New diagnostic and treatment modalities for pulmonary embolism: one path through the confusion

Pulmonary embolism is one of the greatest diagnostic challenges in emergency medicine. New techniques and strategies constantly arise for the diagnosis and treatment of this disease. A review of the new diagnostic and treatment modalities for pulmonary embolism (PE) suggests that it should be suspected in any patient with unexplained dyspnea, tachypnea, or chest pain. All patients suspected of PE must be risk stratified, ideally with a criteria-validated clinical decision rule. After assessing pre-test probability, D-dimer assays will reliably exclude PE in the low risk group and no further imaging is warranted. Computed tomography (CT) angiogram is the initial imaging study of choice for stable patients. V/Q scans should be used only when CT is not available or if the patient has a contraindication to CT scans or intravenous contrast. Bedside echocardiography or stabilization of the patient and CT angiogram are the initial tests for suspected massive PE. If PE is confirmed, hypotensive patients should be treated with thrombolytics. Both heparin and low molecular weight heparin are equally effective initial treatments for stable patients with suspected or confirmed PE. Because accurate screening and identification of pulmonary embolism frequently requires more than a single test, knowledge of existing diagnostic techniques allows an evidence-based strategy for diagnosis. New therapeutic choices may benefit patients with confirmed pulmonary embolism.