Pulmoner tromboemboli ile 27 olgu

Amaç: Pulmoner Emboli tanýsýnda; klinik, laboratuvar ve radyolojik bulgular önemli bir yer tutmaktadýr. Bununla birlikte,tanýda hastalarýn diðer klinik sorunlarý nedeni ile, çoðu zaman zorluklar yaþanmaktadýr. Bu çalýþmada; hastaya ait risk faktörleri, baþvuru anýndaki þikayetleri, klinik ve labaratuvar parametrelerini incelemeyi amaçladýk.
Gereç ve Yöntem: Bu çalýþmaya, 2010-2014 yýllarý arasýnda, Pulmoner Emboli nedeni ile servisimize yatýþý yapýlmýþ 27 olgu alýndý. Olgularýn, taný anýndaki risk faktörleri, semptomlarý, radyolojik görüntüsü retrospektif olarak deðerlendirildi. Hastalarýmýzýn baþvuru anýndaki, Wells (Canadian) pulmoner tromboemboli klinik tahmin skorlamasý yapýldý.
Bulgular: Olgularýn ortalama yaþý 74.56±11.63 olup, %25.9’u erkek, %74.1’i kadýndý. Olgularýn %29.6’sý sigara kullanýyordu. Wells skoru ortalama 3.57±1.7, D-dimer 2697.85±1648.26 idi. Emboliyi hazýrlayýcý faktör olarak cerrahi operasyon/ immobilizasyon (%48.1) ve derin ven trombozu tanýsýndan daha öncelikli alt taný (%55.6) ilk sýralarý aldý. En sýk görülen semptomlar sýrasýyla dispne (%59.3), çarpýntý (%44.4) iken Fizik muayenede en çok bulunan bulgu takipne (%66.7) ve raldi (%48.1) Oda havasýnda bakýlan kan gazýnda, %66,6 hipoksik hipokarbik bazik ph mevcuttu. Akciðer grafisinde en çok bulunan bulgu diafram yüksekliðiydi (%51.9). Derin ven Doppler USG olgularýn %48.1’ine yapýlýrken, yapýlmýþ olgularýn %46.15’de DVT bulgusu mevcuttu. Olgularýn 11 (%40.7)’sine Ventilasyon perfüzyon sintigrafisi yapýlýrken, yapýlmýþ olgularýn %63.63’sýnda yüksek olasýlýklý Pulmoner Emboli mevcuttu. BT anjiyo yapýlan olgularýn %48.1’inde PE bulgusu mevcuttu.
Sonuç: Çalýþmamýz sonunda olgularýn %59.3’üne ventilasyon perfüzyon sintigrafisi, %51.9’una BT Anjio, %51.9’una Derin Ven Doppler USG yapýlmadýðý görüldü. Hastalarýn ileri yaþ olmasý, eþlik eden diðer komorbiditesi yüksek sistemik hastalýklar bu tetkiklerin yapýlmasýnda sýnýrlayýcý olmaktadýr. Bu nedenle PE tanýsýnda klinik þüphenin ve olasý risklerin iyi deðerlendirilmesinin, erken taný ve tedaviye baþlanmasý açýsýndan önemli olduðunu düþünmekteyiz.

27 Patients with pulmonary thromboembolism

Objective: Clinical, laboratory and radiological findings play a major role for the diagnosis of Pulmonary Embolism. However, its diagnosis is usually challenging due to other clinical problems of patients. In this study; our aim is to determine the risk factors of patients, by evaluating their initial complaints, clinical and laboratory parameters.
Material and Method: In this study, we included 27 patients having the findings of pulmonary embolism applying to our clinic between the years 2010-2014. Risk factors at the diagnosis, symptoms, and radiological findings were retrospectively evaluated. Clinical prediction scores of all patients at the time of application was calculated by using Wells scoring system (Canadian score).
Results: The mean age of the patients were 74.56±11.63 and %25.9 were male whereas %74.1 were female. 29.6% of the cases were active smokers. The mean Well’s score and D-dimer values were 3.57±1.7 and 2697.85±1648.26 respectively. The factors that leads to pulmonary embolism were surgery/immobilization in 48.1% and subclinical diagnosis of DVT in 55.6%. The frequent symptoms were dyspnea (59.3%) and palpitations (44.4%) and ýn Physýcal examination the most common findings were tachypnea (66.7%) and pulmonary rales (48.1%). In the blood gases undertaken in room air alkaline PH that revealed hypoxia and hypercarbia were present. The most common pulmonary X ray fýndýng was the elevated diaphragm (51.9%). Doppler Ultrasound was done in 48.1% of the patients and DVT findings was present in 46.15%. 11 (40.7%) cases underwent a ventilation perfusion scintigraphy and out of these 63.3% findings consistent
with Pulmonary Embolism were present. In patients whom CT angiogram was done 48.1% revealed fýndýngs of Pulmonary Embolism (PE).
Conclusion: In conclusion our study showed that ventilation perfusion scintigraphy, CT angiography and Venous Doppler ýn DVT protocol were not done in 59.3%, 51.9%, 51.9% cases respectively. The elder age of the patients and systemic high risk comorbidities are thought to be the limiting factors that lead to nonapplication of the above tests. For this reason, clinical suspicion and assessment of probable risk factors is important for early diagnosis and rapid initiation of treatment for pulmonary embolism.