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Semin Thromb Hemost 2001; 27(1): 025-032
DOI: 10.1055/s-2001-12844
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Diagnosis of Pulmonary Embolism In Outpatients by Sequential Noninvasive Tools

Arnaud Perrier, Henri Bounameaux
  • Medical Clinics 1 and 2 and Division of Angiology and Hemostasis, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
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Publication History

Publication Date:
31 December 2001 (online)

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ABSTRACT

Considerable progress has been made in pulmonary embolism (PE) diagnosis during the last 10 years. New, noninvasive tools such as D-dimer measurement and lower limb venous compression ultrasonography have been introduced as diagnostic strategies. Clinical evaluation of the likelihood of PE has been rehabilitated and has proven to be accurate and useful. The interpretation of lung scan results has become more standardized and clear to clinicians. Finally, two diagnostic strategies have been validated in large scale outcome studies. Both rely on a sequential combination of the aforementioned instruments and have safely treated more than 90% of patients without use of pulmonary angiography. The 3-month venous thromboembolic risk in patients in whom PE was ruled out and, hence, who did not undergo anticoagulation was less than 1% in both studies. In the absence of a formal comparison of their respective cost-effectiveness, choosing between these strategies rests on local preferences or logistics. Finally, spiral computed tomography (CT) seems promising and might modify the diagnostic work-up of PE in the near future. However, it is insufficiently validated, and its place in a rational diagnostic algorithm is not defined.

KEYWORD

Pulmonary embolism - fibrin fibrinogen degradation products - enzyme-linked immunosorbent assay - lung/radionuclide imaging - ultrasonography - spiral CT scan

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