Author/Editor		Požek, Igor; Drinovec, Igor; Cesar, Rok
Title		Pogostost rentgenskih sprememb in nekaterih kliničnih kazalcev pri akutni pljučni emboliji - povezava s stopnjo pljučne arterijske obstrukcije
Translated title		Frequency of plain film abnormalities and some clinical findings of acute pulmonary embolism - correlation with severity of pulmonary arterial obstruction
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 74, št. 7-8
Publication year		2005
Volume		str. 429-33
Language		slo
Abstract		Background. The aim of the study was to find out if chest x-ray abnormalities and some clinical signs and findings in patients with acute pulmonary embolism (PE) correlate with the degree of pulmonary arterial obstruction (CT obstruction index-CTOI) determined with scoring system on spiral CT angiograms (SCTA). Material and methods. In 41pts (16 men, 25 women; age range 20-89 years, mean 65 years) with SCTA proven acute PE, plain chest films were retrospectively reviewed for signs of acute PE. A scoring system based on site and degree of arterial obstruction enabled measurement of severity of obstruction on SCT angiograms. Some clinical signs (sudden onset dispnea, chest pain, syncope), ECG, pH and pCO2 of arterial blood were evaluated and compared between group with major PE (10 pts with CTOI>40%) and the rest (31 pts with CTOI<40%). Results. Mean CTOI for whole group (41 pts) was 22.7%+-18.7%. CTOI was significantly higher in pts with oligemia on chest x-ray films than without it (43.3%+-16.8% vs. 14.1+-11.6%; p value<0.05). Other x-ray signs (increase in the size of the main pulmonary arteries, elevation of the hemidiaphragm, discoid atelectases, consolidation, pleural effusion) did not correlate with CTOI. ECG signs of right ventricular strain were significantly more frequent in patients with CTOI>40% (60%vs.22.5%;p value<0.05). There was no difference in frequency of clinical signs, pH and pCO2 of arterial blood between patients with major and minor PE. Conclusions. In pts with CT proven acute PE, oligemia on chest x-ray and ECG signs of right ventricular strain correlate with severity of pulmonary arterial obstruction. Clinical simptoms, pH and pCO2 of arterial blood show no correlation with degree of pulmonary arterial obstruction.
Summary		Izhodišča. Namen študije je bilo ugotoviti, ali so na rentgenogramih prsnih organov vidni znaki in nekateri klinični simptomi, EKG spremembe, pH in pCO2 arterijske krvi pri bolnikih z akutno pljučno embolijo (PE) povezani z obsežnostjo pljučne arterijske obstrukcije, ugotovljene s spiralno CT angiografijo (SCTA). Preiskovanci in metode. Pri 41 bolnikih (16 moških, 25 žensk; starih od 20 do 89 let; srednja starost 65 let), ki so imeli s SCTA dokazano akutno PE, smo retrogradno na rentgenogramih ocenili rentgenske znake akutne PE. Stopnjo obstrukcije na SCT angiogramih smo izmerili s pomočjo Qanadlijevega indeksa (CTOI), ki upošteva umeščenost tromba in stopnjo obstrukcije pljučne arterije. Med skupino bolnikov z obsežno pljučno embolijo (10 bolnikov s CTOI>40%) in ostalimi (31 bolnikov s CTOI <40%) smo primerjali pogostost nekaterih kliničnih simptomov (nenaden nastanek dispneje, prsna bolečina, sinkopa), EKG, pH in pCO2 arterijske krvi. Rezultati. CTOI je bil pri bolnikih z znaki oligemije na rentgenogramih značilno višji kot pri tistih brez oligemije (43,3+-16,8% proti 14,1%+-11,6%;p<0,01). Ostali RTG znaki akutne PE (razširjene centralne pljučne arterije, dvignjena prepona, ploščate atelektaze, konsolidacija, plevralni izliv) niso bili povezani s stopnjo pljučne arterijske obstrukcije. EKG znaki obremenitve desnega prekata so bili značilno bolj pogosti pri bolnikih s CTOI>40% (60% proti 22,5%; p<0,05). Razlik v pogostosti kliničnih simptomov, pH in pCO2 arterijske krvi med skupinama z obsežno in neobsežno akutno PE ni bilo. Zaključki. RTG znak oligemije in EKG znaki obremenitve desnega prekata so pri bolnikih s SCTA dokazano akutno PE povezani s stopnjo pljučne arterijske obstrukcije. Klinični simptomi, pH in pCO2 arterijske krvi niso odvisni od stopnje zapore pljučnega žilja.
Descriptors		PULMONARY EMBOLISM PULMONARY ARTERY TOMOGRAPHY, X-RAY COMPUTED THORACIC RADIOGRAPHY ELECTROCARDIOGRAPHY