Diagnostic accuracy of focused deep venous, lung, cardiac, and multiorgan ultrasound in suspected pulmonary embolism: a systematic review and meta-analysis

Background: Suspected pulmonary embolism is a frequent cause of referral to emergency departments. Computed tomography angiography is considered the diagnostic gold standard, but exposes the patient to radiation and is complicated or impossible in cases of severe hemodynamic instability, renal failure or allergy to contrast media.Aims: We aimed to review the existing literature on feasibility of point-of-care ultrasonography as a diagnostic alternative.Methods: We conducted a systematic review by searching MEDLINE, Embase, CINAHL, and Cochrane library for studies assessing diagnostic accuracy of deep venous, lung or cardiac ultrasound in suspected pulmonary embolism. Meta-analysis of reported accuracy was performed by construction of hierarchical summary receiver operator curves.Results: Seventy studies on a total of 32 unique ultrasonography signs were included. Most notable signs were bilateral compression of femoral and popliteal veins (22 studies; 4,708 patients; sensitivity 0·44 [0·36-0·51]; specificity 0·97 [0·95-0·98]), presence of at least one hypoechoic pleural based lesion (19 studies; 2,134 patients; sensitivity 0·81 [0·73-0·87]; specificity 0·87 [0·81-0·92]), D-sign (13 studies; 1,579 patients; sensitivity 0·30 [0·25-0·35]; specificity 0·96 [0·93-0·98]), visible right ventricular thrombus (5 studies; 995 patients; sensitivity 0·05 [0·03-0·08]; specificity 1·00 [0·99-1·00], and McConnell’s sign (11 studies; 1,480 patients; sensitivity 0·29 [0·20-0·40]; specificity 0·99 [0·97-0·99]).Conclusions: Several ultrasonography signs exhibit a high specificity for pulmonary embolism and may improve the selection of patients for radiation imaging.FootnotesCite this article as: European Respiratory Journal 2021; 58: Suppl. 65, OA4347.This abstract was presented at the 2021 ERS International Congress, in session “Prediction of exacerbations in patients with COPD”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).