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[Diagnosis of pulmonary embolism].
Journal article

[Diagnosis of pulmonary embolism].

  • Righini M Service d'angiologie et d'hémostase, hôpitaux universitaires de Genève, rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Suisse. Electronic address: marc.righini@hcuge.ch.
  • Robert-Ebadi H Service d'angiologie et d'hémostase, hôpitaux universitaires de Genève, rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Suisse.
  • Le Gal G Département de médecine, institut de recherche de l'hôpital d'Ottawa, Ottawa, Canada.
  • 2019-02-13
Published in:
  • La Revue de medecine interne. - 2019
Angioscanner thoracique
Computed tomography pulmonary angiography
D-dimer
D-dimères
Diagnosis
Diagnostic
Embolie pulmonaire
Pulmonary embolism
Computed Tomography Angiography
Diagnosis, Differential
Diagnostic Tests, Routine
Fibrin Fibrinogen Degradation Products
Humans
Pulmonary Embolism
Radiography, Thoracic
Single Photon Emission Computed Tomography Computed Tomography
English The diagnosis of pulmonary embolism (PE) is nowadays based on the sequential use of several diagnostic tests rather than on a single test. These diagnostic strategies are safe and have been prospectively validated. The first step after identifying patients with suspicion of PE is to establish the pre-test clinical probability. Several scores are available in order to make a standardised and reproducible assessment of the clinical probability, and therefore represent precious diagnostic tools. Indeed, clinical probability guides further investigations. Indeed, in patients with a low or an intermediate clinical probability or an "unlikely" probability, PE can be safely ruled out by negative D-dimers in approximately one third of outpatients without additional imaging. In case of positive D-dimers and a high clinical probability or a "likely" clinical probability, CT pulmonary angiography is now the recommended imaging technique. However, lower limb venous compression ultrasound and ventilation/perfusion scans remain useful in patients with contra-indications to CT, mainly those with renal insufficiency. Finally, some novel diagnostic tests seem promising. For example, V/Q SPECT has arisen as a highly accurate test and a potential alternative to CTPA. However, prospective management outcome studies are still lacking and are warranted before its implementation in routine clinical practice.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/229718
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