Diagnosis of pulmonary embolism.
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Journal: 2003/February - CMAJ
ISSN: 0820-3946
PUBMED: 12538548
Abstract:
No single noninvasive test for pulmonary embolism is both sensitive and specific. Some tests are good for "ruling in" pulmonary embolism (e.g., helical CT) and some tests are good for "ruling out" pulmonary embolism (e.g., D-dimer); others are able to do both but are often nondiagnostic (e.g., ventilation-perfusion lung scanning). For optimal efficiency, choice of the initial diagnostic test should be guided by clinical assessment of the probability of pulmonary embolism and by patient characteristics that may influence test accuracy. This selective approach to testing enables pulmonary embolism to be diagnosed or excluded in a minimum number of steps. However, even with the appropriate use of combinations of noninvasive tests, it is often not possible to definitively diagnose or exclude pulmonary embolism at initial presentation. Most of these patients can be managed safely without treatment or pulmonary angiography by repeating ultrasound testing of the proximal veins after one and 2 weeks to detect evolving deep vein thrombosis. Helical CT and MRI are rapidly improving as diagnostic tests for pulmonary embolism and are expected to become central to its evaluation.
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CMAJ 168(2): 183-194
PMID: 12538548

Diagnosis of pulmonary embolism

Dr. Kearon is Head of the Clinical Thrombosis Service, Henderson General Hospital, and Associate Professor of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.
Copyright © 2003 Canadian Medical Association or its licensors

Abstract

NO SINGLE NONINVASIVE TEST for pulmonary embolism is both sensitive and specific. Some tests are good for “ruling in” pulmonary embolism (e.g., helical CT) and some tests are good for “ruling out” pulmonary embolism (e.g., D-dimer); others are able to do both but are often nondiagnostic (e.g., ventilation–perfusion lung scanning). For optimal efficiency, choice of the initial diagnostic test should be guided by clinical assessment of the probability of pulmonary embolism and by patient characteristics that may influence test accuracy. This selective approach to testing enables pulmonary embolism to be diagnosed or excluded in a minimum number of steps. However, even with the appropriate use of combinations of noninvasive tests, it is often not possible to definitively diagnose or exclude pulmonary embolism at initial presentation. Most of these patients can be managed safely without treatment or pulmonary angiography by repeating ultrasound testing of the proximal veins after one and 2 weeks to detect evolving deep vein thrombosis. Helical CT and MRI are rapidly improving as diagnostic tests for pulmonary embolism and are expected to become central to its evaluation.

Abstract
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Acknowledgments

I thank Shannon Bates for reviewing and improving an earlier version of this article.

Acknowledgments

Footnotes

This article has been peer reviewed.

Dr. Kearon is a Research Scholar of the Heart and Stroke Foundation of Canada.

Competing interests: None declared.

Correspondence to: Dr. Clive Kearon, 70 Wing, Rm. 39, Henderson General Hospital, 711 Concession St., Hamilton ON L8V 1C3

Footnotes

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