Noninvasive diagnosis of pulmonary embolism.
BACKGROUND
We designed a simple and integrated diagnostic algorithm for acute pulmonary embolism (PE). Diagnosis was based on clinical probability assessment, plasma D-dimer testing, then sequential testing to include lower limb venous compression ultrasonography, ventilation perfusion lung scan, and chest multidetector CT (MDCT) imaging.


METHODS
We included 321 consecutive patients presenting at Brest University Hospital in Brest, France, with clinically suspected PE and positive d-dimer or high clinical probability. Patients in whom VTE was deemed absent were not given anticoagulants and were followed up for 3 months.


RESULTS
Detection of DVT by ultrasonography established the diagnosis of PE in 43 (13%). Lung scan associated with clinical probability was diagnostic in 243 (76%) of the remaining patients. MDCT scan was required in only 35 (11%) of the patients. The 3-month thromboembolic risk in patients not given anticoagulants, based on the results of the diagnostic protocol, was 0.53% (95% CI, 0.09-2.94).


CONCLUSIONS
A diagnostic strategy combining clinical assessment, d-dimer, ultrasonography, and lung scan gave a noninvasive diagnosis in the majority of outpatients with suspected PE and appeared to be safe.
Salaun
Pierre-Yves
PY
Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Service de médecine nucléaire, CHU de la Cavale Blanche, Brest, France.
Couturaud
Francis
F
Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France.
Le Duc-Pennec
Alexandra
A
Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Service de médecine nucléaire, CHU de la Cavale Blanche, Brest, France.
Lacut
Karine
K
Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France.
Le Roux
Pierre-Yves
PY
Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Service de médecine nucléaire, CHU de la Cavale Blanche, Brest, France.
Guillo
Philippe
P
Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Service de médecine nucléaire, CHU de la Cavale Blanche, Brest, France.
Pennec
Pierre-Yves
PY
Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Département de cardiologie, CHU de la Cavale Blanche, Brest, France.
Cornily
Jean-Christophe
JC
Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Département de cardiologie, CHU de la Cavale Blanche, Brest, France.
Leroyer
Christophe
C
Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France.
Le Gal
Grégoire
G
Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; Université de Brest, CHU de la Cavale Blanche, Brest, France; Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France. Electronic address: gregoire.legal@chu-brest.fr.
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000792:Angiography; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D008875:Middle Aged; D055420:Perfusion Imaging; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014692:Ventilation-Perfusion Ratio
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D