The Southwest Respiratory and Critical Care Chronicles 2014;2(8) 21 Review ARticle The Diagnosis of Acute Pulmonary Embolism

Pulmonary embolism (PE) is a leading cause of morbidity and mortality in the United States, and be-tween 5 % and 10 % of hospital deaths are attributable to PE.1 From 1998 to 2005, the number of patients discharged from United States hospitals with a diag-nosis of pulmonary embolism increased from 126,546 to 229,637.1 Over this period, the hospital case fa-tality rate decreased from 12.3 % to 8.2 % (p<0.001).1 The length of stay decreased, but hospital charges for these patients increased nearly 100 % (p<0.001). In AbstrAct This paper reviews the most current literature on the diagnosis of pulmonary throm-boembolism. The epidemiology and symptomology of this disorder, including common symptoms such as fever, chest pain, dyspnea, edema, and syncope, are reviewed. The utility of basic and easily available testing, such as electrocardiography and chest radiography, is evaluated. The literature on determining the pretest probability of venous thromboembolism with scoring systems, such as the Wells Score, the Geneva Scoring System, and the Pulmonary Embolism Rule Out Criteria, is appraised. As the evalua-tion of pulmonary embolism has evolved, multiple imaging techniques has been devel-oped and studied. Ultrasonography, computed tomography with angiography, magnetic resonance angiography, ventilation perfusion lung scanning, and SPECT ventilation-perfusion lung imaging are discussed. In conclusion, the diagnosis of pulmonary embo-lism remains complicated. Clinical suspicion and stratification should guide a diagnostic strategy for the comprehensive evaluation and diagnosis of patients with this disorder