How I diagnose acute pulmonary embolism.
Blood. 2013 Apr 16;
Authors: Huisman MV, Klok FA
Abstract
The clinical diagnosis of acute pulmonary embolism is frequently considered in patients presenting to the Emergency Department or when hospitalised. Since this diagnosis is a-specific and the consequences of anticoagulant treatment are considerable, objective tests to either establish or refute the diagnosis have become standard of care. Traditionally, pulmonary angiography has been the gold standard, but over the years computed tomography pulmonary angiography (CTPA) has replaced it and is now the first line imaging test. In view of the large increase in use of CTPA, with resulting diminishing prevalence of PE, it is critical to review the diagnostic algorithm of PE. This should always include a clinical decision rule to assess the likelihood of PE being present, a D-dimer blood test and CTPA. Using a standardised algorithm, CTPA can be avoided in 20-30% of patients presenting with a first or recurrent episode of clinically suspected acute PE. The aim of this review is to provide clinicians a practical diagnostic management approach of acute PE with evidence from the literature.
PMID: 23591793 [PubMed - as supplied by publisher]