Diagnostic validity of ultrasonography in evaluation of pulmonary thromboembolism


1 Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Pharmacology, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Diagnosis of pulmonary embolism (PE) remains difficult due to its nonspecific symptoms and signs. Therefore, many patients die undiagnosed or untreated. We decided to study the sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of pulmonary thromboembolism.
Materials and Methods: In this prospective study, 77 patients with clinically suspected PE in the emergency department of Isfahan Al-Zahra Hospital were enrolled from September 2011 to September 2012. At first, they were evaluated by thoracic ultrasonography (TUS) and then divided into four groups based on their TUS findings. Multi-slice computed tomography (MSCT) was the reference method in this study performed within 24 h from admission. MSCT scans were interpreted by a radiologist who was unaware of the TUS results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPVs) of thoracic ultrasonography were determined.
Results: PE diagnosis was confirmed by MSCT in 25 patients and 54 hypoechoic lesions were detected by TUS with the average size of 16.4 mm × 11.1 mm. In our study, sensitivity, specificity, PPV, NPV, and accuracy of TUS for PE diagnosis were 84%, 94.2%, 87.5%, and 92.5%, respectively.
Conclusion: TUS is an inexpensive, safe and easily available method for timely diagnosis and treatment of PE in emergency department and its NPV is high for cases with low scores for Wells criteria who had a normal or possible TUS findings. It is also specific in the diagnosis of PE in cases with high scores Wells criteria who have confirmed or probable TUS findings.


Mathis G, Blank W, Reissig A, Lechleitner P, Reuss J, Schuler A, et al. Thoracic ultrasound for diagnosing pulmonary embolism: A prospective multicenter study of 352 patients. Chest 2005;128:1531-8.  Back to cited text no. 1
Hoffmann B, Gullett JP. Bedside transthoracic sonography in suspected pulmonary embolism: A new tool for emergency physicians. Acad Emerg Med 2010;17:e88-93.  Back to cited text no. 2
Reissig A, Kroegel C. Transthoracic ultrasound of lung and pleura in the diagnosis of pulmonary embolism: A novel non-invasive bedside approach. Respiration 2003;70:441-52.  Back to cited text no. 3
Reissig A, Heyne JP, Kroegel C. Sonography of lung and pleura in pulmonary embolism: Sonomorphologic characterization and comparison with spiral CT scanning. Chest 2001;120:1977-83.  Back to cited text no. 4
Pfeil A, Reissig A, Heyne JP, Wolf G, Kaiser WA, Kroegel C, et al. Transthoracic sonography in comparison to multislice computed tomography in detection of peripheral pulmonary embolism. Lung 2010;188:43-50.  Back to cited text no. 5
Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3 rd . Trends in the incidence of deep vein thrombosis and pulmonary embolism: A 25-year population-based study. Arch Intern Med 1998;158:585-93.  Back to cited text no. 6
PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990;263:2753-9.  Back to cited text no. 7
Wittram C. How I do it: CT pulmonary angiography. AJR Am J Roentgenol 2007;188:1255-61.  Back to cited text no. 8
Goodman LR, Curtin JJ, Mewissen MW, Foley WD, Lipchik RJ, Crain MR, et al. Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: Helical CT versus angiography. AJR Am J Roentgenol 1995;164:1369-74.  Back to cited text no. 9
Patel S, Kazerooni EA, Cascade PN. Pulmonary embolism: Optimization of small pulmonary artery visualization at multi-detector row CT. Radiology 2003;227:455-60.  Back to cited text no. 10
Mayo JR. Radiation dose issues in longitudinal studies involving computed tomography. Proc Am Thorac Soc 2008;5:934-9.  Back to cited text no. 11
Leonard DM, Joyner CR, Dxmck SJ, Eskin DJ. Clinical use of ultrasound in the early diagnosis of pulmonary embolism. Ann Surg 1967;166:381-92.  Back to cited text no. 12
Mastruzzo C, Perracchio G, Poidomani G, Romano M, Crimi N, Vancheri C. Subsegmental pulmonary embolism: Value of thoracic ultrasound for diagnosis and follow-up. Intern Med 2008;47:1415-7.  Back to cited text no. 13
Beckh S, Bölcskei PL, Lessnau KD. Real-time chest ultrasonography: A comprehensive review for the pulmonologist. Chest 2002;122:1759-73.  Back to cited text no. 14
Mathis G, Metzler J, Fussenegger D, Sutterlütti G, Feurstein M, Fritzsche H. Sonographic observation of pulmonary infarction and early infarctions by pulmonary embolism. Eur Heart J 1993;14:804-8.  Back to cited text no. 15
Parlamento S, Copetti R, Di Bartolomeo S. Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med 2009; 27:379-84.  Back to cited text no. 16
Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med 2005;12:844-9.  Back to cited text no. 17
Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE protocol. Chest 2008; 134:117-25.  Back to cited text no. 18
Reissig A, Copetti R, Kroegel C. Current role of emergency ultrasound of the chest. Crit Care Med 2011;39:839-45.  Back to cited text no. 19
Judith E. Tintinalli, J. Stephan Stapczynski: Tintinalli's Emergency Medicine 7 th ed. China: McGraw-Hill; 2011. p. 434.  Back to cited text no. 20
evda Sener Comert and others, "The Role of Thoracic Ultrasonography in the Diagnosis of Pulmonary Embolism.," Ann Thorac Med 2013;8:99-104.  Back to cited text no. 21