PURPOSE: Pulmonary thromboembolism (PTE) remains under-diagnosed fatal disease at the emergency units suggesting the need for alternative, easy, noninvasive bedside diagnostic approaches. The aim of this study was to determine the diagnostic role of transthoracic ultrasonography (TUS) in PTE, and to evaluate if there is any additive diagnostic value of Color Doppler over gray-scale TUS.

METHODS: Blinded to 64 multi-detectors CT pulmonary angiography (MDCTPA) examination as a gold standard, 60 patients with clinically suspected PTE underwent gray-scale and Color Doppler TUS examination. Results were compared and diagnostic accuracy of TUS was assessed

RESULTS: In 33 patients out of 40 MDCTPA proved cases of PTE, TUS demonstrated 66 lesions with mean (SD) 2±1.20 lesions /patient. For Gray-scale TUS, sensitivity, specificity, positive and negative predictive values and accuracy were 82%, 90%, 94%, 72% and 85%, meanwhile color Doppler TUS had values of 80%, 95%, 97%, 70.4% and 87.5%, respectively.

CONCLUSIONS: TUS is a reliable screening technique for diagnosing PTE with high specificity but relatively low sensitivity. Adding Color Doppler to Gray-scale TUS increases the specificity and consequently the confidence in the diagnosis of peripheral pulmonary infarctions and differentiates them from other pulmonary lesions.

CLINICAL IMPLICATIONS: TUS, in trained hands, has high specificity and diagnostic accuracy allowing its use as bedside screening method in emergency-based situations, especially for critically ill and immobile patients that allows initiation of anticoagulants.