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

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

Alten Oskay, Cihangir Çelik, Kývanç Karaman, Hamit Hakan Armaðan, Önder Tomruk
Department of Emergency Medicine, Süleyman 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

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Pulmoner Emboli Tanýsý Hala Bir Ýkilem mi? Hangi Skorlama Sistemi Bizi Tanýya Götürür?: Olgu Sunumu

Alten Oskay, Cihangir Çelik, Kývanç Karaman, Hamit Hakan Armaðan, Önder Tomruk
Süleyman Demirel Üniversitesi Týp Fakültesi, Acil Týp Ana Bilim Dalý, Isparta, Türkiye

Pulmoner emboli (PE) tanýsýný kolaylaþtýrmak, hastalarýn acil servisten güvenle taburculuðunu saðlayabilmek, hastalarý iyonizan radyasyon ve opak maddelerin komplikasyonlarýndan koruyabilmek için çeþitli skorlama sistemleri kullanýlmaktadýr. Altmýþ altý yaþýnda aktif erkek hasta acil servise geçirmiþ olduðu senkop nedeniyle getirildi. Hasta batýcý tarzdaki göðüs aðrýsýndan, hemoptizi ve hafif bir retrosternal sýkýntý hissinden þikayetçiydi. Vital bulgularýnda hipoksemisi (SpO2=88%) mevcuttu. D-dimer deðeri 165ng/mL (normal sýnýrlar: 69-243) olarak saptandý. PE olasýlýðý 2 kategorili Wells’te düþük, D-dimer negatifliði ile birlikte deðerlendirilen rGeneva skorlama sistemlerinde %2 olarak öngörülmesine ve YEARS skalasýnda tamamen dýþlanmasýna raðmen hastaya pulmoner bilgisayarlý tomografi anjiografi çekildi. Her iki ana pulmoner arterde pulmoner emboli saptandý. Sýklýkla kullanýlan skorlama sistemlerinin tedavi gerektiren PE’yi tanýmakta yetersiz kalabildikleri görülmektedir. Klinik algýnýn üstün olduðu bazý noktalar hala vardýr.

Anahtar Kelimeler: Acil servis, D-dimer, Klinik olasýlýk, Klinik skorlama sistemleri, Pulmoner emboli

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Image Slices of the Case

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