What Is the Best Approach to Diagnosing Pulmonary Embolism?

Computed tomographic pulmonary angiography is as accurate as ventilation-perfusion scan, but detects many smaller emboli.

Computed tomographic pulmonary angiography (CTA) has increasingly replaced ventilation-perfusion (V/Q) scanning in the diagnosis of pulmonary embolism (PE), despite a lack of data comparing the two.

In an investigator-blinded, international, multisite, randomized trial, 1417 patients with a high clinical probability of PE (Wells score, ≥4.5) or positive D-dimer assay underwent CTA or V/Q scan. Subjects with high-probability V/Q scans or with positive CTA were considered to have PE and received anticoagulation. Those with normal V/Q scans were considered to have PE excluded. All others had lower extremity venous ultrasound; those positive for proximal deep venous thrombosis (DVT) were also anticoagulated. A small number of patients crossed ov…

Reviewing Author

Thomas L. Schwenk, MD

Disclosures

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Thomas L. Schwenk, MD

Disclosures

Editorial BoardsUpToDate