Acute pulmonary embolism.

Area of Science:

• Medical Imaging
• Pulmonary Medicine
• Diagnostic Radiology

Background:

• Most fatal pulmonary embolisms (PE) are unsuspected before death.
• Current diagnostic strategies for PE, particularly CT angiography, are overutilized, leading to significant costs and radiation exposure.
• Despite new clinical characteristics for PE identification, diagnostic challenges persist.

Purpose of the Study:

• To evaluate current diagnostic approaches for pulmonary embolism.
• To highlight the overuse of CT angiography and its associated drawbacks.
• To advocate for improved patient triage and the consideration of alternative imaging modalities.

Main Methods:

• Review of diagnostic practices for pulmonary embolism.
• Analysis of the efficacy and cost-effectiveness of different imaging techniques.
• Assessment of clinical assessment and D-dimer testing in PE diagnosis.

Main Results:

• Approximately 90% of outpatient CT angiograms for PE are negative.
• D-dimer testing combined with clinical assessment could obviate the need for imaging in about 30% of suspected PE cases.
• Perfusion imaging, particularly single-photon emission computed tomography lung scans, offers a potentially more effective and less costly alternative to CT angiography.

Conclusions:

• Overutilization of CT angiography for suspected PE is a significant issue, incurring high costs and radiation exposure.
• Implementing triage strategies using D-dimer and clinical assessment can optimize diagnostic pathways.
• Increased utilization of perfusion imaging, like SPECT lung scans, should be considered for diagnosing PE.