RESUMEN
Pulmonary computed tomography angiography (PCTA) is the initial imaging test for the diagnosis of pulmonary thromboembolism (PTE). In the study, it was aimed to determine the clinical, radiological findings in patients diagnosed PTE by PCTA, to investigate the relationship between the thrombus localisation and the clinical, laboratory parameters. 172 patients diagnosed PTE by PCTA between 2004 and 2007 were included in the study. The clinical, laboratory parameters, thrombus localisation were evaluated. Mean age (female/male: 99/73) was 58.27 +/- 15.11, mean Wells score was 2.99 +/- 2.40. 39.5% (n= 68) of patients had low risk, 50.6% (n= 87) intermediate, 9.9% (n= 17) high risk. The most common comorbidities were cardiovascular diseases (n= 46, 26.7%), COPD (n= 26,15%). Recent operation history (n= 47, 27.3%), immobilisation (n= 37, 21.5%) were the most frequent risk factors. Dyspnea (89%), chest pain (59.9%) were the most common complaints. Deep venous thrombosis was detected by Doppler USG in 56.4% of patients. The most common site of thrombus was the right lower lobe artery (44.2%). In 30% of patients, the most proximal level of thrombus was the main pulmonary arteries (MPA). Mean age of patients with MPA thrombus (61.96 +/- 14.47), was higher than patients with distal thrombus (56.62 +/- 15.16, p= 0.03). Patients with the recent operation history (41% vs. 21%, p= 0.009), cancer (24% vs. 2.5%, p< 0.001) had higher rates of MPA thrombus. In patients presented with syncope,16.9% of them had a MPA thrombus compared to others having 3.3% rate of other thrombus localisations (p= 0.004). Mean Wells score in patients with MPA thrombus was higher compared to others (3.59 +/- 2.38/2.72 +/- 2.37, p= 0.02), however it didn't differ the extent of proximal thrombus between low, intermediate and high risk patients. The mean level of D-dimer was not different between patients with MPA thrombus and the others. D-dimer level was significantly higher in patients with thrombus localized at truncus pulmonalis (1357 microg/mL vs. 724 microg/mL). There was no significant difference between Doppler USG positive and negative patients for DVT. In conclusion, it was determined that the thrombus was at MPA in one third of the patients, a significant relationship between the presence of the recent operation, cancer history and syncope with MPA thrombus. In patients with a thrombus at truncus pulmonalis, D-dimer levels were higher.
