title: Venous thromboembolism diagnosis: unresolved issues.
abstract: Recent advances in the management of patients with suspected VTE have both improved diagnostic accuracy and made management algorithms safer, easier to use and well standardised. These diagnostic algorithms are mainly based on the assessment of clinical pretest probability, D-dimer measurement and imaging tests, mainly represented by compression ultrasound (CUS) for suspected DVT and computed tomography pulmonary angiography (CTPA) or lung ventilation-perfusion scan for pulmonary embolism. These diagnostic algorithms allow a safe and cost-effective diagnosis for most patients with suspected VTE. In this review, we focus on the challenge of diagnosing VTE in special patient populations, such as elderly patients, pregnant women, or patients with a prior VTE. Some additional challenges are arising that might require adjustments to current diagnostic strategies, such as the reduced clinical suspicion threshold, resulting in a lower proportion of VTE among suspected patients; the overdiagnosis and overtreatment of VTE, especially regarding calf deep-vein thrombosis (DVT) and subsegmental pulmonary embolism (SSPE).
authors.affiliation: Marc Righini, MD, Division of Angiology and Hemostasis, Department of Medical Specialties, Geneva University Hospital and Faculty of Medicine, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland, Tel.: +41 22 372 92 94, Fax. +41 22 372 92 99, E-mail: Marc.Righini@hcuge.ch.
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.forename: Grégoire
authors.initials: G
authors.lastname: Le Gal
authors.forename: Henri
authors.initials: H
authors.lastname: Bounameaux
mesh_terms: D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D019091:Critical Pathways; D003952:Diagnostic Imaging / Q000379:methods; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000628:therapy
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; Deep vein thrombosis; age-adjusted D-dimer; compression ultrasonography; computed tomography pulmonary angiography; pulmonary embolism