Diagnostic management of acute pulmonary embolism

Presse Med. 2024 Sep;53(3):104241. doi: 10.1016/j.lpm.2024.104241. Epub 2024 Aug 23.

Abstract

Straightforward, accurate diagnostic management in patients presenting with clinically suspected pulmonary embolism (PE) is essential, since starting anticoagulant treatment may give important adverse effects of bleeding, while false exclusion of the disease may lead to recurrent VTE, with associated morbidity and mortality. In the past three decades, considerable improvement in the diagnostic management of PE has been made. Computed tomography pulmonary angiography (CTPA) has largely replaced conventional pulmonary angiography and ventilation-perfusion lung scanning as the imaging methods of choice. Several diagnostic algorithms, all able to minimize the need for radiological imaging have been developed and validated. Lastly, within the diagnostic algorithms, varying d-dimer cut-off levels have successfully been introduced to further downsize the need for radiological imaging.

Keywords: CT pulmonary angiography; Diagnosis; Pulmonary embolism; V-Q lung scan; d-dimer.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Algorithms*
  • Computed Tomography Angiography*
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Pulmonary Embolism* / diagnosis
  • Pulmonary Embolism* / diagnostic imaging
  • Pulmonary Embolism* / therapy
  • Ventilation-Perfusion Scan

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D