LUNG ALERT
Evidence-based recommendations on the investigation of acute pulmonary embolism
Senior House Officer, Harefield Hospital, Middlesex, UK; stevencowman@yahoo.co.uk
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Stein PD, Woodard PK, Weg JG, et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators. Am J Med 2006;119:1048–55.[CrossRef][Medline]
This paper from the PIOPED (Prospective Investigation Of Pulmonary Embolism Diagnosis) II investigators presents updated guidelines on diagnostic algorithms for pulmonary embolism (PE).
In all cases, an objective clinical assessment of the probability of PE is initially recommended. In patients at low or moderate risk of PE this should be followed by a rapid ELISA-based D-dimer assay. A negative D-dimer effectively allows PE to be ruled out in these groups. Where PE cannot be ruled out, and for those in the high-risk group, CT pulmonary angiography (CTPA) should be performed, ideally with venous phase imaging of the lower leg veins (CT venography).
In moderate- and high-risk patients with a positive CTPA, and low-risk patients with a main or lobar
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