“il percorso diagnostico dell’embolia polmonare” - flow-chart diagnostica -
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Dipartimento Misto di Specialità Mediche e Chirurgiche (Dir.: Prof. A. Albertazzi). “IL PERCORSO DIAGNOSTICO DELL’EMBOLIA POLMONARE” - flow-chart diagnostica -. Prof. Stefano Petruzzelli Sezione di Malattie dell’Apparato Respiratorio (Dir.: Prof. L.M. Fabbri). - PowerPoint PPT PresentationTRANSCRIPT
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“IL PERCORSO DIAGNOSTICO DELL’EMBOLIA POLMONARE”- flow-chart diagnostica -
Dipartimento Misto di Specialità Mediche e Chirurgiche
(Dir.: Prof. A. Albertazzi)
Prof. Stefano PetruzzelliSezione di Malattie dell’Apparato Respiratorio
(Dir.: Prof. L.M. Fabbri)
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Fedullo PF, Tapson VF. The Evaluation of Suspected Pulmonary Embolism. N Engl J Med 2003; 349: 1247-1256
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Fedullo PF, Tapson VF. The Evaluation of Suspected Pulmonary Embolism. N Engl J Med 2003; 349: 1247-1256
![Page 4: “IL PERCORSO DIAGNOSTICO DELL’EMBOLIA POLMONARE” - flow-chart diagnostica -](https://reader030.vdocuments.net/reader030/viewer/2022033018/56814efd550346895dbc8bd1/html5/thumbnails/4.jpg)
Fedullo PF, Tapson VF. The Evaluation of Suspected Pulmonary Embolism. N Engl J Med 2003; 349: 1247-1256
![Page 5: “IL PERCORSO DIAGNOSTICO DELL’EMBOLIA POLMONARE” - flow-chart diagnostica -](https://reader030.vdocuments.net/reader030/viewer/2022033018/56814efd550346895dbc8bd1/html5/thumbnails/5.jpg)
Fedullo PF, Tapson VF. The Evaluation of Suspected Pulmonary Embolism. N Engl J Med 2003; 349: 1247-1256
![Page 6: “IL PERCORSO DIAGNOSTICO DELL’EMBOLIA POLMONARE” - flow-chart diagnostica -](https://reader030.vdocuments.net/reader030/viewer/2022033018/56814efd550346895dbc8bd1/html5/thumbnails/6.jpg)
British Thoracic Society guidelines for the management ofsuspected acute pulmonary embolism. Thorax 2003; 58:470-484
Blood D-dimer assay should only be considered following assessment of clinical probability (B)
A negative D-dimer test reliably excludes PE in patients with low clinical probability (B)
CTPA is now the recommended initial lung imaging modality for non-massive PE (B)
Patients with a good quality negative CTPA do not require further investigation or treatment for PE (A)
Isotope lung scanning may be considered as the initial imaging investigation providing (a) facilities are available on site, and (b) chest radiograph is normal, and (c) there is no significant concurrent cardiopulmonary disease, and (d) standardised report criteria are used, and (e) a non-diagnostic result is always followed by further imaging (B)
In patients with coexisting clinical DVT, leg ultrasound as the initial imaging test is often sufficient to confirm VTE (B)
CTPA or echocardiography will reliably diagnose clinically massive PE (B)
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Calcolo della probabilità di TEP (Miniati M et Al. Am J Respir Crit Care Med 1999; 159: 864-871)
Almeno uno di tre sintomi pertinenti (dispnea, dolore,
deliquio) non altrimenti spiegabili
associato ad almeno uno dei tre segni radiografici
(amputazione dell’arteria polmonare discendente,
oligoemia, consolidamento parenchimale suggestivo di
infarto polmonare)
in presenza o assenza di segni elettrocardiografici di
sovraccarico ventricolare destro acuto.
Alta (circa 90 %)
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Almeno uno di tre sintomi pertinenti (dispnea, dolore,
deliquio) non altrimenti spiegabili
non associato a segni radiografici (amputazione dell’ arteria
polmonare discendente, oligoemia, consolidamento
parenchimale suggestivo di infarto polmonare)
o associato solamente a segni elettrocardiografici di
sovraccarico ventricolare destro acuto.
Intermedia (circa 50 %)
Calcolo della probabilità di TEP (Miniati M et Al. Am J Respir Crit Care Med 1999; 159: 864-871)
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Assenza dei tre sintomi pertinenti (dispnea, dolore,
deliquio) o identificazione di una condizione clinica
alternativa che possa giustificarne la presenza
(esacerbazione di BPCO, edema polmonare, pleurite,
pneumotorace, ischemia miocardica, pericardite … )
Bassa (circa 10 %)
Calcolo della probabilità di TEP (Miniati M et Al. Am J Respir Crit Care Med 1999; 159: 864-871)
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ESC Task Force on Pulmonary Embolism(Eur J Cardiol 2000; 21: 1301-1336)
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Commissione ANMCO-SIC per EP(Ital Heart J Suppl 2001; 2: 1342-1356)
no trattamento
APGAPG pos.
APG neg.
trattamento
no trattamento
TC SPIRALE
non compatibile compatibile
trattamento
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Commissione ANMCO-SIC per EP(Ital Heart J Suppl 2001; 2: 1342-1356)
PLS o TC o APG
compatibile
trattamento
ECOCARDIOGRAMMA
compatibile non compatibileo
non probativo
PLS o TC o APG
altradiagnosi
trattamento
specifico