The gold standard for diagnosis of pulmonary embolism
Pulmonary embolism The risk factors for pulmonary embolism are the risk factors for thrombi formation within the venous circulation.The most common site for DVT: Calf veinsMost common source of pulmonary emboli: proximal vein of lower extremity (femoropopliteal and iliac vein)Calf venous thrombosis is itself associated with a low risk for embolism but when the thrombosis progresses proximally to involve the larger veins then the risk factors become very highClinical featuresFactors for clinical assessment of pulmonary embolismSymptoms: dyspnoea (MC), chest pain, hemoptysis, coughSigns: tachypnoea (MC), fever, unilateral leg swelling, wheeze, pleural friction rubClinical signs and symptoms of DVTAn alternative diagnosis is less likely than pulmonary embolismHea rate > 100/minImmobilization or previous surgery in 4 weeksPrevious DVT/PEHemoptysisMalignancy (on treatment, treatment in past 6 months)ECG changesDiagnosisFeatures suggesting acute right hea strain on ECG occur relatively infrequently, these include :Acute right axis detionP pulmonaleRight bundle branch blockInveed T wavesST segment changeECG changes highly predictive (but found in <12% pts) S wave in lead IQ wave in lead IIIInveed T wave in lead III (S1Q3T3)S wave in lead I, II, and III (S1S2S3)D-dimer is an excellent screening test for the diagnosis of PE Best investigation when there is clinical suspicion of PE: Multidetector Contrast CTLung scanning is now a second line diagnostic test for PE.Pulmonary angiography is the gold standard for the diagnosis of PE ECG changesDiagnosisFeatures suggesting acute right hea strain on ECG occur relatively infrequently, these include :Acute right axis detionP pulmonaleRight bundle branch blockInveed T wavesST segment changeECG changes highly predictive (but found in <12% pts) S wave in lead IQ wave in lead IIIInveed T wave in lead III (S1Q3T3)S wave in lead I, II, and III (S1S2S3)D-dimer is an excellent screening test for the diagnosis of PE Best investigation when there is clinical suspicion of PE: Multidetector Contrast CTLung scanning is now a second line diagnostic test for PE.Pulmonary angiography is the gold standard for the diagnosis of PE (Refer: Harrison's Principle of Internal Medicine, 18thedition, pg no- 2174)
Chest X-ray
Pulmonary angiography
Ventilation perfusion scintiscan
CECT
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