THE ROLE OF SUSPICION IN THE DIAGNOSIS OF PULMONARY-EMBOLISM

Pulmonary embolism (PE) is largely undiagnosed because clinical suspic ion is not raised in most instances, and thus, patients with PE go und etected. In this pap er, we try to define the role of clinical assessm ent (including chest radiograph, electrocardiogram, arterial blood gas analysis) in making the diagnosis early, accurate, and at low cost, a nd propose a flow chart to be used in clinical practice. All patients with otherwise unexplained dyspnea or chest pain should be sent for pe rfusion lung scintigraphy; accordingly, underdetection of PE and morta lity of PE should be reduced. If, within I h after the clinical suspic ion has been raised, the above-mentioned simple and noninvasive examin ations are available, they may be employed to reduce the number of unn ecessary procedures, without losing patients actually affected by PE. Finally, when diagnostic tools are not promptly available, noninvasive techniques may be employed to identify patients with the highest prob ability of PE where to start with heparin coverage while waiting for d efinitive diagnosis.