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Related Experiment Videos

Diagnostic methods in pulmonary embolism.

M Nijkeuter1, M V Huisman

  • 1Department of General Internal Medicine and Endocrinology, University Medical Centre Leiden, LUMC Room C1 R 43, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.

European Journal of Internal Medicine
|August 9, 2005
PubMed
Summary
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Diagnostic management of acute pulmonary embolism.

Presse medicale (Paris, France : 1983)·2024

Diagnosing pulmonary embolism (PE) is challenging due to non-specific symptoms. Clinical prediction rules combined with D-dimer testing can safely rule out PE in low-risk outpatients, reducing the need for further diagnostic tests.

Area of Science:

  • Medical Diagnostics
  • Radiology
  • Cardiology

Background:

  • Pulmonary embolism (PE) diagnosis is difficult due to non-specific clinical presentations.
  • Existing diagnostic tests for PE are often invasive, costly, and resource-intensive.
  • Clinical prediction rules and D-dimer testing offer simpler diagnostic adjuncts.

Purpose of the Study:

  • To review current diagnostic strategies for pulmonary embolism.
  • To evaluate the efficacy and limitations of various diagnostic tools for PE.
  • To discuss the role of imaging in PE diagnosis and management.

Main Methods:

  • Review of diagnostic tests including clinical prediction rules, D-dimer assays, pulmonary angiography, lung scintigraphy, and helical CT.
  • Assessment of test accuracy, invasiveness, cost, and resource utilization.

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  • Discussion of diagnostic algorithms incorporating these tools.

    • Main Results:

    • Clinical prediction rules combined with D-dimer testing can reduce the need for further diagnostic workup by 30%.
    • A normal sensitive ELISA D-dimer test can safely exclude PE in low-to-moderate clinical probability outpatients.
    • Helical CT is increasingly favored for its ability to directly visualize thromboemboli and suggest alternative diagnoses, with normal results potentially ruling out PE when combined with leg vein ultrasonography.

    Conclusions:

    • Pulmonary angiography is rarely used due to invasiveness and cost.
    • Lung scintigraphy can exclude PE if normal, but often yields indeterminate results.
    • Helical CT is a valuable first-line test, but safety of withholding anticoagulation based solely on a normal multi-row detector helical CT requires further demonstration.