[Diagnostic approach to pulmonary embolism]

Abstract

Despite its relatively high frequency, pulmonary embolism remains difficult to diagnose due to its non-specific symptomatology and the diagnostic uncertainties of the paraclinical tests used. The diagnostic approach is based initially on evaluation of the a priori clinical probability of thromboembolic disease, then on a decisional strategy regarding the choice of the most efficient paraclinical tests. The specific characteristics of the paraclinical tests are reviewed. A series of decisional algorithms is proposed based on the notion that pulmonary embolism and deep-vein thrombosis are two facets of the same disease. In the majority of cases, performing invasive tests such as pulmonary angiography and phlebography of the legs become less necessary with the use of the proposed strategies, which serve to identify the patients to be treated as well as those who do not require anticoagulant therapy.