[Transthoracic sonography in the diagnosis of pulmonary embolism]

In many cases of pulmonary diseases extending up to the pleura, ultrasound helps to identify the etiology of the lesion. There are several sonomorphological criteria to differentiate peripheral pulmonary consolidations. Clinical studies and the sonographic appearance with pathologic correlation showed pulmonary infarctions in location, form and size exactly corresponding with pathological findings. Fresh reperfusable infarcts were homogenous and hypoechoic. Older infarcts were well demarcated, mainly wedge shaped. Triangular pleural based lesions, more roughly structured, were observed with a hyperechoic reflex in the center corresponding to the bronchiole: a sign of segmental involvement. The sensitivity of transthoracic ultrasound in diagnosis of pulmonary embolism was 86 to 94%, the specificity 67 to 87%, positive predictive value 55 to 92%, negative predictive value 91%, accuracy 73 to 91%. In massive central lung embolism, both fresh and old infarctions are found. An imminent larger embolism can be predicted, for instance,in a deep vein thrombosis. With one ultrasound system, we can "kill three birds with one stone": source, way and outcome of pulmonary embolism by bedside examination.