Cost-effective diagnosis of deep vein thrombosis and pulmonary embolism

Suspected acute venous thromboembolism is a frequent and challenging clinic al problem. Phlebography and pulmonary angiography are costly and invasive and, hence, ill-suited for diagnosing a disease present in only 20% of pati ents in whom it is suspected. Novel noninvasive instruments, such as plasma D-dimer measurement, lower limb compression ultrasonography and helical CT scan are important breakthroughs in the management of patients with suspec ted venous thromboembolism. However, none of these instruments is ideal, an d they must be combined in rational and cost-effective diagnostic algorithm s including clinical assessment, which is increasingly standardized. Such s trategies must be validated in management studies, in which patients withou t venous thromboembolism are not treated and followed up during 3 months. S uspected massive pulmonary embolism is a distinct clinical situation requir ing a specific diagnostic approach, in which echocardiography plays a major role. This paper reviews the performance of clinical evaluation and diagno stic tests for venous thromboembolism, and recently validated diagnostic sc hemes.