[When to suspect pulmonary embolism: a balancing act].

Area of Science:

• Pulmonology
• Diagnostic Imaging
• Clinical Decision-Making

Background:

• Pulmonary embolism (PE) is a common condition with varied presentations.
• Diagnostic challenges exist in balancing underdiagnosis with over-testing or overdiagnosis.
• Diagnostic delays are prevalent, particularly in patients with pre-existing cardiopulmonary disease or non-specific symptoms.

Purpose of the Study:

• To explore factors contributing to PE underdiagnosis and overdiagnosis.
• To provide recommendations for optimizing diagnostic strategies for PE.
• To illustrate diagnostic challenges through clinical cases.

Main Methods:

• Review of three clinical cases of pulmonary embolism.
• Overview of factors influencing diagnostic delay and accuracy.
• Discussion of the role of clinical prediction rules in PE diagnosis.

Main Results:

• Diagnostic delay is common, especially in specific patient groups.
• Increased diagnostic imaging may lead to overdiagnosis and overtreatment, such as in subsegmental PE.
• Clinical prediction rules can safely reduce the need for diagnostic imaging.

Conclusions:

• Optimizing PE diagnosis involves a careful balance to avoid both underdiagnosis and overdiagnosis.
• Clinical prediction rules are valuable tools for safe and efficient PE diagnosis.
• Recommendations are provided to improve the diagnostic approach to PE.