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01.11.2018 | Peripheral Vascular Disease (CJ Cooper and R Gupta, Section Editors) | Ausgabe 11/2018

Current Cardiology Reports 11/2018

Pulmonary Embolism for the Cardiologist: Emphasis on Diagnosis

Zeitschrift:
Current Cardiology Reports > Ausgabe 11/2018
Autoren:
Jonathan Halevy, Mary Cushman
Wichtige Hinweise
This article is part of the Topical Collection on Peripheral Vascular Disease

Abstract

Purpose of Review

Pulmonary embolism (PE) is a common condition with high morbidity and mortality particularly if misdiagnosed or untreated. It has non-specific clinical manifestations, often presenting similarly to other cardiovascular conditions. The aim of this review is to summarize the clinical presentation, diagnostic algorithms, and imaging studies utilized to efficiently make or exclude the diagnosis of pulmonary embolism.

Recent Findings

Recent cohort studies have raised questions about the classic presentations of PE (particularly with regard to syncope) or lack thereof. Diagnosis of PE continues to evolve with new diagnostic algorithms, use of age-adjusted D-dimer cutoffs, validation of older algorithms, and emerging data on multimodality ultrasound and ventilation-perfusion (V/Q) single-photon emission computed tomography (SPECT) imaging in the diagnosis of PE.

Summary

Optimizing clinical outcomes of PE depend on correct diagnosis of the condition. Given significant variability in clinical presentation, use of a diagnostic algorithm is essential. Use of a clinical decision rule and D-dimer testing can risk stratify patients to allow for judicious use of diagnostic imaging. V/Q scan, CT pulmonary angiography, and lower extremity ultrasound remain the diagnostic imaging modalities of choice with other promising imaging modalities requiring further study.

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