Diagnosis of acute pulmonary embolism: an update

Considerable progress has been made in pulmonary embolism diagnosis during the last ten pears. New diagnostic instruments such as plasma D-dimer measu rement and lower venous compression ultrasonography have been developed. Cl inical evaluation of the likelihood of pulmonary embolism has been rehabili tated and proven accurate and valid. The interpretation of lung scan result s has become more simple and clear to clinicians. Finally, two diagnostic s trategies have been validated in large scale outcome studies. Both rely on a sequential combination of the above mentioned instruments and have been a ble to safely manage more than 90% of patients without a pulmonary angiogra m. The 3-month venous thromboembolic risk in patients without pulmonary emb olism and, hence, not anticoagulated was less than 1%; in both studies. In the absence of a formal comparison of their respective cost-effectiveness, choosing between these strategies may rest on local preferences or logistic s. Finally spiral CT scan is highly promising and may considerably modify t he diagnostic workup of pulmonary embolism ill the near future. However, it is insufficiently validated and its position in a rational algorithm for d iagnosing pulmonary embolism is not pet defined.