[Consensus diagnosis pulmonary embolism].
Pulmonary embolism is a frequent occurrence and requires adequate diagnosis and treatment to avoid unnecessary mortality and complications. However, until recently, the optimal diagnostic management was not determined. This prompted the organisation of a consensus meeting. The advised diagnostic strategy was derived from available data in the literature, a cost-effectiveness analysis, and the discussions which took place at the meeting. The preferred diagnostic strategy consists of a combination of perfusion-ventilation lung scintigraphy, ultrasonography of the legs, and finally pulmonary angiography. Perfusion scintigraphy is performed first. If a normal perfusion is seen further anticoagulant therapy may be withheld. Ventilation scintigraphy is performed if a segmental or larger perfusion defect is found. If a normal ventilation scan is obtained (mismatch) the diagnosis of pulmonary embolism is sufficiently certain to warrant institution of long-term anticoagulant therapy. In all other lung scan findings (non-conclusive or non-diagnostic) the meeting advised to perform ultrasonography of the legs. If deep venous thrombosis is detected the patient requires long-term anticoagulant therapy. If a normal ultrasound result is found, pulmonary angiography is required as the final test in the diagnostic strategy.
Briët
E
E
Afd. Hematologie, Academisch Ziekenhuis, Leiden.
van Beek
E J
EJ
Oudkerk
M
M
D003362:Cost-Benefit Analysis; D006801:Humans; D008487:Medical History Taking; D010808:Physical Examination; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics; D011877:Radionuclide Imaging; D013927:Thrombosis / Q000000981:diagnostic imaging; D014463:Ultrasonography