Acute pulmonary embolism. Part 1: epidemiology and diagnosis.
Pulmonary embolism (PE) is a frequently occurring, acute, and potentially fatal condition. Numerous risk factors for PE, both inherited and acquired, have been identified. Adequate diagnosis is mandatory to prevent PE-related morbidity and mortality on the one hand, and unnecessary treatment on the other. Only around 1 in 5 individuals with suspected PE will have the diagnosis confirmed, therefore, the diagnostic work-up for PE should comprise safe, efficient, and noninvasive methods. The first step in the approach to diagnosis of patients with suspected PE is to determine the clinical probability and to perform a D-dimer test. PE can be excluded in patients with a 'low', 'intermediate' or 'unlikely' clinical probability and a normal D-dimer test. Additional imaging is required for those with a 'high' or 'likely' clinical probability or a positive D-dimer test. CT pulmonary angiography or ventilation-perfusion scintigraphy, followed by additional testing is the next step when test results are nondiagnostic. Although various diagnostic strategies have been introduced and validated, selected patients may require a tailored approach.
Douma
Renée A
RA
Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. r.a.douma@amc.uva.nl
Kamphuisen
Pieter W
PW
Büller
Harry R
HR
D000465:Algorithms; D017023:Coronary Angiography; D014943:Global Health; D006801:Humans; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D011877:Radionuclide Imaging; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology