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Diagnostic de l’embolie pulmonaire au service des urgences

Diagnosis of pulmonary embolism at the emergency department

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Réanimation

Résumé

L’embolie pulmonaire (EP) est la troisième affection cardiovasculaire aiguès l’infarctus myocardique et l’accident vasculaire cérébral. Son diagnostic reste difficile aux urgences et commence par une suspicion clinique fondée sur des facteurs de risque et des symptômes souvent peu spécifiques. L’étape suivante consiste à déterminer la probabilité pré-test d’EP par des scores validés ou par l’expérience clinique. Cette probabilité va être affinée par divers tests diagnostiques dont il faut connaître les indications et limites. Cette démarche systématique permet d’affirmer ou exclure une EP de manière efficiente en évitant la surconsommation d’examens complémentaires. Notre travail s’attache à revoir les approches pratiques du diagnostic d’EP aux urgences chez le patient stable d’un point de vue hémodynamique.

Abstract

Pulmonary embolism (PE) is the third most common acute cardiovascular disease after myocardial infarction and stroke. Nevertheless, the diagnosis still remains difficult in the emergency setting. Clinical suspicion is raised by risk factors and often unspecific symptoms. The next step is to determine the pretest probability of PE either with validated scores or clinical gestalt. This probability is further refined with various diagnostic tests for which indications and limitations should be known. This systematic approach allows an efficient diagnosis of PE, avoiding the overconsumption of tests. The aim of our work is to review the practical diagnostic approach of PE at the emergency department in hemodynamically stable patients.

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Authors and Affiliations

  1. Service des urgences, hôpital universitaire Érasme, route de Lennik 808, 1070, Bruxelles, Belgique

    T. Nguyen, V. Collot & C. Mélot

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  1. T. Nguyen
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  2. V. Collot
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  3. C. Mélot
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Correspondence to C. Mélot.

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Nguyen, T., Collot, V. & Mélot, C. Diagnostic de l’embolie pulmonaire au service des urgences. Réanimation 22, 593–599 (2013). https://doi.org/10.1007/s13546-013-0730-7

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  • DOI: https://doi.org/10.1007/s13546-013-0730-7

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