Pulmonary embolism diagnostic approach

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The diagnostic approach to pulmonary embolism requires the initial assessment of the pretest probability of the disease.

Diagnosis Algorithm

 
 
 
 
 
 
 
Assess the pretest probability of PE
by using one of the risk score:
- Wells score
- Geneva score
- PERC
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low pretest probability of PE
(Wells score ≤ 4)
 
 
 
 
 
 
 
High pretest probability of PE
(Wells score) > 4
OR
Presence of shock
OR
Presence of hypotension
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order D-dimer
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Normal D-dimer (<500 ng/ml)
 
Elevated D-dimer (>500 ng/ml)
 
 
 
 
 
Order CT pulmonary angiography
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PE is excluded
 
 
 
 
 
 
Negative
 
 
Positive
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PE is excluded
 
 
PE is confirmed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Click here for treatment

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