Pulmoner Emboli Tan�s� Hala Bir �kilem mi? Hangi Skorlama Sistemi Bizi Tan�ya G�t�r�r?: Olgu Sunumu

Oskay, Alten; �elik, Cihangir; Karaman, K�van�; Arma�an, Hamit Hakan; Tomruk, �nder

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Pulmoner Emboli Tan�s� Hala Bir �kilem mi? Hangi Skorlama Sistemi Bizi Tan�ya G�t�r�r?: Olgu Sunumu [Respir Case Rep]

Respir Case Rep. 2019; 8(1): 17-20 | DOI: 10.5505/respircase.2019.35762

Pulmoner Emboli Tan�s� Hala Bir �kilem mi? Hangi Skorlama Sistemi Bizi Tan�ya G�t�r�r?: Olgu Sunumu

Alten Oskay, Cihangir �elik, K�van� Karaman, Hamit Hakan Arma�an, �nder Tomruk
S�leyman Demirel �niversitesi T�p Fak�ltesi, Acil T�p Ana Bilim Dal�, Isparta, T�rkiye

Pulmoner emboli (PE) tan�s�n� kolayla�t�rmak, hastalar�n acil servisten g�venle taburculu�unu sa�layabilmek, hastalar� iyonizan radyasyon ve opak maddelerin komplikasyonlar�ndan koruyabilmek i�in �e�itli skorlama sistemleri kullan�lmaktad�r. Altm�� alt� ya��nda aktif erkek hasta acil servise ge�irmi� oldu�u senkop nedeniyle getirildi. Hasta bat�c� tarzdaki g��s a�r�s�ndan, hemoptizi ve hafif bir retrosternal s�k�nt� hissinden �ikayet�iydi. Vital bulgular�nda hipoksemisi (SpO2=88%) mevcuttu. D-dimer de�eri 165ng/mL (normal s�n�rlar: 69-243) olarak saptand�. PE olas�l�� 2 kategorili Wells�te d��k, D-dimer negatifli�i ile birlikte de�erlendirilen rGeneva skorlama sistemlerinde %2 olarak �ng�r�lmesine ve YEARS skalas�nda tamamen d��lanmas�na ra�men hastaya pulmoner bilgisayarl� tomografi anjiografi �ekildi. Her iki ana pulmoner arterde pulmoner emboli saptand�. S�kl�kla kullan�lan skorlama sistemlerinin tedavi gerektiren PE�yi tan�makta yetersiz kalabildikleri g�r�lmektedir. Klinik alg�n�n �st�n oldu�u baz� noktalar hala vard�r.

Anahtar Kelimeler: Acil servis, D-dimer, Klinik olas�l�k, Klinik skorlama sistemleri, Pulmoner emboli

Is the Diagnosis of Pulmonary Embolism Using Scoring Systems Still a Dilemma?: A Case Report

Alten Oskay, Cihangir �elik, K�van� Karaman, Hamit Hakan Arma�an, �nder Tomruk
Department of Emergency Medicine, S�leyman Demirel University, Isparta, Turkey

Various scoring systems are used to facilitate the diagnosis of pulmonary embolism (PE), provide for the safe discharge of patients from emergency departments (EDs), and protect patients from complications caused by ionizing radiation and iodinated contrast media. A 66-year-old active male patient was brought to the ED due to syncope. He complained of a stinging type of chest pain, hemoptysis, and a mild feeling of retrosternal distress. He had hypoxemia (SpO2=88%). The D-dimer level determined was 165ng/mL (normal range: 69�243 ng/mL). He was evaluated to be at low risk using the Wells Criteria, to have a 2% probability of PE according to the Geneva scoring system when viewed in combination with D-dimer negativity, and PE was excluded using the YEARS algorithm. However, computerized tomography pulmonary angiography revealed PE in 2 main pulmonary arteries. The common scoring systems may fail to recognize PE, which requires treatment. Clinical perception may still be superior.

Keywords: Clinical probability, D-dimer, Diagnostic algorithms, Emergency department, Pulmonary embolism

Olgunun G�r�nt� Kesitleri

Sorumlu Yazar: Alten Oskay, T�rkiye
Makale Dili: �ngilizce

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