Introduction:
Life threatening central pulmonary embolism (PE) is defined as thrombotic occlusion of the main pulmonary trunk or of main or lobar pulmonary artery. These vessels accompany the trachea, the main and lobar bronchi at a distance of less than 5 mm. Chest CT enhanced with iv contrast (Angio-CT) has become the gold standard to evaluate suspected, central PE. Here we report imaging of central PE using real-time endobronchial ultrasound (rtEBUS).
Hypothesis:
rtEBUS is equivalent to Angio-CT in diagnosing central PE.
Methods:
In 20 consecutive patients we compared the visualization of central PE by rtEBUS versus Angio-CT using an Olympus ultrasonic bronchoscope BFUC 160F.
Results:
PE was discovered fortuitously via rtEBUS in 7 patients, who were submitted for rtEBUS for hilar and mediastinal lymph nodes in staging of lung cancer. In all 7 patients PE was verified by Angio-CT. In 12 patients with primary documented PE by Angio-CT we were able to visualize all central pulmonary emboli by rtEBUS. Two additional patients were explored for PE by rtEBUS as initial diagnostic procedure because of massive obesity and renal failure. The first diagnosis was confirmed by autopsy, the second by Angio-CT after 4 days with normalized renal function. In all patients we could visualize the pulmonary trunk, both main pulmonary arteries and the lobar arteries at a length of 10 mm by rtEBUS. Duration of the rtEBUS procedure was 5 +/-2 minutes. There were no rtEBUS related complications. All central PE were confirmed by Angio-CT, demonstrating a valid congruence.
Conclusions:
This is the first study to demonstrate that rtEBUS of central pulmonary arteries is a reliable and safe tool for the diagnosis of central PE. Especially in patients with renal impairment, anaphylaxis to intravenous contrast, pregnancy, cardiogenic shock or signs of acute right ventricular failure rt EBUS may be a valuable alternative to Angio-CT.
Multiple Bilateral Lobar Pulmonary Emboli Diagnosed With Endobronchial Ultrasound in an Asymptomatic Patient