Diagnóstico por imagem do tromboembolismo pulmonar agudo

Abstract

The diagnosis of acute pulmonary thromboembolism is based on clinical probability, use of D-dimer (when available) and imaging. The main imaging modalities used in the diagnosis are ventilation-perfusion (V/Q), pulmonary angiography, and computed tomography (CT). In the last decade several studies have demonstrated that spiral CT has a high sensitivity and specificity in the diagnosis of acute pulmonary thromboembolism. The evaluation of the pulmonary arteries has further improved with the recent introduction of multidetector spiral CT scanners. Several groups of investigators have suggested that contrast enhanced spiral should replace scintigraphy in the assessment of patients whose symptoms are suggestive of acute PE. This article discusses the role of the various imaging modalities in the diagnosis of acute pulmonary thromboembolism with emphasis on spiral CT.

Trombose venosa profunda e suspeita de tromboembolismo pulmonar: avaliação simultânea por meio de angiotomografia pulmonar e venotomografia combinadas

“…Esse fato, somado ao grau de suspeita clínica de TEP, fez com que o resultado fosse considerado definitivo, sem necessidade de complementação. Pacientes com exames de TC de má qualidade e negativos para TEP, mas com elevada suspeita clínica, devem ser submetidos à angiografia pulmonar (31) . O protocolo incluindo cortes tomográficos até os joelhos também foi muito útil nesses casos, pois o afastamento da hipótese de TVP falava a favor de um diagnóstico negativo, enquanto a constatação de um trombo venoso no abdome ou membro inferior tornava o diag-nóstico automaticamente positivo, independente de a visualização de trombos pulmonares ter sido prejudicada ou não.…”

Uma realidade

“…Silva et al 5 present a concise review of diagnosis of acute PTE through imaging, with an emphasis on the role of helical computed tomographic angiography. Since the publication of the first article by Remy-Jardim et al 6 , this technique ascended rapidly and sharply to be, initially, a means of diagnostic confirmation and, later, a means of ruling out acute PTE.…”

Characterization of the outcome of CT angiography for pulmonary thromboembolism depending on age group and gender

“…Angiotomography for the diagnosis of pulmonary thromboembolism (TEP) has replaced, in most cases, angiography of pulmonary vessels and pulmonary ventilation and perfusion scintigraphy, mainly because it is less invasive and cheaper, in addition to having a diagnostic capacity similar to others methods [3,4].…”