Diagnosing Thromboembolic Disease: Keep It Simple

Many combinations of tests have been promoted as ideal algorithms for diagnosing pulmonary embolisms, Dr. Herold said.

Most are too complex. He urged institutions to develop their own simple approaches. As an example, he offered the following:

All patients with intermediate or high clinical probability (independent from any other clinical or laboratory result) must be imaged.

Clinical symptoms determine the particular region to be imaged.

No further imaging is required to institute treatment in a patient whose primary examination is positive.

If the patient has a moderate or high clinical probability for pulmonary embolism and the primary imaging exam is negative, the complementary region should be assessed with CT angiography, CT venography, and ultrasound.

If the patient has a low clinical probability of pulmonary embolism, D-dimer tests can help determine whether imaging is necessary.

Dr. Herold noted that most of the algorithms involve CT angiography, D-dimer testing, and ultrasound.

Lung ventilation-perfusion scanning and pulmonary angiography are rarely used, he said.