Pulmonary embolism: diagnostic algorithms.
In 90% of cases the clinical suspicion of pulmonary embolism (PE) is raised by clinical signs and symptoms, while in only 10% of cases PE is suspected on the basis of electrocardiographic, arterial blood gas analysis or radiological findings. The combination of clinical signs and symptoms and the results of first-level diagnostic tests (electrocardiography, gas analysis and chest X-ray) allows a fairly accurate classification of patients with "clinical suspicion of PE" into three categories of clinical (or pre-test) probability: low, intermediate and high. The clinical diagnosis of PE is very often inaccurate making the use of additional tests, including imaging techniques, mandatory. The choice and the combination (= diagnostic algorithms) of second- and third-level diagnostic tests (D-dimer, venous ultrasound, echocardiography, lung scintigraphy, helical computed tomography and pulmonary angiography) depend primarily on the clinical conditions of patients and their pre-test probability. We propose two diagnostic algorithms: 1) a diagnostic algorithm for patients with clinically suspected PE and critical clinical conditions (unstable patients), 2) a diagnostic algorithm for patients with clinically suspected PE and non-critical clinical conditions (hemodynamically stable patients).
Favretto
Giuseppe
G
Division of Cardiac Rehabilitation, Rehabilitation Hospital, Motta di Livenza TV, Italy. giuseppe.favretto1@tin.it
Stritoni
Paolo
P
D000465:Algorithms; D001784:Blood Gas Analysis; D003952:Diagnostic Imaging / Q000379:methods*; D004562:Electrocardiography; D006801:Humans; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000175:diagnosis*