Diagnosis of pulmonary embolism: in transition

To discuss reports published in 2005 on the diagnosis of clinically suspected nonmassive pulmonary embolism.

Progress has been made in assessing the clinical probability of pulmonary embolism, in addressing diagnosis in the elderly, in evaluating the diagnostic performance of single-detector and multidetector row helical computed tomography, and in the role of D-dimer measurement and lower limb venous compression ultrasonography in the diagnostic work-up of pulmonary embolism.

Diagnosing venous thromboembolism depends mainly on noninvasive diagnostic tools that are used sequentially. In most patients, a noninvasive work-up is feasible and the diagnostic algorithms are becoming simpler. This review focuses on developments in clinical probability assessment, pulmonary embolism in the elderly, potential new uses of D-dimer measurement, advent of multidetector row helical computed tomography, and utility of ultrasonography in detecting deep vein thrombosis in patients with suspected pulmonary embolism. With the development of potentially more sensitive diagnostic tests for pulmonary embolism, physicians are now facing the risk of overdiagnosis and hence overtreatment. The issue will no longer be just to detect clots but to identify patients who must be treated using anticoagulants, a complicated question.