Using Clinical Evaluation and Lung Scan to Rule Out Suspected Pulmonary Embolism

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Abstract
SUSPECTED PULMONARY embolism (PE) is a frequent and vexing clinical problem. Pulmonary angiography, although the criterion standard, is costly, invasive,1 and not available in many clinical settings. Lung scans are diagnostic (high-probability lung scan establishes diagnosis of PE and low-probability lung scan [normal or near-normal] rules out PE) in only 30% to 50% of patients.2-4 Newer diagnostic instruments, such as plasma D-dimer measurement5,6 and lower-limb venous compression ultrasonography (US),4,7,8 have increased the options for noninvasive diagnosis. Nevertheless, even when combining all these tests, a significant proportion of patients still require an angiogram if clinical assessment is left out (36% in a recent study by our group9).