Materiały źródłowe

• #1 Pulmonary Embolism: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17400-pulmonary-embolism

  A pulmonary embolism (PE) is a blood clot in one of the blood vessels in your lung. This happens when a clot in another part of your body (often your leg or arm) moves through your veins to your lung. A PE restricts blood flow to your lungs, lowers oxygen levels in your lungs and increases blood pressure in your pulmonary arteries. […] This condition is a medical emergency. Without quick treatment, a pulmonary embolism can cause heart or lung damage and even death. About 33% of people with a pulmonary embolism die before they get a diagnosis and treatment. […] After looking at your symptoms and risk factors, a provider will use the following tests to make a PE diagnosis: Blood tests (including the D-dimer test). Computed tomography (CT) angiogram. Ultrasound of your leg. (This helps identify blood clots in peoples legs, or deep vein thrombosis, which can move to the lungs, become a PE and cause more damage.) A VQ scan, if youre unable to get contrast for a CT scan. (This is a nuclear scan that can detect clots in your lung.) A pulse oximeter (pulse ox) that attaches to your fingertip to check your oxygen level. Echocardiogram.

• #2 Pulmonary embolism – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647

  A pulmonary embolism (PE) occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of the lung. […] A pulmonary embolism is a blood clot that blocks and stops blood flow to an artery in the lung. […] Because one or more clots block blood flow to the lungs, pulmonary embolism can be life-threatening. However, prompt treatment greatly reduces the risk of death. […] A pulmonary embolism can be life-threatening. Seek urgent medical attention if you experience unexplained shortness of breath, chest pain or fainting. […] A pulmonary embolism occurs when a clump of material, most often a blood clot, gets stuck in an artery in the lungs, blocking the flow of blood. […] In many cases, multiple clots are involved. […] A pulmonary embolism can be life-threatening. About one-third of people with an undiagnosed and untreated pulmonary embolism don’t survive. When the condition is diagnosed and treated promptly, however, that number drops dramatically.

• #3 Pulmonary embolism diagnosis part 1: clinical assessment at the front door | Emergency Medicine Journal

  https://emj.bmj.com/content/39/12/945

  This first of two practice reviews addresses pulmonary embolism (PE) diagnosis considering important aspects of PE clinical presentation and comparing evidence-based PE testing strategies. […] Symptoms and signs of PE are varied, and emergency physicians frequently use testing to rule out the diagnosis in people with respiratory or cardiovascular symptoms. […] The emergency clinician must balance the benefit of reassuring negative PE testing with the risks of iatrogenic harms from over investigation and overdiagnosis.

• #4 Pulmonary Embolism Symptoms and Diagnosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/pulmonary-embolism/symptoms-diagnosis

  The signs and symptoms of pulmonary embolism vary greatly depending on the size of the clot, how much of the lung is involved and whether you have an underlying medical condition. […] Because pulmonary embolism can be difficult to diagnose, it is important to consult your healthcare provider immediately if you are experiencing symptoms. They will probably do a physical exam and ask about your personal history, including any potential risk factors. […] Your healthcare provider may also do blood tests and imaging studies to determine the most likely diagnosis to fit with your symptoms. […] Common tests that may be ordered are: CTPA or a computed tomographic angiography is a special type of X-ray that is the most common test used to diagnose PE because it uses contrast to analyze blood vessels.

• #4 Pulmonary Embolism Symptoms and Diagnosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/pulmonary-embolism/symptoms-diagnosis

  Pulmonary V/Q scan to show which parts of your lungs are getting airflow and blood flow. […] D-Dimer blood tests to detect clot formation in your blood. […] Chest X-ray of your heart and lungs to rule out other conditions with similar symptoms. […] Ultrasound of the legs to measure blood flow and assess for clots in the veins. […] Pulmonary angiography to show the blood clots in the lungs. […] Electrocardiogram to record heart activity. […] Echocardiogram to measure heart function and assess for elevated pressure in the pulmonary arteries. […] MRI is usually reserved for pregnant people and individuals that may not be able to tolerate the contrast used in other imaging tests.

• #5 Pulmonary embolism – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/diagnosis-treatment/drc-20354653

  MRI is a medical imaging technique that uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in your body. […] During the physical exam, your health care provider will likely examine your legs for evidence of a deep vein clot an area that’s swollen, tender, red and warm. Your provider will also listen to your heart and lungs, check your blood pressure and likely order one or more tests.

• #5 Pulmonary embolism – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/diagnosis-treatment/drc-20354653

  A pulmonary embolism can be difficult to diagnose, especially if you have underlying heart or lung disease. […] Your health care provider will likely discuss your medical history, do a physical exam, and order tests that may include one or more of the following. […] Your health care provider may order a blood test for the clot-dissolving substance D dimer. High levels may suggest an increased likelihood of blood clots, although many other factors can cause high D dimer levels. […] Blood tests also can measure the amount of oxygen and carbon dioxide in your blood. A clot in a blood vessel in your lungs may lower the level of oxygen in your blood. […] In addition, blood tests may be done to determine whether you have an inherited clotting disorder. […] This noninvasive test shows images of your heart and lungs on film. Although X-rays can’t diagnose a pulmonary embolism and may even appear fine when a pulmonary embolism exists, they can rule out other conditions with similar symptoms.

• #6 Acute Pulmonary Embolism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560551/

  Acute pulmonary embolism (PE) occurs when a blood clot that has arisen from another area obstructs the pulmonary arteries. […] Diagnosis combines clinical probability scoring systems like the Wells and Geneva criteria with tests such as D-dimer levels, CT pulmonary angiography, and ultrasound. […] Despite advancements in diagnostic tools and treatment options, the nonspecific symptoms of PE (eg, dyspnea, chest pain, and syncope) often overlap with other cardiovascular and respiratory conditions, making timely diagnosis challenging for clinicians. […] Risk stratification tools such as the Wells criteria and Geneva score, alongside diagnostic imaging, are essential for accurate diagnosis. […] The diagnosis of an acute PE comprises various laboratory and imaging studies in conjunction with clinical probability scoring systems, such as the Wells and Geneva criteria.

• #6 Acute Pulmonary Embolism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560551/

  Unexplained hypoxemia with a normal chest radiograph should raise clinical suspicion for PE. […] D-dimer levels are elevated in plasma whenever an acute thrombotic process occurs in the body because the coagulation and fibrinolysis pathways are activated simultaneously. […] Multidetector computed tomographic pulmonary angiography (CTPA) is the diagnostic modality of choice for patients with suspected PE. […] The PIOPED (Prospective Investigation On Pulmonary Embolism Diagnosis) II study showed a sensitivity of 83% and a specificity of 96% for CTPA in PE diagnosis. […] The diagnosis of PE on echocardiography is supported by the presence of a clot in the right heart or new right heart strain, especially in hemodynamically unstable patients with suspected PE. […] Compression ultrasound has a 90% sensitivity and a specificity of about 95% for proximal symptomatic DVT. […] Wells criteria and Geneva score are scoring systems most commonly used to estimate the pretest probability of having a PE.

• #7 Pulmonary Embolism: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/pulmonary-embolism-pro

  Important information […] Pulmonary embolism (PE) is a medical emergency. It may present with very few clinical signs and/or symptoms, making it easy to miss, and a high index of suspicion is warranted. […] […] If a patient presents with signs or symptoms of PE, carry out an assessment of their general medical history, a physical examination and CXR to exclude other causes. […] If clinical suspicion for PE is low, use the pulmonary embolus rule-out criteria to determine if further investigation of PE is indicated. […] If PE is suspected, use the two-level PE Wells’ score to estimate the clinical probability of PE. […] Offer patients in whom PE is suspected and with a likely two-level PE Wells’ score (more than 4 points) an immediate computerised tomography pulmonary angiogram (CTPA).

• #7 Pulmonary Embolism: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/pulmonary-embolism-pro

  If a CTPA cannot be carried out immediately or is contra-indicated, offer immediate interim parenteral anticoagulant therapy followed by a CTPA. […] Consider a proximal leg vein ultrasound scan if the CTPA is negative and DVT is suspected. If the scan is negative consider alternative diagnoses but ensure the person is aware of the signs and symptoms of PE and that they should seek immediate medical help if these develop. […] Offer patients in whom PE is suspected and with a two-level PE Wells’ score less than 4 points a D-dimer test with the result available within four hours if possible. If the result is not available within four hours, offer interim therapeutic anticoagulation. […] If the result is positive, offer either an immediate CTPA or immediate interim parenteral anticoagulant therapy followed by a CTPA, if a CTPA cannot be carried out immediately.

• #8 Diagnosis of pulmonary embolism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC140429/

  Clinical assessment is considered here within the framework of diagnostic tests that influence the probability of pulmonary embolism. […] Approaches to clinical assessment of pulmonary embolism have fallen into 2 categories: (1) empirical (nonstandardized) and, more recently, (2) standardized clinical models or prediction rules. […] The prevalence of pulmonary embolism in each of these clinical probability categories, established by pulmonary angiography in patients with abnormal perfusion scans, was 15%, 38% and 79% in the McMaster study and 9%, 30% and 68% in the PIOPED study. […] More recently, using mostly noninvasive tests as the criterion standard, Perrier and colleagues recorded prevalences of pulmonary embolism of 8%, 36% and 67% based on empirical clinical assessment. […] Three research groups have recently published explicit prediction rules for determining the clinical probability of pulmonary embolism.

• #8 Diagnosis of pulmonary embolism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC140429/

  NO SINGLE NONINVASIVE TEST for pulmonary embolism is both sensitive and specific. Some tests are good for ruling in pulmonary embolism (e.g., helical CT) and some tests are good for ruling out pulmonary embolism (e.g., D-dimer); others are able to do both but are often nondiagnostic (e.g., ventilation-perfusion lung scanning). […] For optimal efficiency, choice of the initial diagnostic test should be guided by clinical assessment of the probability of pulmonary embolism and by patient characteristics that may influence test accuracy. […] Objective testing for pulmonary embolism is crucial, because clinical assessment alone is unreliable and the consequences of misdiagnosis are serious. […] Failure to diagnose pulmonary embolism is associated with high mortality, and incorrect diagnosis of the condition unnecessarily exposes patients to the risks of anticoagulant therapy.

• #9 Pulmonary embolism | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pulmonary-embolism?lang=us

  Pulmonary embolism (PE) refers to partial or complete embolic occlusion of one or more pulmonary arteries, most commonly due to thrombus. […] Clinical decision rules, in conjunction with physician gestalt and estimated pretest probability of disease, may serve as a supplement in risk stratification: […] Wells score […] Geneva score […] PERC rule (to rule out PE) […] YEARS criteria. […] D-dimer (ELISA) is commonly used as a screening test in patients with a low and moderate probability clinical assessment, in these patients: normal D-dimer has almost 100% negative predictive value (virtually excludes PE): no further testing is required. […] raised D-dimer is seen with PE but has many other causes and is, therefore, non-specific: it indicates the need for further testing if pulmonary embolism is suspected.

• #10 Pulmonary embolism – Wikipedia

  https://en.wikipedia.org/wiki/Pulmonary_embolism

  Blockage of an artery in the lungs Medical condition […] Diagnostic method Based on symptoms, D-dimer, CT pulmonary angiography, lung ventilation/perfusion scan […] Diagnosis is based on signs and symptoms in combination with test results. […] If the risk is low, a blood test known as a D-dimer may rule out the condition. […] Otherwise, a CT pulmonary angiography, lung ventilation/perfusion scan, or ultrasound of the legs may confirm the diagnosis. […] To diagnose a pulmonary embolism, a review of clinical criteria to determine the need for testing is recommended. […] In those who have low risk, age less than 50, heart rate less than 100 beats per minute, oxygen level more than 94% on room air, and no leg swelling, coughing up of blood, surgery or trauma in the last four weeks, previous blood clots, or estrogen use, further testing is not typically needed.

• #10 Pulmonary embolism – Wikipedia

  https://en.wikipedia.org/wiki/Pulmonary_embolism

  In situations with more high-risk individuals, further testing is needed. A CT pulmonary angiogram (CTPA) is the preferred method for the diagnosis of a pulmonary embolism due to its easy administration and accuracy. […] The diagnosis of PE is based primarily on validated clinical criteria combined with selective testing because the typical clinical presentation (shortness of breath, chest pain) cannot be definitively differentiated from other causes of chest pain and shortness of breath. […] The most commonly used method to predict clinical probability, the Wells score, is a clinical prediction rule, whose use is complicated by multiple versions being available. […] There are additional prediction rules for PE, such as the Geneva rule. […] In people with a low or moderate suspicion of PE, a normal D-dimer level (shown in a blood test) is enough to exclude the possibility of thrombotic PE, with a three-month risk of thromboembolic events being 0.14%. […] D-dimer is highly sensitive but not specific (specificity around 50%). […] CT pulmonary angiography is the recommended first-line diagnostic imaging test for most people.

• #11 Diagnosis of pulmonary embolism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC140429/

  A simplified version of their original model yielded a prevalence of pulmonary embolism of 2% in low-probability (40% of patients), 19% in intermediate-probability (52% of patients) and 50% in high-probability (8% of patients) categories. […] This clinical model has been prospectively validated by its use, in conjunction with other tests, to manage outpatients with suspected pulmonary embolism successfully. […] The combination of a low clinical probability and a negative moderately sensitive D-dimer assay (sensitivity 85%) has a negative predictive value for pulmonary embolism of about 99%. […] The combination of a nondiagnostic lung scan (i.e., an abnormal lung scan result lower than high probability) and a normal moderately sensitive D-dimer assay has been estimated to have a negative predictive value of about 97%.

• #12 Pulmonary Embolism: Diagnosis and Treatments | Carda Health

  https://www.cardahealth.com/post/pulmonary-embolism-diagnosis

  Additionally, blood tests can tell a provider how much oxygen and carbon dioxide reside in a patients blood, in which case a drop in blood oxygen levels could indicate a pulmonary embolism. […] In addition to blood tests, the following imaging tests can be helpful in identifying a pulmonary embolism: A computed tomography (CT) lung scan or pulmonary angiography (CTPA). […] A pulmonary embolism is a treatable condition. […] Treatment usually involves prevention: preventing the blood clot from growing as well as preventing any new blood clots from developing. […] A surgical procedure to remove the clot or to filter the vein is one treatment option for pulmonary embolism. […] A more popular approach to pulmonary embolism treatment is medication, usually in the form of an anti-coagulation medication (also called a blood thinner).

• #13 Pulmonary Embolism Diagnosis and Imaging | BackTable

  https://www.backtable.com/shows/vi/articles/pulmonary-embolism-diagnosis-imaging

  Additionally, it further divides cases into the subclassifications of intermediate high risk and intermediate low risk according to whether there are RV dysfunction and biomarkers, or RV dilation and biomarkers. […] The main ones are BNP and troponin. […] When the BNP is elevated but the troponin is not, you have to start thinking more about a subacute PE. […] When they’re both elevated, you know they are a particularly higher risk acute PE patient. […] The CT scan is also used for measuring RV/LV ratio. […] He prefers to use echocardiograms to determine right heart systolic pressure and pulmonary hypertension in follow-up care.

• #14 Pulmonary Embolism (PE): Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/300901-overview

  Evidence-based literature supports the practice of using clinical scoring systems to determine the clinical probability of pulmonary embolism before proceeding with testing. Validated clinical prediction rules should be used to estimate pretest probability of pulmonary embolism. The use of a diagnostic algorithm based on a clinical decision rule, consisting of medical history and physical examination findings, combined with D-dimer testing is recommended in patients with clinically suspected PE to exclude the disease and thereby reduce the need for CT scans. […] Clinical signs and symptoms for pulmonary embolism are nonspecific; therefore, patients suspected of having pulmonary embolism because of unexplained dyspnea, tachypnea, or chest pain or the presence of risk factors for pulmonary embolism must undergo diagnostic tests until the diagnosis is ascertained or eliminated or an alternative diagnosis is confirmed. Further, routine laboratory findings are nonspecific and are not helpful in pulmonary embolism, although they may suggest another diagnosis. Pulmonary angiography historically was the criterion standard for the diagnosis of pulmonary embolism, but with the improved sensitivity and specificity of CT angiography, it is now rarely performed.

• #14 Pulmonary Embolism (PE): Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/300901-overview

  Immediate full anticoagulation is mandatory for all patients suspected to have DVT or pulmonary embolism. Diagnostic investigations should not delay empirical anticoagulant therapy. Long-term anticoagulation is critical to the prevention of recurrence of DVT or pulmonary embolism. The general consensus is that a significant reduction in recurrence is associated with 3-6 months of anticoagulation.

• #15 Pulmonary embolism – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000115

  Pulmonary embolism (PE) is a life-threatening condition resulting from dislodged thrombi occluding the pulmonary vasculature; right heart failure and cardiac arrest may ensue if not aggressively treated. […] Clinical probability, assessed by a validated prediction rule and clinical judgement, is the basis for all diagnostic strategies for PE. Computed tomographic pulmonary angiography is the definitive diagnostic investigation. […] Key diagnostic factors include dyspnoea, chest pain, signs of concurrent deep vein thrombosis (DVT), risk factors, hypoxaemia, failure to meet Pulmonary Embolism Rule-out Criteria (the PERC rule), positive Wells (or Geneva) score, and signs of haemodynamic instability or severely reduced haemodynamic reserve. […] 1st investigations to order include computed tomographic pulmonary angiography (CTPA), echocardiography, D-dimer, full blood count, ECG, urea and electrolytes, coagulation studies, and liver function tests. […] Emerging tests include biomarkers, point-of-care D-dimer testing, D-dimer adjusted to clinical probability, and magnetic resonance angiography (MRA).

• #16 Testing and Diagnosis for Venous Thromboembolism | Venous Thromboembolism (Blood Clots) | CDC

  https://www.cdc.gov/blood-clots/testing-diagnosis/index.html

  Your doctor must perform special tests to diagnose deep vein thrombosis (DVT) and pulmonary embolism (PE). […] Therefore, special tests that can look for clots in the veins or in the lungs (imaging tests) are needed to diagnose DVT or PE. […] The following tests are available for PE: […] Computed tomographic pulmonary angiography (CTPA) is a special type of X-ray test that includes injection of contrast material (dye) into a vein. This test can provide images of the blood vessels in the lungs. It is the standard imaging test to diagnose PE. […] Pulmonary angiography is a special type of X-ray test that requires insertion of a large catheter (a long, thin hollow tube) into a large vein (usually in the groin) and into the arteries within the lung, followed by injection of contrast material (dye) through the catheter. It provides images of the blood vessels in the lung and it is the most accurate test to diagnose PE.

• #17 Pulmonary Embolism Diagnosis: How Doctors Diagnose PE

  https://www.webmd.com/lung/doctors-diagnose-pulmonary-embolism

  If you think you have a pulmonary embolism (PE), you should get medical help right away. […] Your doctor will likely start with a physical exam. Theyll look closely at your legs to see if theyre swollen, tender, discolored, or warm. These are signs that you may have a clot deep in one of your veins. […] Next, your doctor may order a number of tests, like a chest X-ray or ultrasound. You might also have blood tests. These can measure the amount of oxygen and carbon dioxide in your blood. They can also help your doctor detect a substance called D dimer. This is a small protein fragment thats present in the blood after a clot is broken down by the body. […] Other tests your doctor might order include: […] Computed tomographic pulmonary angiography (CTPA). This is a special type of X-ray test. Its also the main one doctors use to see if you have a PE. Your doctor will inject dye (contrast) into your veins. Theyll be able to see the blood vessels in your lungs on the X-ray.

• #17 Pulmonary Embolism Diagnosis: How Doctors Diagnose PE

  https://www.webmd.com/lung/doctors-diagnose-pulmonary-embolism

  Ventilation/perfusion (V/Q) scan. This test is used if the CTPA isnt available, or isnt a good match for you. It uses a radioactive material to show which parts of your lungs are getting air flow (ventilation) and blood flow (perfusion). If theres low blood flow to a certain area, but the air flow is normal, a clot may be present. […] Catheter-based pulmonary angiography. This is the most accurate test to detect PE. It may be used if other tests havent shown clear results. A specialist inserts a long, thin tube (catheter) into a large vein in your groin and into the arteries within your lung. They then inject dye through the catheter. Images of the blood vessels inside the lung will pop up on an X-ray. This is now only very rarely used because of CTPA. […] MRI. This may be a good option if youre pregnant or your doctor is concerned that other tests that use contrast might be harmful to you. […] Echocardiogram. This is an ultrasound of the heart. It cant detect a PE, but it does show if you have strain on your heart caused by one.

• #17 Pulmonary Embolism Diagnosis: How Doctors Diagnose PE

  https://www.webmd.com/lung/doctors-diagnose-pulmonary-embolism

• #18 Imaging of acute pulmonary embolism: an update – Moore – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/17831/html

  CTPA is the imaging modality of choice for the workup of patients with suspected acute PE and is a crucial component in commonly used clinical diagnostic algorithms. […] CTPA has high sensitivity and specificity, with PIOPED II trial demonstrating sensitivity of 83% and specificity of 96%. […] The sensitivity and specificity of VQ scanning was 85% and 93%, respectively using PIOPED II criteria and 80% and 97% using PISAPED criteria, which is close to the diagnostic accuracy of CTPA. […] The major limitation of MRPA in this trial was the large proportion of technically inadequate results and the investigators indicate that MRPA should be considered only in well-experienced facilities and only for patients with contraindications to standard tests. […] Echocardiography has limited sensitivity and specificity for diagnosis of acute PE. A negative echocardiogram cannot exclude a diagnosis of PE, and similarly positive findings can be secondary to cardiorespiratory disease in the absence of PE. […] CPA was the reference standard for the diagnosis of PE in PIOPED I and PIOPED II trials. However, it is an invasive procedure and has limited role for PE diagnosis in the modern era of multi-detector CT.

• #18 Imaging of acute pulmonary embolism: an update – Moore – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/17831/html

  Imaging plays an important role in the evaluation and management of acute pulmonary embolism (PE). Computed tomography (CT) pulmonary angiography (CTPA) is the current standard of care and provides accurate diagnosis with rapid turnaround time. […] While multi-detector computed tomography (CT) pulmonary angiography (CTPA) is the most commonly used modality in the workup of suspected PE, it is not the only available modality and may not always be the most appropriate study despite its commonality. […] Multiple imaging modalities are available in the evaluation of acute PE. This includes chest radiographs, CTPA, CT venography (CTV), magnetic resonance (MR) pulmonary angiography (MRPA), nuclear medicine ventilation/perfusion scan, venous ultrasound, echocardiography, and catheter pulmonary angiography.

• #19 Pulmonary Embolism (PE) – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/pulmonary-embolism/pulmonary-embolism-pe

  The sensitivity of CT angiography is highest for pulmonary embolism in the main pulmonary artery or lobar or segmental vessels. Sensitivity of CT angiography is lowest for emboli in subsegmental vessels (about 30% of all pulmonary emboli). However, CT angiography is still the preferred means of diagnosing acute PE if there are no contraindications. […] There is no universally accepted algorithm for the approach to suspected acute pulmonary embolism. Tests most useful for diagnosing or excluding PE are D-dimer testing, CT angiography, ventilation/perfusion scanning, and Doppler ultrasound.

• #19 Pulmonary Embolism (PE) – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/pulmonary-embolism/pulmonary-embolism-pe

  Diagnosis of pulmonary embolism is most commonly accomplished with CT angiography, although ventilation perfusion scanning is sometimes required. […] The diagnosis of pulmonary embolism is challenging because symptoms and signs are nonspecific and diagnostic tests are not 100% sensitive and specific. […] Initial evaluation should include pulse oximetry and chest radiograph. […] The chest radiograph usually is nonspecific but may show atelectasis, focal infiltrates, an elevated hemidiaphragm, or a pleural effusion. […] Clinical probability of pulmonary embolism can be assessed by combining ECG and chest radiograph findings with findings from the history and physical examination. […] The diagnosis of pulmonary embolism is challenging because symptoms and signs are nonspecific and diagnostic tests are not 100% sensitive and specific.

• #20 Detection of Pulmonary Embolism | CDA-AMC

  https://www.cda-amc.ca/detection-pulmonary-embolism

  Imaging of PE allows for the mapping of blood flow in the lungs. The procedure allows for detection of the perfusion defect caused by the clot (embolus) but not the embolus itself. Treatment is typically with anticoagulant therapy with fractionated heparin, low-molecular-weight heparin, or warfarin. […] The basic principle of V/Q scanning is to recognize lung segments or sub-segments without perfusion but preserved ventilation; i.e., mismatch between the amount of air and blood reaching the gas exchange units in the lung. A V/Q scan is a combination of two nuclear tests that involve administration of inhaled and intravenous radioisotopes to measure ventilation and perfusion in all areas of the lungs. The tests can be performed simultaneously or separately. A ventilation study is performed after inhalation of tracers such as xenon-133 (133mXe) gas, krypton (81mKr), or technetium-99m(99mTc)-labelled aerosols of diethylenetriamine pentaacetic acid (99mTc-DTPA) or 99mTc-labelled carbon microparticles (99mTc-technegas). Perfusion studies are performed after intravenous injection of 99mTc-labelled macroaggregated albumin (99mTc-MAA) particles. A gamma camera acquires images of the lungs and pulmonary vessels. Any mismatches i.e., regions with normal ventilation image and a visible defect on the perfusion image should be considered as a site of potential PE.

• #20 Detection of Pulmonary Embolism | CDA-AMC

  https://www.cda-amc.ca/detection-pulmonary-embolism

  The mortality rate of undiagnosed and untreated PE is 30%. However, a timely diagnosis and adequate treatment can reduce the mortality rate to 2% to 8%. Diagnostic imaging test results can have significant impact on mortality. Undiagnosed and untreated PE may lead to disabling morbidity from pulmonary hypertension and right ventricular failure, and predispose patients to recurrent venous thromboembolism. […] Patients suspected of having PE should be promptly evaluated using appropriate diagnostic tests and receive anticoagulant therapy if the diagnosis is confirmed. According to the Saskatchewan hospital guidelines, V/Q lung scan or CT scan should be performed within the first 24 hours in patients with suspected acute PE.

• #21 Diagnosis of pulmonary embolism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC140429/

  When individual tests are nondiagnostic, it may be possible to combine their results to confirm or exclude pulmonary embolism. […] The clinical assessment of pulmonary embolism is complementary to ventilation-perfusion lung scanning. […] A high-probability lung scan with a moderate or high clinical probability of pulmonary embolism is diagnostic (prevalence of pulmonary embolism of 90%). […] Pulmonary angiography is the criterion standard for the diagnosis of pulmonary embolism, but it is associated with serious side effects, is technically demanding to perform, may be difficult to interpret and is costly. […] Transthoracic or transesophageal echocardiography may directly visualize embolized thrombi or show right heart hemodynamic changes that indirectly suggest pulmonary embolism.

• #22 Diagnosis of Pulmonary Embolism | SpringerLink

  https://link.springer.com/chapter/10.1007/88-470-0350-4_14

  Pulmonary embolism (PE) is a relevant clinical occurrence. Despite advances in diagnostic modalities, PE remains a commonly under diagnosed and lethal disease. […] The diagnostic gold standard is pulmonary angiography, against which other imaging modalities have been historically evaluated. Pulmonary angiography is an invasive and expensive procedure, with limited availability and potentially serious complications. […] Despite being the gold standard, pulmonary angiograms are not infallible. A patient with a normal pulmonary angiogram can still expect a 2.2% (95%CI, 0.3 to 8.0%) venous thromboembolic event rate at the one-year follow-up.

• #23 Pulmonary Embolism (PE): Causes, symptoms, diagnosis, treatment

  https://ecgwaves.com/topic/pulmonary-embolism-causes-risk-factors-diagnosis-wells-score-treatment/

  Acute pulmonary embolism is diagnosed when CTPA shows complete or partial filling defects in the pulmonary arteries. Partial filling defects can be centrally or peripherally located within the artery and will be surrounded by contrast. […] Lung scintigraphy is performed if CTPA is inappropriate due to pregnancy, contrast allergy or renal failure. Scintigraphy is time-consuming and requires low doses of radioactive markers. Pulmonary perfusion is compared with pulmonary ventilation and any regional discordance, referred to as mismatch, in ventilation and perfusion is suggestive of pulmonary embolism. […] Echocardiography is recommended to visualize indirect signs of pulmonary embolism and right ventricular strain. The following echocardiographic findings suggest acute pulmonary embolism: Increased tricuspid regurgitation (TI), Increased PASP (systolic PA pressure), Dilated vena cava inferior, with loss of respiratory variation, Right ventricular dilatation, Paradoxical septal movement. […] Pulmonary angiography is performed in selected cases, especially if endovascular therapy is feasible. […] Magnetic resonance imaging has high sensitivity and specificity and can be performed if the diagnosis is unclear or if other modalities are not feasible.

• #24 Diagnosing Pulmonary Embolism (PE) | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/pulmonary-embolism/diagnosis.html

  Other tests […] D-dimer. This blood test measures a substance that is released when a blood clot breaks up. D-dimer levels are usually high in people with pulmonary embolism. […] CT (computed tomography) scan or CT angiogram. These tests might be done to look for pulmonary embolism or for a blood clot that may cause it. […] Magnetic resonance imaging (MRI). This test may be used to view clots in the lungs. […] Doppler ultrasound. This test uses reflected sound waves to look for a blood clot in the large veins of the legs. […] Echocardiogram (echo). It finds abnormalities in the size or function of the heart’s right ventricle, which may be a sign of pulmonary embolism. […] Ventilation-perfusion scanning. This test scans for abnormal blood flow through the lungs after a radioactive tracer has been injected and you breathe a radioactive gas. […] Pulmonary angiogram. This invasive test is done only in rare cases to diagnose pulmonary embolism.

• #24 Diagnosing Pulmonary Embolism (PE) | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/pulmonary-embolism/diagnosis.html

  How is pulmonary embolism diagnosed? […] It may be hard to diagnose pulmonary embolism. That’s because the symptoms are like those of many other problems, such as a heart attack, panic attack, or pneumonia. […] A doctor will do a physical exam and ask questions about your past health and your symptoms. This helps the doctor decide if you are at high risk for pulmonary embolism. […] Based on your risk, you might have tests to look for blood clots or rule out other causes of your symptoms. […] Tests that are often done if you have shortness of breath or chest pain […] A chest X-ray. Results may rule out an enlarged heart or pneumonia as a cause of your symptoms. If the chest X-ray is normal, you may need other tests. […] Electrocardiogram (EKG, ECG). The electrical activity of the heart is recorded with this test. EKG results will help rule out a possible heart attack.

• #25 Pulmonary embolism diagnosis & treatment of low-risk PE – EMCrit Project

  https://emcrit.org/ibcc/pulmonary-embolism/

  Pulmonary embolism may cause nearly any pulmonary symptom other than purulent sputum production (e.g., dyspnea, cough, hemoptysis, fever, wheeze, chest pain). Thus, listing every potential symptom may simply cause bewilderment. It’s more helpful to consider a few constellations of symptoms that should be recognizable: […] D-dimer is very sensitive for acute PE/DVT (~98% sensitive). […] If D-dimer is negative and index of suspicion for PE is low or moderate, this generally is sufficient to exclude PE. […] Arterial blood gas lacks adequate sensitivity or specificity for the diagnosis of pulmonary embolism. […] DVT ultrasound has a sensitivity of ~40% for detecting lower extremity thrombus among patients with PE. […] CT angiography is generally the definitive test of choice. […] The testing threshold is the likelihood of disease above which testing is beneficial. In the case of pulmonary embolism, the test threshold is 2%.

• #26 British Journal of Nursing – The diagnosis and management of pulmonary embolism

  https://www.britishjournalofnursing.com/content/clinical/the-diagnosis-and-management-of-pulmonary-embolism/

  In the authors’ experience, patients often present with non-specific symptoms, which makes diagnosis of a PE difficult. In addition, the assessment and diagnosis of PE can vary across specialties and clinicians. […] Advanced clinical practitioners (ACPs) are often faced with ruling out a diagnosis of PE in patients with non-specific symptoms such as dyspnoea and pleuritic chest pain, which can be fairly mild, and therefore a diagnosis of PE easily missed. […] Pulmonary embolism can be a challenge to diagnose, especially in elderly people, since it can be difficult to differentiate their symptoms from other less serious illnesses.

• #27 How is PE Diagnosed? – Blood Clots

  https://www.stoptheclot.org/learn_more/signs-and-symptoms-of-blood-clots/how_is_pe_diagnosed/

  A pulmonary embolism can be difficult to diagnose, especially if pre-existing conditions are present. […] For that reason, your healthcare provider will likely discuss your medical history, do a physical exam, and order tests that may include one or more of the following: […] Often, the first test performed when PE is suspected is a blood oxygen level. […] A more precise measurement of blood oxygen level is obtained from a sample taken directly from an artery with a needle or a thin tube (catheter). […] A chest x-ray cannot prove that PE is present or absent because clots do not show up on x-ray. […] A VQ lung scan may be a useful test to determine whether a person has experienced PE. […] If the VQ scan interpretation is low, intermediate, or uncertain probability of PE, or if the spiral CT is normal yet the symptoms are still suspicious, then the definitive test is a pulmonary angiogram. […] An echocardiogram is an ultrasound of the heart. […] While an echocardiogram is not actually used to diagnose a PE, it can identify strain on the right side of the heart caused by a large PE as well as certain heart problems that may imitate a PE.

• #28 Diagnosis of pulmonary embolism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC140429/

  Echocardiography shows indirect evidence of pulmonary embolism in about 80% of patients with massive embolism. […] In conjunction with clinical assessment and the results of other noninvasive tests, echocardiography may enable pulmonary embolism to be diagnosed, or anticoagulants to be withheld, in severely ill patients, at least until it becomes feasible to perform additional testing.

• #29 Diagnosis of Pulmonary Embolism | IntechOpen

  https://www.intechopen.com/chapters/79256

  PE diagnosis is accomplished with the help of multiple imaging studies, of which chest computed tomography (CT) is the one used frequently. […] Clinical predictive rules for acute PE include Wells criteria, revised Geneva score, Pisa model, PERC (PE rule-out criteria), and Charlotte rule. […] Most diagnostic algorithms for acute PE use either CTPA or V/Q scintigraphy as a first test. […] The imaging modality of choice to exclude acute PE in suspected patients is CTPA. […] CTPA sensitivity is 83%, specificity is 96%, with an NPV of 97% plus a PPV of 86% in suspected patients. […] A clinical trial PIOPED III evaluated a magnetic resonance angiogram for PE diagnosis.

• #30 Role of MRI in diagnosis of pulmonary embolism | The Egyptian Journal of Bronchology | Full Text

  https://ejb.springeropen.com/articles/10.1186/s43168-023-00212-7

  Non-contrast pulmonary MRA has a high sensitivity and specificity in the diagnosis of PE, especially in proximal pulmonary arteries. So, it can be used as an alternative to the CTA and CE-MRA, especially when the CTA and the use of gadolinium are contraindicated. […] Using either CTPA as gold standard techniques or contrast-enhanced MRA as a potential alternative and effective diagnostic technique to CTPA for primary PE diagnosis. The overall sensitivity of non-contrast MRA in detection of PE in this study was 84%, specificity 100%, and accuracy 90%. […] The per-vessel results in our study, including sensitivity, specificity and accuracy were as follow: for central arteries (trunk and main) and lobar arteries, they were 100% for each parameter, for segmental vessels 88%, 100%, and 94% were encountered and for sub segmental vessels 34.6%, 100%, and 66% were noticed respectively. […] The low sensitivity for PE detection at the subsegmental level in our study is attributed to bad image resolution of MRI at the subsegmental branches in comparison to the CT due to breathing motion artifacts.

• #31 Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1115/p913.html

  Pulmonary angiography is needed only when the clinical suspicion for pulmonary embolism remains high, even when less invasive study results are negative. […] To provide prompt and accurate diagnosis, clinical prediction rules and diagnostic algorithms have been developed for VTE. […] The American Academy of Family Physicians and the American College of Physicians developed a joint guideline on the diagnosis and management of VTE, and the European Society of Cardiology has developed diagnosis and management guidelines for acute pulmonary embolism. […] A common approach is to use a validated prediction rule for risk stratification, screen with d-dimer assay as appropriate, and if necessary, perform the appropriate imaging studies to confirm or exclude VTE. […] This article reviews the diagnosis of pulmonary embolism and DVT.

• #31 Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/1115/p913.html

  In patients with intermediate to high pretest probability of VTE, a d-dimer assay should not be performed initially because a negative result cannot safely exclude the diagnosis of VTE. […] The initial evaluation of patients with suspected pulmonary embolism includes chest radiography, electrocardiography, pulse oximetry, and blood gases. […] However, they are necessary to evaluate for other causes of the presenting symptoms, and may assist in raising or lowering the pretest probability of pulmonary embolism. […] In conjunction with these clinical prediction rules, algorithms for VTE diagnosis have been published and modified as new evidence has emerged for various diagnostic strategies and tests. […] Several diagnostic algorithms for pulmonary embolism have been published as well. […] Among the algorithms available, none has been shown to be superior.

• #32 Pulmonary Embolism Diagnosis

  https://fpnotebook.com/Lung/CV/PlmnryEmblsmDgns.htm

  PE mortality has not changed since the late 1990s despite a 10 fold increase in CT Pulmonary Angiography […] Accelerated Diagnostic Protocols can safely reduce unnecessary CT Pulmonary Angiography […] Normalization of Vital Signs does not reduce the probability of acute Pulmonary Embolism […] At least one of three factors are present in 97% of Pulmonary Embolism […] All three symptoms absent nearly excludes Pulmonary Embolism (97% probability) […] Pulmonary Embolism Pretest Probability (Wells Clinical Prediction Rule for PE or Revised Geneva Score) […] Moderate to high probability requires diagnostic testing (typically CT angiogram) […] Low pretest probability may be evaluated with PERC Rule […] Low probability for PE with a negative PERC Rule nearly excludes Pulmonary Embolism (Very low probability)

• #33 Pulmonary embolism: An update

  https://www.racgp.org.au/afp/2017/november/pulmonary-embolism

  Pulmonary embolism is a common condition and can be the source of significant morbidity and mortality. […] This article reviews the approach to the diagnostic assessment and management of patients with suspected pulmonary embolism. […] Various clinical decision rules and algorithms are available to assist in the diagnosis of pulmonary embolism, and the Wells score and Pulmonary Embolism Rule-out Criteria rule are presented in this article. The utility of D-dimer testing and the role of imaging to confirm the diagnosis are also discussed. […] The current solution to this problem is to risk-stratify patients with suspected pulmonary embolism, and to use validated risk stratification tools to guide investigation. There are numerous clinical decision rules, including the Wells score, modified Wells score, simplified Wells score, revised Geneva score, Charlotte rule and Pulmonary Embolism Rule-out Criteria (PERC) rule.

• #33 Pulmonary embolism: An update

  https://www.racgp.org.au/afp/2017/november/pulmonary-embolism

  A Wells score 4 warrants imaging. […] A Wells score 4 makes pulmonary embolism unlikely, but does not fully exclude it. Tests such as D-dimer can add greater certainty to excluding pulmonary embolism as a diagnosis. […] If imaging is required, this should be performed as soon as possible and urgently (via the emergency department) if there are significant cardiac or respiratory signs, such as tachypnoea, hypotension, tachycardia or hypoxia. […] Definitive diagnosis will require CTPA or V/Q scanning. […] Anticoagulation is the mainstay of treatment for pulmonary embolism. […] The ACCP recommends that clinical surveillance is preferred to anticoagulation for patients with SSPE (no involvement of proximal pulmonary arteries) and no proximal DVT with low risk for recurrent VTE.

• #34 Pulmonary Embolism Diagnosis: The 3-Step Process

  https://www.verywellhealth.com/pulmonary-embolism-diagnosis-4163944

  If the probability of a pulmonary embolus in step one is determined to be intermediate, or if the clinical probability of pulmonary embolus is low but the PERC criteria have not been met, the next step is to obtain a D-dimer blood test. […] A D-dimer test can be used only to rule out a pulmonary embolus, not to make the diagnosis. So if the D-dimer test is positive (or if a persons clinical probability of a pulmonary embolus was deemed to be high in step one), it is time for step three. […] Step three involves a diagnostic imaging study. Generally, one of three kinds of tests will be used. […] A computerized tomography (CT) scan is a computerized X-ray technique that allows a healthcare provider to examine the pulmonary arteries for an obstruction caused by a blood clot. […] A CT scan is accurate more than 90% of the time in detecting a pulmonary embolus and is considered to be the test of choice if imaging is required to make the diagnosis.

• #34 Pulmonary Embolism Diagnosis: The 3-Step Process

  https://www.verywellhealth.com/pulmonary-embolism-diagnosis-4163944

  In diagnosing a pulmonary embolus, it is important to rule out other medical diagnoses whose symptoms can be similar to those of a pulmonary embolus. […] Even if one of these other diagnoses is made, it does not necessarily mean that a pulmonary embolus is ruled out, because a person may have two conditions at the same time and many cardiovascular diseases increase the risk of pulmonary embolus.

• #35 Diagnostic Approaches to Possible Pulmonary Embolism | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0901/p844a.html

  The authors provide a diagnostic algorithm for suspected PE that incorporates clinical suspicion, d-dimer level and radiologic testing. […] If the suspicion for PE is low, a normal d-dimer level can exclude the diagnosis. […] If the clinical suspicion is moderate to high, the authors suggest that CT angiography is an appropriate initial diagnostic method. […] When the use of contrast dye is contraindicated, ventilation-perfusion scanning and sonography of the lower extremities are options. […] Pulmonary angiography might be considered if the results of the CT study are inadequate and the suspicion for PE is still high. […] In an unstable patient, bedside echocardiography can be performed initially to look for pulmonary hypertension, a thrombus or other cardiologic conditions (such as pericardial tamponade, valvular disease) to explain the clinical presentation.

• #36 Pulmonary Embolism – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pulmonary-embolism-diagnosis/

  Pulmonary embolism (PE) is a major cause of morbidity and mortality worldwide and requires timely diagnosis and treatment. […] The clinical starting point for the diagnosis of PE in suspected patients is to estimate the likelihood based on clinical features. Presentations are variable so keeping suspicion initially high is important. […] Diagnostic test findings that may suggest PE: ECG – sinus tach, signs of right heart strain (S1Q3T3, T wave inversions V1-3, RBBB). […] Choosing Wisely Canada guidelines recommend risk stratification using a clinical decision rule prior to ordering a CT Pulmonary Angiogram (CTPA) or Ventilation/Perfusion (VQ) scan in patients with suspected PE. […] The first step in selecting a diagnostic approach is to develop a PTP for PE. […] Patients with a lower PTP (<15%) stratified by the application of the Well’s criteria for PE, should be further risk stratified using the Pulmonary Embolus Rule Out Criteria (PERC) rule or with the use of a D-dimer test. [...] A negative PERC score means that the likelihood of PE is < 2%. [...] CTPA – this is the imaging modality of choice in most patients. [...] If there is a high probability for PE based on clinical features then start empiric treatment urgently and order confirmatory testing.

• #37 Pulmonary Embolism (PE) Differential Diagnoses

  https://emedicine.medscape.com/article/300901-differential

  The variability of presentation for pulmonary embolism (PE) sets the patient and clinician up for potentially missing the diagnosis. Such missed diagnoses occur in approximately 400,000 patients in the United States per year; approximately 100,000 deaths could be prevented with proper diagnosis and treatment. […] The diagnostic challenge is that the „classic” presentation of the condition, with abrupt onset of pleuritic chest pain, shortness of breath, and hypoxia, is rarely seen. Studies of patients who died unexpectedly from PE have revealed that the patients complained of nagging symptoms, often for weeks, before dying. Forty percent of these patients had been seen by a physician in the weeks prior to their death. […] The differential diagnoses are extensive, and they should be considered carefully with any patient thought to have pulmonary embolism. These patients also should have an alternative diagnosis confirmed, or pulmonary embolism should be excluded, before discontinuing the workup.

• #38 Diagnosis of Pulmonary Embolism: A Review of Evidence-Based Approaches

  https://www.mdpi.com/2077-0383/13/13/3722

  Diagnosis is key to providing appropriate treatment in a safe and timely fashion. […] The presence of clinical symptoms and provoking risk factors for PE enables patients to be classified into distinct pretest probability categories. […] The Pulmonary Embolism Rule-out Criteria (PERC) rule should be utilized for patients who are considered to have a low probability of PE. […] D-dimer can help to exclude PE in low and intermediate-risk patients. […] The performance of the D-dimer test is significantly influenced by age. […] The presence of various clinical and laboratory features in patients can provide hints for diagnosis and indicate characteristics that can reduce the chances of erroneously ruling out the diagnosis of PE. […] Laboratory testing and imaging may be indicated in patients with intermediate and high risk for PE.

• #39 Diagnosing Pulmonary Embolism | NYU Langone Health

  https://nyulangone.org/conditions/pulmonary-embolism/diagnosis

  NYU Langone doctors can quickly identify pulmonary embolism, a blockage in the lungs that can be life threatening. […] When pulmonary embolism occurs, it requires immediate emergency medical attention. […] During an exam, your doctor may order tests to help determine if you have a pulmonary embolism. […] In a chest X-ray, light beams produce pictures of structures inside the chest. For pulmonary embolism, a chest X-ray may reveal a blockage in the arteries in the lungs. […] Your doctor may use a CT angiograman X-ray scan of the blood vesselsto look for evidence of pulmonary embolism. […] MRI scans use magnetic waves and computers to create two- and three-dimensional pictures of the inside of the body. It is an important tool for diagnosing pulmonary embolism. […] Doctors may use this on the leg to determine if you have deep vein thrombosis, which may be the source of pulmonary embolism.

• #40 Diagnosis and treatment of subsegmental pulmonary embolism

  https://www.wjgnet.com/2218-6255/full/v9/i3/30.htm

  Subsegmental pulmonary embolism (SSPE) affects the 4th division and more distal pulmonary arterial branches. […] Symptoms, clinical risk scores and biomarkers are less sensitive for diagnosing SSPE compared to more central pulmonary embolism. The diagnosis is confirmed using radiological imaging, predominately computed tomographic pulmonary angiogram (CTPA) or ventilation/perfusion scanning. […] There is insufficient evidence of improved mortality or reduced venous thromboembolism recurrence with anticoagulation treatment for SSPE however, the major and clinically significant haemorrhage risks are well described. […] Current guidelines suggest that isolated subsegmental pulmonary embolism (SSPE) patients at low risk of venous thromboembolism (VTE) recurrence and without concurrent proximal VTE can be followed up with clinical surveillance in preference to anticoagulation.

• #41 Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach | Multidisciplinary Respiratory Medicine | Full Text

  https://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-8-75

  A false diagnosis thus exposes patients to unnecessary risk of death from PE or of bleeding which can also be fatal. […] Second, the use of individual diagnostic tests in isolation may lead to mismanagement of suspected PE. […] For these reasons, integrated diagnostic approaches that include a combination of different diagnostic tests are preferred. […] The present Task Force recommends that pre-test clinical probability of PE must always be objectively assessed in each patient, while D-dimer measurements should be determined if pre-test probability of pulmonary embolism is low or intermediate. […] Diagnostic imaging of the chest should be used to assess post-test probability of PE in most patients. […] Further testing is necessary when the post-test probability of PE is neither sufficiently low nor sufficiently high to permit therapeutic decisions.

• #41 Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach | Multidisciplinary Respiratory Medicine | Full Text

  https://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-8-75

  A thorough clinical evaluation is the key step in raising the suspicion of the disease and setting up appropriate diagnostic strategies. […] The combination of clinical and laboratory data may either increase the clinical suspicion of PE, or suggest alternative diagnoses. […] The value of D-dimer measurement in the diagnostic work-up of each patient must be considered according to the determined clinical probability of PE and the sensitivity of the particular method of D-dimer measurement employed. […] A negative D-dimer test result, measured by any method, in combination with a low probability clinical assessment, excludes PE with accuracy. […] Conversely, if clinical assessment results in a high probability of PE, a concomitant negative D-dimer test does not exclude PE. […] The contribution of computed tomographic angiography (CTA) to the diagnosis of pulmonary embolism has greatly increased as a consequence of the extraordinary advancement in CTA technology.

• #41 Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach | Multidisciplinary Respiratory Medicine | Full Text

  https://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-8-75

  The diagnosis of pulmonary embolism (PE) is frequently considered in patients presenting to the emergency department or when hospitalized. […] Objective tests to either establish or refute the diagnosis have become a standard of care. […] The accuracy of diagnostic tests for PE are high when the results are concordant with the clinical assessment. […] Additional testing is necessary when the test results are inconsistent with clinical probability. […] The present review article represents the consensus-based recommendations of the Interdisciplinary Association for Research in Lung Disease (AIMAR) multidisciplinary Task Force for diagnosis and treatment of PE. […] The diagnostic pathway of PE is guided by two principles. First, accurate and fast identification of patients with PE is critical because PE is a potentially fatal condition and anticoagulation is associated with the risk of major bleeding.

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