Diagnostic approach to pulmonary embolism: our strategy

Area of Science:

• Cardiology
• Pulmonary Medicine
• Diagnostic Imaging

Background:

• Acute pulmonary embolism (PE) presents with nonspecific clinical features, leading to high suspicion but frequent exclusion of diagnosis.
• Standard diagnostic tests like arterial blood gas analysis and electrocardiography offer limited specificity for PE.
• Plain chest X-rays can provide valuable initial information, while lung scans are useful for excluding PE when normal.

Purpose of the Study:

• To review the diagnostic challenges and current imaging modalities for acute pulmonary embolism.
• To highlight the role of pulmonary angiography as the definitive diagnostic tool.

Main Methods:

• Review of clinical presentations and diagnostic workup for acute pulmonary embolism.
• Evaluation of the utility of various imaging techniques including chest X-ray, lung scan, and pulmonary angiography.

Main Results:

• High rates of diagnostic exclusion (up to 80%) due to nonspecific clinical signs and laboratory findings.
• Chest X-ray and lung scans offer supportive or exclusionary evidence, but are not definitive.
• Pulmonary angiography is currently the gold standard for confirming the presence of pulmonary emboli.

Conclusions:

• Pulmonary angiography remains the most reliable method for diagnosing pulmonary embolism.
• Widespread acceptance of angiography is anticipated with the increasing use of thrombolytic therapy.