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December 7, 2021

Diagnostic Strategies for Suspected Pulmonary Embolism

Author Affiliations
  • 1Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
  • 2Department of Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
  • 3Cardiometabolic Programme-NIHR UCLH/UCL BRC, London, United Kingdom
JAMA. 2021;326(21):2135-2136. doi:10.1001/jama.2021.19282

Pulmonary embolism is a serious and potentially life-threatening condition. However, after a timely and accurate diagnosis and initiation of appropriate treatment, patients usually quickly recover and most will have an excellent prognosis.

The diagnosis of pulmonary embolism can be difficult because patients may present with nonspecific clinical manifestations and typical signs and symptoms frequently are absent.1 In the past few decades, a rapid and reliable diagnosis of pulmonary embolism has been made easier with the availability of high-resolution computed tomography (CT) pulmonary angiography (PA). However, because many patients with clinically suspected pulmonary embolism have alternative diagnoses, such as pulmonary infections, cardiac conditions, pleural disease, or musculoskeletal problems, much effort has been devoted to develop triage protocols to identify the right patients who need CTPA to avoid unnecessary scanning, contrast-induced nephropathy, radiation exposure, cost, and overdiagnosis of small subsegmental clots, of which the clinical relevance is controversial.2,3 This is becoming more important as the threshold of physicians to consider the diagnosis of pulmonary embolism is currently much lower, as illustrated by a decreasing pulmonary embolism prevalence in diagnostic management studies. In some studies, pulmonary embolism was confirmed in less than 10% of patients in whom the diagnosis was initially suspected.4,5

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