings among patients with suspected PE. Patients, material, method: 331 consecutive patients with suspected PE were examined and classified with V/P SPECT. Patients were followed up clinically and by means of other laboratory tests. Results: 80 patients had a normal V/P SPECT and no clinical consequences in the follow-up. PE had 104 patients: 23 of them had also additional findings. Among the remaining 147 patients, pneumonias were shown in 82, acute in 75 patients and 7 had chronic post inflammatory state. COPD was present in 42 patients, in 3 combined with pneumonia. Sign of LHF was observed in 10: in 7 the acute LHF diagnosis was established, 3 were classified as having a chronic cardiopulmonary disease. Furthermore, in 16 patients, the V/P pattern was suggestive of a tumour. The clinical outcomes were 6 lung tumours, 3 empyema, one sarcoidosis, 2 were unclarified and 4 were lost in the follow-up. Conclusion: V/P SPECT identifies a high prevalence of other cardiopulmonary diseases among patients with a clinical suspicion of PE. Ancillary findings with V/P SPECT clarified patients' symptoms and had an impact on the treatment. These findings were verified by a clinical outcome by the follow-up over three months.

Zusammenfassung

Die Ventilations-Perfusionstomographie (V/PSPECT) ist ein für die Diagnose und Verlaufskontrolle der Lungenembolie (LE) empfohlenes Verfahren. Außer einer LE können auch andere Krankheitsbilder erkannt werden, z. B. Pneumonie, COPD oder Linksherz insuffizienz (LHI). Ziel dieser prospektiven Studie war es, die Häufigkeit von Nebenbefunden bei Patienten mit Verdacht auf (V.a.) LE festzustellen. Patienten, Material, Methoden: 331 konsekutive Patienten mit V.a. LE wurden mittels V/P-SPECT untersucht und klassifiziert. Sie wurden klinisch und mit anderen Labormethoden nachuntersucht. Ergebnisse: Bei 80 Patienten war die V/P-SPECT bei der Nachuntersuchung normal und ohne klinische Konsequenz. 104 Patienten hatten eine LE, davon 23 zusätzlich einen Nebenbefund. Unter den verbleibenden 147 Patienten hatten 82 eine Pneumonie, davon 75 Patienten i akuten und 7 im chronisch post-inflammatorischen Stadium. Eine COPD lag bei 42 Patienten vor, bei 3 kombiniert mit Pneumonie. Anzeichen für eine LHI wurden bei 10 beobachtet: bei 7 wurde eine akute LHI diagnostiziert, 3 wurden als chronische kardiopulmonale Erkrankung klassifiziert. Ferner deutete das V/P-Muster bei 16 Patienten auf einen Tumor hin. Klinisch ergaben sich 6 Lungentumore, 3 Empyeme, eine Sarkoidose, 2 blieben unklar und 4 konnten nicht nachuntersucht werden. Schlussfolgerung: Mit V/P- SPECT wird bei Patienten mit V.a. LE eine hohe Prävalenz anderer kardiopulmonaler Erkrankungen entdeckt. Die Nebenbefunde aus der V/P-SPECT konnten die Symptome klären und wirkten sich auf die Behandlung aus. Diese Befunde wurden in einem dreimonatigen Follow-up durch den klinischen Verlauf verifiziert.

Keywords

V/P SPECT - pulmonary embolism - ancillary finding - clinical outcome

Schlüsselwörter

V/P-SPECT - Lungenembolie - Zufallsbefunde - klinischer Verlauf

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