Emergency angiography in acute pulmonary embolism: role in clinically suspected cases

Excerpt

Massive and submassive pulmonary embolisms (PE) have been diagnosed by clinical suspicion according to the criteria of low, intermediate and high probability subgroups, depending on symptoms (sudden dyspnea, chest pain, syncope), signs (tachycardia, hypotension, elevated central venous pressure), electrocardiogram (right ventricle strain, right bundle branch block, S1Q3), laboratory data (hypoxia, hypocapnia, elevated plasma D-dimer, lactate dehydrogenase, fibrin degradation products) and echocardiography (right ventricular dilatation, paradoxical septal motion, pulmonary hypertension) in a patient with predisposing risk factors and diagnostic confirmation via ventilation perfusion lung scan. The latter was not done for all patients as it is diagnostic in only 30–50% of cases, and the remaining 50–70% nondiagnostic scans may represent a probability for underlying PE of between 4% and 66% depending on clinical circumstances. …