CONTRIBUTION AND LIMITS OF THE COMBINATION OF LUNG-SCAN AND VENOUS DUPLEX IN THE MANAGEMENT OF PULMONARY-EMBOLISM

Purpose.-To assess the accuracy of diagnostic strategy of pulmonary em bolism (PE) based on clinical examination, lung scan and venous duplex US findings. Methods.-1,819 patients have been included in a prospect ive study (mean age: 66, range: 6-102, F 54% H 46%) over a 13 month pe riod. Results.-To decide the opportunity of anticoagulant therapy, lun g scan alone is decisive in 30.6% of the cases. When taking into accou nt clinical examination, lung scan and venous duplex US findings in a combined diagnostic strategy, a therapeutic decision can be made for 7 4.2% of the patients. The decisive characteristics of this strategy we re influenced by two factor: age (therapeutic decision can be reached for 83% of the patients aged 30 to 50 vs 65% when they are over 85, p < 0.01); history of heart or pulmonary disease (therapeutic decision r eached in 62% of the cases with history vs 78% without, p < 0.01). Con clusion.-Pulmonary angiography seems theoretically necessary in less t han 26% of the patients with suspected PE when they have undergone lun g scan and venous duplex US. In this case, and when these strategies a re not very decisive, it would be important to assess the diagnostic v alue of spiral spiral CT scaning.