Evaluation of the effectiveness of transthoracic echocardiography and compression ultrasonography (echo-cus) in the diagnosis of pulmonary embolism in the emergency department

Abstract

Aim: The aim of this study was to evaluate the effectiveness of echocardiography and compression ultrasonography in the diagnosis of pulmonary embolism and to investigate the diagnostic power of echocardiography and compression ultrasonography in patients with suspected pulmonary embolism. Methods: The cross-sectional study was conducted on patients who were admitted to the emergency department between 01.10.2020 and 30.09.2021 with complaints of shortness of breath, chest pain, palpitations, bloody cough, fainting, and who were recommended to undergo pulmonary computed tomography angiography according to the YEARS protocol. The study included 52 patients according to power analysis. The patients included in our study were evaluated at the bedside with the ultrasound of the emergency department. The main echocardiographic findings and compression ultrasonography finding of the deep veins of the lower extremities were evaluated. Then pulmonary computed tomography angiography was performed to patients. The right ventricle/left ventricle diameter ratio was recorded from the computed tomography images of the patients. The patients were divided into 2 groups according to pulmonary computed tomography angiography report: pulmonary embolism and non-pulmonary embolism. To see whether pulmonary embolism could be diagnosed, the main echocardiographic findings of the criteria we defined and compression ultrasonography of the deep veins of the lower extremities were evaluated. Statistical analysis of the data was performed in IBM SPSS Statics Version 26 program. Results: There were 52 patients and 20 (%38.5) patients diagnosed with pulmonary embolism according to computed tomography. Fifty percent of the patients included in the study were male and fifty percent were female. The symptom distribution of the cases according to the diagnosis of pulmonary embolism was examined and no significant difference was found between the symptoms (p>0.05). When the distribution of echocardiography and compression ultrasonography findings of the patients according to pulmonary embolism diagnosis was analyzed, a statistically significant difference was found between the groups in terms of tricuspid regurgitation jet flow velocity, right ventricle/left ventricle diameter ratio, D-sign, McConnell’s sign and deep vein thrombosis findings (p<0.05). When the results of the receiver operating characteristic curve analysis for the power of Wells and Geneva scores, echocardiography, compression ultrasonography and computed tomography findings to diagnose pulmonary embolism were analyzed; the cut-off values calculated for Wells and Geneva scores; the area under curve values calculated for the power of current echocardiography findings of tricuspid regurgitation jet flow velocity, right ventricle/left ventricle diameter ratio, D-sign, McConnell’s sign findings and computed tomography right ventricle/left ventricle diameter ratio findings to diagnose pulmonary embolism were found to be statistically significant (p<0.05). Conclusion: The results of our study showed that in patients diagnosed with pulmonary embolism, echocardiography is easily available and can help diagnose pulmonary embolism by showing right ventricular dysfunction. The results suggest that bedside echocardiography may help emergency physicians to make faster decisions in pulmonary embolism by increasing the provider's index of suspicion.