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The diagnostic evaluation of pulmonary embolism
Simon J McRae1, Jeffrey S Ginsberg
1Department of Medicine, McMaster University Medical Centre HSC 3W11, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5. smcrae@mcmaster.ca
The American Heart Hospital Journal
|February 22, 2005
Summary
Accurate diagnosis of pulmonary embolism (PE) is crucial. Noninvasive tests, often combined, help determine PE likelihood, guiding treatment decisions and improving patient outcomes.
Area of Science:
- Cardiology
- Radiology
- Pulmonary Medicine
Background:
- Pulmonary embolism (PE) diagnosis is critical due to associated morbidity and mortality.
- Pulmonary angiography, the gold standard, is invasive and costly.
- Noninvasive diagnostic strategies are essential for PE evaluation.
Purpose of the Study:
- To review noninvasive diagnostic strategies for pulmonary embolism.
- To discuss the role of various tests in PE diagnosis and management.
- To highlight the need for validated diagnostic algorithms.
Main Methods:
- Review of noninvasive diagnostic tests for pulmonary embolism.
- Validation of diagnostic algorithms in management trials.
- Assessment of clinical assessment, ultrasonography, D-dimer, V/Q scan, and CT.
Main Results:
- Noninvasive tests often require combination for accurate PE diagnosis.
- Diagnostic algorithms incorporating multiple tests have been validated.
- Computed tomography is a recent addition to diagnostic strategies.
Conclusions:
- Optimal PE diagnostic strategy depends on institutional resources and expertise.
- Magnetic resonance imaging and CT pulmonary angiography/venography show promise as standalone tests but need further research.
- Accurate and timely PE diagnosis is essential for appropriate patient management.