[Diagnostics of acute pulmonary embolism : An update]

Pulmonary embolism is an acute and potentially life-threatening condition requiring a differentiated diagnostic algorithm. Assessment of the risk and clinical probability are of utmost importance in order to initiate early treatment or to reliably exclude a pulmonary embolism. Computed tomography of the pulmonary arteries (CTPA) has become the non-invasive gold standard for the diagnostic approach. Alternatively, scintigraphy can also be used. A negative CTPA excludes a pulmonary embolism with a high degree of probability. Furthermore, CTPA can supply additional information, such as estimation of the right ventricular strain (right ventricular dysfunction, RVD) or alternative diagnoses if pulmonary embolism has been ruled out as the primary cause of symptoms. An essential prerequisite is a high quality CTPA with sufficient contrast enhancement in the pulmonary arteries, avoidance of artifacts and optimization of both the radiation dosage as well as the amount of contrast medium, individually determined for each patient.