Comparative evaluation of imaging methods used in the emergency diagnosis of pulmonary embolism

Introduction and Aim: Pulmonary embolism is a disease that can be life-threatening when misdiagnosed. In this study, we examined the methods that allow effective diagnosis of pulmonary embolism in emergency departments, we aimed to accelerate the diagnosis of patients, and contribute to decrease the mortality rates of patients in the future. Materials and Methods: In this prospective and cross-sectional study, patients aged 18 years and over who were suspected pulmonary embolism at the Emergency Department of Çukurova University Faculty of Medicine between February 1, 2019 and February 27, 2021 were included. Demographic data, medical history, laboratory findings, electrocardiogram and chest radiograph findings were evaluated. Bedside focused cardiac ultrasonography and venous compression ultrasonography were performed in all patients. The incidence of respiratory system disease was found to be lower in those with embolism (p = 0.011). Findings: Sixty patients were included in the study and pulmonary embolism was detected in 38 (63.3%) of these patients. Of the patients, 32 (53.3%) were male, 28 (46.7%) were female, 54 (90%) had chronic disease. It was observed that the Wells score of 5 (8.3%) patients was low, 41 (68.3%) had moderate, and 14 (23.3%) patients had a high risk. In patients with pulmonary embolism normal inferior vena cava volume was found to be higher (p<0.05) and right dilatation was higher (p<0.001). The presence of right dilatation was more common in pulmonary embolism patients with moderate risk according to Wells (p=0.003). It was found that lactate level did not contribute to the diagnosis of pulmonary embolism (p=0.247). Elevated white blood cell count was found to be significantly higher in pulmonary embolism patients (p=0.037). While it was observed that discharge rates were lower in patients with the presence of embolism (p=0.001), the frequency of admission to intensive care was higher (p=0.029). Three patients were diagnosed with SARS-COV-2 disease and embolism was detected in all of these patients. Conclusion: Detection of right ventricular dilatation in focused cardiac ultrasonography, patients with complaints such as dyspnea and chest pain, makes a significant contribution to the diagnosis when evaluated alone or with Wells score. Elevated D-dimer and white blood cell count, absence of atelectasis is important for diagnosing of pulmonary embolism in the emergency department. Keywords: FOCUS, Lactate, Pulmonary Embolism, Wells scoring