In Case You Missed It: Updates in the Evaluation and Management of Pulmonary Embolism in 2025

Acute pulmonary embolism (PE) is a major cause of morbidity and mortality and represents a unique challenge for emergency physicians. Recent research has focused on pretest probability assessment, improving diagnostic imaging strategies, risk stratification, and optimizing treatment and disposition decisions across diverse patient populations.

This review summarized key developments from the 2025 literature regarding the evaluation and management of PE, with an emphasis on advancements relevant to emergency medicine.

Updated evidence highlights improvements in probability assessment tools, including the superior performance of the revised Geneva score. Emerging data suggest that D-dimer testing may safely exclude PE in some high‑probability patients. Imaging research confirms the value of right ventricular-to-left ventricular diameter ratios on computed tomography. The addition of findings such as an elevated serum lactate level or low-voltage QRS complexes on electrocardiogram can better predict patients at risk for clinical deterioration. Further studies support the role of PE response teams in improving access to advanced therapies. Key studies identified the value of catheter-directed therapies than anticoagulation alone and the superiority of large-bore mechanical thrombectomy. Disposition research reinforces the safety of outpatient management for low‑risk patients and describes emerging tools to guide these decisions. Additional investigations address management nuances in pregnancy, pediatrics, cancer‑associated thrombosis, and disparities in care.

This extensive research from 2025 supports safer, more evidence-based care in the diagnosis and management of acute PE. Emergency physicians should be familiar with these advances in clinical practice.