[Diagnosis of acute pulmonary embolism]

Several recent studies have clarified the diagnostic strategy for suspected pulmonary embolism. Lung scan is diagnostic in aproximately 30% of patients. The combination of a low clinical probability and a low probability lung scan renders pulmonary embolism unlikely. A plasma D-dimer level lower than 500 micrograms/L measured by an ELISA assay virtually excludes pulmonary embolism. Finding a deep venous thrombosis by lower limb venous compression ultrasonography warrants anticoagulant treatment without resorting to further tests. Pulmonary angiography is usually performed only when the diagnosis remains unclear after noninvasive testing.