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Intensive and Critical Care Medicine pp 167–182Cite as

Diagnosis of Pulmonary Embolism

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Abstract

Pulmonary embolism (PE)is a relevant clinical occurrence. Despite advances in diagnostic modalities,PE remains a commonly under diagnosed and lethal disease. In North America it has been reported that the occurrence of 600 000 PE cases are accountable for 50 000 to 200 000 deaths annually [1–4 ]. Unexpected deaths due to pulmonary embolism are frequently diagnosed post mortem. When diagnosis is established in the emergency department, appropriate anticoagulation is usually effective in reducing the possibility of recurrence and death. Undiagnosed PE has a hospital mortality rate as high as 30% that falls to near 8% if diagnosed and treated properly [3–6 ]. The mortality rate in ambulatory patients is less than 2%[7]. Clinicians are aware of unexpected deaths due to pulmonary embolism and that appropriate anticoagulation is usually effective in reducing the possibility of recurrence and death. For this reason,image methods are requested whenever there is clinical suspicion of PE. The diagnostic ‘gold standard’ is pulmonary angiography, against which other imaging modalities have been historically evaluated. Pulmonary angiography is an invasive and expensive procedure,with limited availability and potentially serious complications. There is limited radiological experience with this method as it is not always recognised that,with sub-segmental clot,interobserver disagreement occurs in up to one third of cases [8]. Despite being the ‘gold standard’ ,pulmonary angiograms are not infallible. A patient with a normal pulmonary angiogram can still expect a 2.2% (95%CI, 0.3 to 8.0%) venous thromboembolic event rate at the one-year follow-up [9].

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Authors and Affiliations

  1. Department of Surgery, Faculdade de Ciências Médicas, Universidade Estadual de Campinas UNICAMP, Campinas, Sã Paulo, Brazil

    R. G. G. Terzi & M. Mello Moreira

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  1. R. G. G. Terzi
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Editors and Affiliations

  1. Department of Perioperative Medicine Intensive Care and Emergency, Trieste University School of Medicine, Trieste, Italy

    Antonino Gullo

  2. Department of Anaesthesiology, Keck School of Medicine at USC, Los Angeles, CA, USA

    Philip D. Lumb

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Terzi, R.G.G., Mello Moreira, M. (2005). Diagnosis of Pulmonary Embolism. In: Gullo, A., Lumb, P.D. (eds) Intensive and Critical Care Medicine. Springer, Milano. https://doi.org/10.1007/88-470-0350-4_14

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