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Journal Articles Chest Year : 2011

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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Dates and versions

hal-00677049 , version 1 (07-03-2012)

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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, 2011, 139 (6), pp.1294-8. ⟨10.1378/chest.10-1209⟩. ⟨hal-00677049⟩
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