The presentation of pulmonary embolism is variable, which can lead to delays in diagnosis and treatment. A high level of clinical suspicion and the ability to stratify patients according to their level of risk are therefore needed to prevent potentially fatal outcomes. This article provides a framework for the investigative approach to patients with suspected pulmonary embolism.
- In most patients, pulmonary embolism is suspected based on the presence of dyspnoea, chest pain, presyncope or syncope, and/or haemoptysis.
- A negative D-dimer assay in a nonhigh-risk outpatient can safely exclude pulmonary embolism.
- If a pregnant woman is suspected of having a pulmonary embolism and the chest x-ray is normal, ventilation perfusion scintigraphy scan may be preferable to computed tomographic pulmonary angiography because of lower maternal radiation exposure.
- The finding of a proximal lower limb deep vein thrombosis on compression ultrasonography in a patient suspected of having a pulmonary embolism is sufficient to diagnose pulmonary embolism when further imaging modalities are not readily available or their use is prohibited.
- Use of the simplified Pulmonary Embolism Severity Index may help select patients with pulmonary embolism who may be suitable for outpatient care or early hospital discharge.
Picture credit: © John Bavosi/SPL.