Contemporary approach to the diagnosis of non-massive pulmonary embolism

Minimally invasive diagnostic strategies for pulmonary embolism are in constant evolution, integrating new diagnostic tools along with the better use of clinical information.

In the past year, several reports have provided more data on the value of clinical signs and symptoms for diagnosing pulmonary embolism and improved clinical prediction rules for pulmonary embolism. Among the diagnostic tools, the use of multislice computed tomography of the chest received further validation, whereas the yield of bedside tests, such as the D-dimer test or alveolar dead-space measurement, have been further investigated. Furthermore, data linking good outcomes with appropriate diagnostic strategies in patients with suspected pulmonary embolism were reported this year for the first time.

These new data allow a more evidence-based and cost-effective approach to patients with suspected non-massive pulmonary embolism. Multislice computed tomography is replacing other imaging tests. More research should be performed on the role of lower limb venous compression ultrasonography, and on how to select patients in whom pulmonary embolism should be suspected and investigated.