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Noninvasive diagnosis of pulmonary embolism.

Abstract : BACKGROUND: We designed a simple and integrated diagnostic algorithm for acute pulmonary embolism (PE). Diagnosis was based on clinical probability assessment, plasma D-dimer testing, then sequential testing to include lower limb venous compression ultrasonography, ventilation perfusion lung scan, and chest multidetector CT (MDCT) imaging. METHODS: We included 321 consecutive patients presenting at Brest University Hospital in Brest, France, with clinically suspected PE and positive d-dimer or high clinical probability. Patients in whom VTE was deemed absent were not given anticoagulants and were followed up for 3 months. RESULTS: Detection of DVT by ultrasonography established the diagnosis of PE in 43 (13%). Lung scan associated with clinical probability was diagnostic in 243 (76%) of the remaining patients. MDCT scan was required in only 35 (11%) of the patients. The 3-month thromboembolic risk in patients not given anticoagulants, based on the results of the diagnostic protocol, was 0.53% (95% CI, 0.09-2.94). CONCLUSIONS: A diagnostic strategy combining clinical assessment, d-dimer, ultrasonography, and lung scan gave a noninvasive diagnosis in the majority of outpatients with suspected PE and appeared to be safe.
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https://hal.univ-brest.fr/hal-00677049
Contributor : Ghislaine Calvez <>
Submitted on : Wednesday, March 7, 2012 - 10:18:40 AM
Last modification on : Thursday, November 29, 2018 - 4:09:32 PM

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Pierre-Yves Salaun, Francis Couturaud, Alexandra Le Duc-Pennec, Karine Lacut, Pierre-Yves Le Roux, et al.. Noninvasive diagnosis of pulmonary embolism.. Chest, American College of Chest Physicians, 2011, 139 (6), pp.1294-8. ⟨10.1378/chest.10-1209⟩. ⟨hal-00677049⟩

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