[Diagnosis approach of pulmonary embolism]

ABSTRACT

Pulmonary embolism [PE] is a fairly common condition that can be fatal. The variability of presentation sets clinician up for potentially missing the diagnosis. Routine laboratory findings are nonspecific and are not useful in diagnosis of PE. Diagnosis is based on clinical prediction rule in combination with laboratory tests such as the D-dimers test leading to the realization of a confirming examination. To precise the confirming examinations of PE and propose an algorithm based on clinical prediction rules in combination with D dimmers. A Pub Med search was conducted using the following key words pulmonary embolism computed tomography pulmonary angiography, scintigraphy and D Dimer. The study was based on a review of 18 studies including meta analysis, reviews and original articles referring recent strategy diagnosis of pulmonary embolism. Ventilation/ perfusion scan is a type of examination that is used less often because it is not a widespread technology. However, it may be useful in patients who have an allergy to iodinated contrast. Ultrasonography of the legs, also known as leg doppler, in search of deep venous thrombosis [DVT] may help the diagnosis approach particularly when other exams are not available or contraindicated. This may be a valid approach in pregnancy. The gold standard for diagnosing PE is pulmonary angiography. It is used less often due to wider acceptance of multi detector CT scans, which are non-invasive. A normal ventilation/perfusion scan rules out the diagnosis of PE with negative predictive value of 97%. There is no consensus in pregnancy. Finally, the MRI has a low and insufficient sensibility to diagnose PE. D Dimers, multidetector CT, ventilation/ perfusion scintigraphy and ultrasonography of the legs are the most useful examinations to diagnose PE. Many algorithms were established depends on medical experience and examination availability: