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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hemos querido conocer nuestra prevalencia de tromboembolismo pulmonar agudo &#40;TEP&#41;&#44; as&#237; como establecer la confianza diagn&#243;stica de la gammagraf&#237;a pulmonar &#40;GG&#41; y la influencia del contexto cl&#237;nico &#40;<span class="elsevierStyleSmallCaps">CC</span>&#41;&#46; Para ello hemos realizado un estudio prospectivo durante 2 a&#241;os&#44; exigiendo para el diagn&#243;stico la arteriograf&#237;a pulmonar o la GG de perfusi&#243;n normal&#46; Sobre un total de 97 pacientes&#44; 73 &#40;75&#37;&#41; han sido diagnosticados de TEP&#46; En el grupo de 58 pacientes con GG de ventilaci&#243;n&#47;perfusi&#243;n &#40;<span class="elsevierStyleSmallCaps">V</span>&#47;Q&#41; 33 casos ten&#237;an un test de &#8220;alta probabilidad&#8221;&#44; de ellos 32 con TEP &#40;sensibilidad 88&#37;&#44; especificidad 94&#37;&#41;&#46; Si combinamos la GG de <span class="elsevierStyleSmallCaps">V</span>&#47;Q de &#8220;alta probabilidad&#8221; con un CC de &#8220;alta sospecha&#8221; obtenemos una sensibilidad del 51&#37; y una especificidad del 100&#37;&#46; Hay un grupo de pacientes &#40;28&#41; con m&#225;s edad y con mayor grado de disnea y taquipnea que no fueron capaces de realizar la GG de ventilaci&#243;n&#46; De los 21 pacientes con GG de &#8220;alta probabilidad&#8221;&#44; 19 casos ten&#237;an TEP &#40;sensibilidad 86&#37;&#44; especificidad 85&#37;&#41;&#46; Si combinamos el test GG de &#8220;alta probabilidad&#8221; con un CC de &#8220;alta sospecha&#8221; tenemos una sensibilidad del 32&#37; y una especificidad del 100&#37;&#46; La GG de perfusi&#243;n normal excluye el TEP cl&#237;nicamente relevante&#46; Los resultados GG de &#8220;intermedia o baja&#8221; probabilidad&#44; incluso si lo combinamos con el CC&#44; no tienen validez diagn&#243;stica&#46;</p></span>"
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Journal Information
Vol. 30. Issue 8.
Pages 381-384 (October 1994)
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Vol. 30. Issue 8.
Pages 381-384 (October 1994)
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Diagnóstico gammagráfico del tromboembolismo pulmonar agudo
Scintigraphic evaluation for diagnosis of acule pulmonary thromboembolism
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A. Capelastegui, M. Oribe1, C. Esteban
Servicio de Neumología. Hospital de Galdakao. Vizcaya
V. Llorens*, J.L. Miguélez**, A. Marco**
* Servicio de Medicina Nuclear. Hospital de Cruces. Vizcaya
** Servicio de Radiodiagnóstico. Hospital de Galdakao. Vizcaya
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Hemos querido conocer nuestra prevalencia de tromboembolismo pulmonar agudo (TEP), así como establecer la confianza diagnóstica de la gammagrafía pulmonar (GG) y la influencia del contexto clínico (CC). Para ello hemos realizado un estudio prospectivo durante 2 años, exigiendo para el diagnóstico la arteriografía pulmonar o la GG de perfusión normal. Sobre un total de 97 pacientes, 73 (75%) han sido diagnosticados de TEP. En el grupo de 58 pacientes con GG de ventilación/perfusión (V/Q) 33 casos tenían un test de “alta probabilidad”, de ellos 32 con TEP (sensibilidad 88%, especificidad 94%). Si combinamos la GG de V/Q de “alta probabilidad” con un CC de “alta sospecha” obtenemos una sensibilidad del 51% y una especificidad del 100%. Hay un grupo de pacientes (28) con más edad y con mayor grado de disnea y taquipnea que no fueron capaces de realizar la GG de ventilación. De los 21 pacientes con GG de “alta probabilidad”, 19 casos tenían TEP (sensibilidad 86%, especificidad 85%). Si combinamos el test GG de “alta probabilidad” con un CC de “alta sospecha” tenemos una sensibilidad del 32% y una especificidad del 100%. La GG de perfusión normal excluye el TEP clínicamente relevante. Los resultados GG de “intermedia o baja” probabilidad, incluso si lo combinamos con el CC, no tienen validez diagnóstica.

We aimed to determine the prevalence of acute pulmonary embolism (APE) in our population and to establish the diagnostic reliability of pulmonary scintigraphy (PS), as well as the influence of the clinical context (CC). During a 2-year prospective study, patients were diagnosed by either pulmonary angiography or normal-perfusion PS. A diagnosis of APE was made in 73 (75%) of a total of 97 patients. In the group of 58 patients diagnosed by ventilation/perfusion (V/Q) PS, 33 were classified as “highly probably” having APE; 32 of these in fací had the syndrome (sensitivity 88%, specificity 94%). Combining the “highly probable” patients with the “highly suspected” patients diagnosed by ventilation/perfusion PS, we obtained a sensitivity of 51% and specificity of 100%. Ventilation scintigrams were unobtainable in 28 older patients with greater dyspnea and tachypnea, who were unable to perform the maneuvers. Of the 21 “highly probable” patients as assessed by PS, 19 were diagnosed as having APE (sensitivity 86%, specificity 85%). Combining the “highly probable” patients with the “highly suspected” group, we obtained a sensitivity of 32% and specificity of 100%. Normal perfusion PS exeludes clinically relevant APE. “Intermedíate” or “slight” probability PS results, even when combined with CC, have no diagnostic validity.

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Copyright © 1994. Sociedad Española de Neumología y Cirugía Torácica
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