Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach

Federico Lavorini; Vitantonio Di Bello; Maria Luisa De Rimini; Giovanni Lucignani; Letizia Marconi; Gualtiero Palareti; Raffaele Pesavento; Domenico Prisco; Massimo Santini; Nicola Sverzellati; Antonio Palla; Massimo Pistolesi

doi:10.4081/mrm.2013.587

Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach

Authors

Federico Lavorini Department of Experimental and Clinical Medicine, University of Florence, Florence
Vitantonio Di Bello Cardiac Thoracic and Vascular Department, University of Pisa, Pisa
Maria Luisa De Rimini Nuclear Medicine Department, AO Ospedali dei Colli – Monaldi, Naples
Giovanni Lucignani Health Sciences and Centre of Molecular and Cellular Imaging (IMAGO), University of Milan, Hospital San Paolo, Milan
Letizia Marconi Cardiac Thoracic and Vascular Department, University of Pisa
Gualtiero Palareti Department of Angiology and Blood Coagulation, University Hospital of Bologna, Bologna
Raffaele Pesavento Department of Cardiothoracic and Vascular Sciences, University of Padua, Padua
Domenico Prisco Department of Experimental and Clinical Medicine, University of Florence, Florence
Massimo Santini Emergency Department, University of Pisa, Pisa
Nicola Sverzellati Department of Clinical Sciences, Section of Diagnostic Imaging, University of Parma, Parma
Antonio Palla Cardiac Thoracic and Vascular Department, University of Pisa, Pisa
Massimo Pistolesi Department of Experimental and Clinical Medicine, University of Florence, Florence

DOI: https://doi.org/10.4081/mrm.2013.587

Keywords:

Anticoagulant, Clinical probability, D-dimer, Pulmonary embolism, Venous thromboembolism

Abstract

The diagnosis of pulmonary embolism (PE) is frequently considered in patients presenting to the emergency department or when hospitalized. Although early treatment is highly effective, PE is underdiagnosed and, therefore, the disease remains a major health problem. Since symptoms and signs are non specific and the consequences of anticoagulant treatment are considerable, objective tests to either establish or refute the diagnosis have become a standard of care. Diagnostic strategy should be based on clinical evaluation of the probability of PE. The accuracy of diagnostic tests for PE are high when the results are concordant with the clinical assessment. Additional testing is necessary when the test results are inconsistent with clinical probability. The present review article represents the consensus-based recommendations of the Interdisciplinary Association for Research in Lung Disease (AIMAR) multidisciplinary Task Force for diagnosis and treatment of PE. The aim of this review is to provide clinicians a practical diagnostic and therapeutic management approach using evidence from the literature.