Pulmonary embolism and spiral computerized tomographic scans

Abstract

Purpose of review: The potential impact of helical computerized tomography (CT) on earlier diagnosis and earlier treatment of pulmonary embolism and improved health outcomes is significant. The purpose of this review is to summarize the state-of-the-art of radiographic pulmonary embolism detection and consider future directions to reduce this significant public health problem.

Recent findings: Technologic advances in CT have greatly improved the sensitivity and specificity of pulmonary embolism detection. Although there are controversies regarding the significance of peripheral subsegmental emboli, higher radiation risk, and cost, there is increasing evidence that this improved technology provides for earlier pulmonary embolism detection, at an earlier stage of disease, allowing for earlier treatment, at lower severity of illness, with lower mortality. Whether small peripheral pulmonary embolism requires treatment or negative CT requires more testing remain unsettled issues.

Summary: CT of the lung is an evolving technology that is improving medical decision making and health outcomes for individuals who sustain pulmonary embolism, one of the leading causes of in-hospital death. Future approaches include reducing cost and radiation risk, and promoting anticoagulation prophylaxis and provider and consumer awareness. The time is ripe to ensure evolving technology equates with long-term healthier outcomes.