Abstract

Abstract

Pulmonary embolism is a treatable disease in which fatal outcome can occur in the absence of treatment. Since the sensitivity and the specificity of clinical picture are quite low, objective diagnostic tests are needed to establish the diagnosis. In this study, we aimed to evaluate the value of a simple diagnostic algorithm for pulmonary embolism based on non-invasive methods, such as ventilation/perfusion lung scan, D-dimer measurement, lower limb vein ultrasonography and spiral computed tomographic angiography to reduce the need for pulmonary angiography. In this prospective study; 70 patients with high pretest clinical probability of pulmonary embolism were evaluated with a sequential, decision analysis-based strategy in order to reduce the need for pulmonary angiography. A definitive diagnosis could be established by the non-invasive protocol in 94% of these patients: normal or high probability lung scan established the diagnosis in 43 (61%) members of the study group, D-dimer concentration <500 µg/L-1 ruled out pulmonary embolism in 10 (14%), whereas lower limb vein ultrasonography and spiral computed tomographic angiography established the diagnosis in 5 (8%) and 8 (11%) patients respectively. During the 3-month follow up, no pulmonary embolism has been observed in the non-treated group. In conclusion; our diagnostic algorithm based on non-invasive strategy allowed to forego pulmonary angiography in vast majority of patients with high clinical probability of pulmonary embolism and appeared to be safe.