Diagnosing pulmonary embolism: new facts and strategies

Article Abstract:

Pulmonary embolism, the lodging of a blood clot in the lungs, is estimated to be the third most common cause of death in the US. Left untreated, it has a 30 percent mortality; treated, that rate drops to 10 percent. Diagnosing pulmonary embolism accurately has been difficult because symptoms vary and diagnostic tests are not infallible. An analysis of the various tests was done by searching the medical literature on the topic. The most common study to diagnose or exclude pulmonary embolism is the ventilation-perfusion scan, in which radioactive materials are inhaled and injected, and photographic images of the lungs' air flow and blood flow are made and compared. An area that demonstrates good air flow, but no blood flow is suggestive of pulmonary embolism. The results of these scans have traditionally been interpreted as normal, low-, intermediate-, or high-probability. Studies to date conclude that scans read as normal and high-probability are the most reliable. In two studies, normal scans were found to be 99 percent correct in excluding pulmonary embolism. High-probability scans had an 85 percent accuracy rate in making a diagnosis of pulmonary embolism. A strong clinical suspicion for pulmonary embolism seems to lend greater credibility to an equivocal lung scan result. The more definitive test for pulmonary embolism is pulmonary angiogram, a dye study of the lungs' blood flow. Like a lung scan, a negative pulmonary angiogram has a 99 percent accuracy rate. Since pulmonary emboli originate in blood clots in the legs, noninvasive studies of the venous system of the legs might be helpful in confirming a clinical suspicion of pulmonary embolus, but the data are less clear on the accuracy of this method. Some limitations exist with the current tests. Not all hospitals can perform pulmonary angiography or noninvasive venous studies. Opting to treat a patient with equivocal lung scan results is problematic in that the treatment for pulmonary embolism is the administration of anticoagulant drugs, with their attendant risk of hemorrhage. Research is needed to assess the risks and benefits of treating suspected pulmonary emboli in the face of nondiagnostic test results. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Angiography, Pulmonary circulation, Ventilation-perfusion ratio, Lung ventilation-perfusion scan

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The clinical course of pulmonary embolism

Article Abstract:

Patients with a pulmonary (lung) embolism who are diagnosed and treated appropriately have a lower risk of dying from this condition. Of 399 patients with a pulmonary embolism, 375 (94%) were treated for the embolism, with 291 (73%) receiving conventional treatment with an anticoagulant. Ninety-five patients (23.8%) died within a year. The death rate for those in hospitals who were treated was only 9.5%, compared with the predicted rate of 30% for hospital patients who are not diagnosed and treated for pulmonary embolism. Thirty-three patients (34.7%) died from cancer, 21 died from an infection (22.1%), 16 (16.8%) died from heart disease, 10 (2.5%) died from a pulmonary embolism, and 5 (5.3%) died from chronic lung disease. Thirty-three patients (8.3%) had a clinically apparent recurrence of a pulmonary embolism, nine of whom died. Most patients (48%) who had a recurrence had it within one week of the first embolism. Patients with a pulmonary embolism who have cancer, congestive heart failure or chronic lung disease have a higher risk of dying within one year than those without these conditions.

Development and progression

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Multidetector computed tomography for acute pulmonary embolism

Article Abstract:

A study aims to determine whether multidetector computed tomographic angiography (CTA) can reliably detect and rule out acute pulmonary embolism and whether the addition of multidetector CT venography (CTV) improves the ability to detect and rule out pulmonary embolism. Results show that multidetector CTA-CTV has a higher diagnostic sensitivity than does CTA alone, with similar specificity.

New England States, Evaluation, CT imaging, CAT scans, Clinical report

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