SearchDiagnosing Pulmonary Embolism
Diagnosing PE — signs and symptoms
The signs and symptoms of pulmonary embolism (PE) include chest pain, shortness of breath, anxiety, and cough. These symptoms overlap with those for many other cardiac and pulmonary conditions.8 For this reason, the diagnostic process, and decisions regarding the need for imaging studies specifically designed to detect PE, should begin with a careful clinical examination and a determination of the likelihood that the patient has suffered PE.
Pulmonary embolus with haemorrhage
Diagnosing PE — tests and studies
The ventilation-perfusion scan has been the first-line study in patients with suspected PE for decades.42 A ventilation-perfusion scan indicating a high probability of PE provides sufficient evidence for the initiation of treatment, although it should be noted that a scan indicating a low probability of PE does not rule out the condition.47 Helical computed tomography has a high sensitivity and specificity for detecting large pulmonary emboli but is generally unable to detect small ones. The current gold standard for diagnosis is pulmonary angiography. This is rarely a first-line diagnostic test, as it is more invasive than either ventilation-perfusion scans or helical CT.48
A clinical probability score can help estimate the likelihood of PE based on data from the history and physical examination, blood tests, and imaging study results.42
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Windows Live- 8 - Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008;358(10):1037-1052.
- 42 - Ramzi DW, Leeper KV. DVT and pulmonary embolism: Part I. Diagnosis. Am Fam Physician. 2004;69(12):2829-2836.
- 47 - The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators. JAMA. 1990;263(20):2753-2759.
- 48 - Blann AD, Lip GY. Venous thromboembolism. BMJ. 2006;332(7535):215-219.
- Angiography
- Angiography is imaging of the blood vessels using X-rays or magnetic resonance tomography. The vessels are visualised by injecting contrast medium into a vein. Angiography is used to diagnose disorders of the blood vessels.
- Computed tomography
- Also know as CAT scan. A radiographic technique that uses a computer to assimilate multiple X-ray images into a two-dimensional cross-sectional image.
