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Diagnostic approach to pulmonary embolism: our strategy

  • Special Topic: Pulmonary Embolism
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Abstract

The nonspecificity and variety of clinical features in acute pulmonary embolism account for a high suspicion rate, with a further exclusion of the diagnosis in up to 80% of cases. Arterial blood gas analysis and other laboratory tests are highly nonspecific, and suggestive signs on the electrocardiogram are uncommon. The plain chest X-ray often yields valuable information. Lung scan, when normal, has the great advantage of excluding pulmonary embolism. At present, no procedure has superseded pulmonary angiography to attest the presence of emboli. Angiography will probably gain widespread acceptance with the larger use of thrombolysis.

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References

  1. Alderson PO, Gottschalk A (1979) Ventilation-perfusion studies for pulmonary embolism: a rebuttal to Dr Eugene Rogin. Semin Nucl Med 9:145 (Letter)

    Google Scholar 

  2. Alderson PO, Biello DR, Sachariah KG, Siegel BA (1981) Scintigraphic detection of pulmonary embolism in patients with obstructive pulmonary disease. Radiology 138:661

    Google Scholar 

  3. Beall AC, Collins JJ (1975) What is the role of pulmonary embolectomy? Am Heart J 89:411

    Google Scholar 

  4. Bell WR, Simon TL (1976) A comparative analysis of pulmonary perfusion scans with pulmonary angiograms. From a national cooperative study (USPET). Am Heart J 92:700

    Google Scholar 

  5. Bell WR, Simon TL, DeMets DL (1977) The clinical features of submassive and massive pulmonary emboli. Am J Med 62:355

    Google Scholar 

  6. Biello DR, Mattar AG, Osei-Wusu A et al (1979) Interpretation of indeterminate lung scintigrams. Radiology 133:189

    Google Scholar 

  7. Biello DR, Mattar AG, McKnight RC, Siegel BA (1979) Ventilation-perfusion studies in suspected pulmonary embolism. Am J Roentgenol 133:1033

    Google Scholar 

  8. Cheely R, McCartney WH, Perry R et al (1981) The role of noninvasive tests versus pulmonary angiography in the diagnosis of pulmonary embolism. Am J Med 70:17

    Google Scholar 

  9. Dalen JE, Banas JS, Brooks HL et al (1969) Resolution rate of acute pulmonary embolism in man. N Engl J Med 280:1194

    Google Scholar 

  10. Dalen JE, Brooks HL, Johnson LW et al (1971) Pulmonary angiography in acute pulmonary embolism: indications, techniques, and results in 367 patients. Am Heart J 81:175

    Google Scholar 

  11. Even P, Sors H, Safran D et al (1981) Diagnostic des embolies pulmonaires. Analyse critique à propos de 338 observations. In: Maladie thrombo-embolique, vol 1. Masson, Paris, p 45

    Google Scholar 

  12. Feihl F, Depeursinge F, Enrico JF, Perret CI (1981) Abstract Bedside hemodynamic investigation in massive pulmonary embolism with shock. Crit Care Med 9:209

    Google Scholar 

  13. Fraser RG, Paré JA (1978) Diagnosis of disease of the chest, vol II, 2nd ed. Saunders, Philadelphia 1143

    Google Scholar 

  14. Gilday DL, Poulose KP, DeLand FH (1972) Accuracy of detection of pulmonary embolism by lung scanning correlated with pulmonary angiography. Am J Roentgenol 115:732

    Google Scholar 

  15. Goodman PC, Brant-Zawadzki M (1982) Digital subtraction pulmonary angiography. Am J Roentgenol 139:305

    Google Scholar 

  16. Kasper W, Meinertz R, Kersting F et al (1980) Echocardiography in assessing acute pulmonary hypertension due to pulmonary embolism. Am J Cardiol 45:567

    Google Scholar 

  17. Kerr IH, Simon G, Sutton GC (1971) The value of the plain radiograph in acute massive pulmonary embolism. Br J Radiol 44:751

    Google Scholar 

  18. Lauritzen T, Bugge PB (1979) Diagnostic decision-process in suspected pulmonary embolism. Report of the Herlev Hospital Study Group. Lancet 1 (8130):1336

    Google Scholar 

  19. McIntyre KM, Sasahara AA, Littmann D (1972) Relation of the electrocardiogram to hemodynamic alterations in pulmonary embolism. Am J Cardiol 30:205

    Google Scholar 

  20. McNeil B (1976) A diagnostic strategy using ventilation-perfusion studies in patients suspect for pulmonary embolism. J Nucl Med 17:613

    Google Scholar 

  21. Menzoian JO, Williams LF (1979) Is pulmonary angiography essential for the diagnosis of acute pulmonary embolism? Am J Surg 137:543

    Google Scholar 

  22. Miller GAH, Sutton GC (1970) Acute massive pulmonary embolism. Clinical and haemodynamic findings in 23 patients studied by cardiac catheterization and pulmonary arteriography. Br Heart J 32:518

    Google Scholar 

  23. Mills SR, Jackson DC, Older RA et al. (1980) The incidence, etiologies and avoidance of complications of pulmonary angiography in a large series. Radiology 136:295

    Google Scholar 

  24. Moser KM, Harsanyi P, Rius-Garriga G et al. (1969) Assessment of pulmonary photoscanning and angiography in experimental pulmonary embolism. Circulation 39:663

    Google Scholar 

  25. Moses DC, Silver TM, Bookstein JJ (1974) The complementary roles of chest radiography, lung scanning and selective pulmonary angiography in the diagnosis of pulmonary embolism. Circulation 49:179

    Google Scholar 

  26. Novelline RA, Baltarowich OH, Athanasoulis CA et al (1978) The clinical course of patients with suspected pulmonary embolism and a negative angiogram. Radiology 126:561

    Google Scholar 

  27. Robin ED (1977) Overdiagnosis and overtreatment of pulmonary embolism: the emperor may have no clothes. Ann Int Med 87:775

    Google Scholar 

  28. Sagel SS, Greenspan RH (1970) Nonuniform pulmonary arterial perfusion: pulmonary embolism? Radiology 99:541

    Google Scholar 

  29. Sasahara AA, Sharma GVRK, Parisi AR (1979) New developments in the detection and prevention of venous thromboembolism. Am J Cardiol 43:1214

    Google Scholar 

  30. Sautter RD (1965) Massive pulmonary thromboembolism. Experience with 12 pulmonary embolectomies. JAMA 194:104

    Google Scholar 

  31. Sostman HD, Ravin CE, Sullivan DC et al (1982) Use of pulmonary angiography for suspected pulmonary embolism: influence of scintigraphic diagnosis. Am J Roentgenol 139:673

    Google Scholar 

  32. Spodick DH (1972) Electrocardiographic responses to pulmonary embolism. Am J Cardiol 30:695

    Google Scholar 

  33. Stein PD, Willis PW, Dalen JE (1979) Importance of clinical assessment in selecting patients for pulmonary angiography. Am J Cardiol 43:669

    Google Scholar 

  34. Szucs MM, Brooks HL, Grossman W et al (1971) Diagnostic sensitivity of laboratory findings in acute pulmonary embolism. Ann Int Med 74:161

    Google Scholar 

  35. Urokinase pulmonary embolism trial (UPET). A national cooperative study (1973) Circulation 47 (suppl II):81

    Google Scholar 

  36. Wagner HN, Sabiston DC, McAfee JE et al (1964) Diagnosis of massive pulmonary embolism in man by radioisotope scanning. N Engl J Med 271:377

    Google Scholar 

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Vincent, A., Poli, S. & Perret, C. Diagnostic approach to pulmonary embolism: our strategy. Intensive Care Med 10, 85–89 (1984). https://doi.org/10.1007/BF00297564

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