Diagnosis and treatment of pulmonary embolism

Since PE is the result of DVT, predominantly of the lower extremities, prevention of DVT in patients who are at high risk is important. Regimens including Coumadin, heparin, and physical intervention have all been beneficial. In the presence of pulmonary symptoms, especially when risk factors for DVT are present, an imaging diagnostic work-up is indicated. Ventilation/perfusion scans and duplex scans of the lower extremities will be diagnostic in most cases. Pulmonary angiography should be performed when there is diagnostic uncertainty. Heparin followed by Coumadin is the mainstay of therapy. Fibrinolytic therapy is reserved for cases requiring medical thromboembolectomy. In patients for whom anticoagulation is contraindicated and in patients who have PE while on therapy, the inferior vena cava should be interrupted with a transvenously inserted filter.