Current trends on diagnostic work up of pulmonary thromboembolism

This report describes a six month prospective double blind study of 30 consecutive patients who were evaluated at Jackson Memorial Medical Center for pulmonary emboli. In this series, 77 per cent of the patients with lung scans interpreted as high probability for pulmonary emboli had angiographic confirmation of emboli. In 90 per cent of the patients with lung scans interpreted as low probability for pulmonary emboli, angiography confirmed the absence of pulmonary emboli. Five patients had radionuclide scans that were interpreted as nondiagnostic. Although pulmonary arteriography remains the gold standard for the diagnosis of pulmonary emboli we feel it should not be used in the low probability category because of the accuracy of the ventilation perfusion scans. It should be used in the indeterminant group and in the high probability category when anticoagulation therapy is contraindicated; prior to embolectomy or Mobin-Uddin umbrella insertion.