[Pulmonary embolism]

Acute pulmonary thromboembolism (PTE) is associated with considerable morbidity and mortality and may, if unrecognized, lead to severe chronic heart failure. Most cases are adequately treated with anticoagulants, while thrombolytic agents and other, more risky treatment regimens should still be reserved for the most severe cases. Even so, a definite diagnosis of PTE is prerequisite to any treatment, because of the risk of serious bleeding complications. However, the diagnosis of PTE is often difficult and always depends on confirmation by one or more diagnostic procedures, of which only pulmonary arteriography is of sufficient diagnostic value to be used alone. As pulmonary arteriography is costly and not without risk to the patient, the paper proposes a diagnostic strategy to limit the need for invasive procedures maximally without loss of diagnostic value. In critically ill patients with suspected PTE, bedside haemodynamic evaluation and balloon-occlusion-angiography may be valuable, as illustrated by two cases histories.