Diagnostic imaging of pulmonary embolism using endobronchial ultrasound

Pathway and application value of exploration of the pulmonary artery by endobronchial ultrasound

Background

The current standard methods for detecting pulmonary artery diseases are pulmonary artery enhanced computed tomography (CT) scan and pulmonary arteriography. However, some patients cannot tolerate these procedures for various reasons. The present study aimed to investigate the feasibility and operation process of endobronchial ultrasound (EBUS) in exploring the pulmonary artery.

Methods

Based on normal contrast-enhanced chest CT images, the sites and process for exploring the pulmonary arteries were established. Then the feasibility of the exploration by the convex probe EBUS were evaluated, and roadmaps for exploration of the pulmonary arteries were drawn.

Results

Among patients who underwent pulmonary artery exploration, sonograms of the left and right pulmonary artery were obtained by the convex probe EBUS. The above-mentioned pulmonary artery branches can be positioned by means of anatomical markers under the bronchoscopic view and follow a certain route for continuous exploration. Sonograms had a certain degree of identification and can be used as an auxiliary tool for pulmonary artery exploration.

Conclusions

EBUS can be used to explore the main branches of the pulmonary artery continuously. Therefore, EBUS could be considered as a candidate for the diagnosis of pulmonary artery diseases in a selected group of patients, i.e., patient with contrast allergy or renal failure.

Endobronchial ultrasound: beyond nodes and masses

Pulmonary embolism (PE) is a life‐threatening condition with varied presentation and, therefore, poses clinical challenge for early diagnosis and proper management without which it carries high mortality. Previous studies on the role of endobronchial ultrasound (EBUS) in diagnosis of PE were carried out after PE was already diagnosed by computed tomography pulmonary angiography. We report a case of massive PE with shock, promptly diagnosed with bed side EBUS – Doppler study, as patient's clinical condition did not allow conventionally proposed diagnostic algorithm.

Endobronchial ultrasound-guided transbronchial needle aspiration of pulmonary artery tumors: A systematic review (with video)

Convex probe endobronchial ultrasound (CP-EBUS) was originally introduced as a diagnostic and staging tool for lung cancer and subsequently utilized for diagnosis of other malignant and benign mediastinal diseases such as melanoma, lymphoma, and sarcoidosis. More recently, CP-EBUS has been successfully used for the visualization and diagnosis of pulmonary emboli and other vascular lesions including primary and metastatic pulmonary artery (PA) tumors. In this review, we will underline the role of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of pulmonary arterial tumors such as sarcomas and tumor emboli. We will concisely discuss the clinical applications of EBUS-TBNA and the types of pulmonary arterial tumors and their different diagnostic modalities. We searched the Cochrane Library and PubMed from 2004 to 2014 to provide the most comprehensive review. Only 10 cases of EBUS-TBNA for intravascular lesions were identified in the literature. Although many cases of EBUS and EUS-guided transvascular tumor biopsies were described in the literature, there were no reported cases of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for intravascular tumor biopsies. Except for one paper, all cases were published as case reports.

Role of Transthoracic Lung Ultrasonography in the Diagnosis of Pulmonary Embolism: A Systematic Review and Meta-Analysis

Background

Pulmonary embolism (PE) is a potentially life-threatening condition. Although computed tomography pulmonary angiography (CTPA) is the reference standard for diagnosis, its early diagnosis remains a challenge, and the concerns about the radiation exposures further limit the general use of CTPA. The primary aim of this meta-analysis was to evaluate the overall diagnostic accuracy of transthoracic lung ultrasound (TLS) in the diagnosis of PE.

Methods

PubMed, Web of science, OvidSP, ProQuest, EBSCO, Cochrane Library and Clinicaltrial.gov were searched systematically. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and hierarchical summary receiver operating characteristic (HSROC) curves were used to examine the TS performance. The Bayes analysis was used to calculate the post-test probability of PE. Publication bias was assessed with Deeks funnel plot.

Results

The results indicated that the sensitivity, specificity, PLR and NLR were 0.85 (95% confidence interval (CI), 0.78 to 0.90), and 0.83 (95% CI, 0.73 to 0.90). And the DOR and HSROC were 28.82 (95% CI, 17.60 to 47.21), 0.91(95% CI, 0.88, 0.93).

Conclusions

The present meta-analysis suggested that transthoracic lung ultrasonography is helpful in diagnosing pulmonary embolism. Although the application of transthoracic lung ultrasound may change some patients’ diagnostic processes, it is inappropriate to generally use transthoracic ultrasonography in diagnosing pulmonary embolism currently.