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Original Research: PULMONARY VASCULAR DISEASE |

Noninvasive Diagnosis of Pulmonary Embolism

Pierre-Yves Salaun, MD, PhD; Francis Couturaud, MD, PhD; Alexandra Le Duc-Pennec, MD; Karine Lacut, MD, PhD; Pierre-Yves Le Roux, MD; Philippe Guillo, MD; Pierre-Yves Pennec, MD; Jean-Christophe Cornily, MD, PhD; Christophe Leroyer, MD, PhD; Grégoire Le Gal, MD, PhD; Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology
Author and Funding Information

From the Université Européenne de Bretagne (Drs Salaun, Couturaud, Le Duc-Pennec, Lacut, Le Roux, Guillo, Pennec, Cornily, Leroyer, and Le Gal); Université de Brest (Drs Salaun, Couturaud, Le Duc-Pennec, Lacut, Le Roux, Guillo, Pennec, Cornily, Leroyer, and Le Gal); Service de médecine nucléaire (Drs Salaun, Le Duc-Pennec, Le Roux, and Guillo), Département de médecine interne et de pneumologie (Drs Couturaud, Lacut, Leroyer, and Le Gal), and the Département de cardiologie (Drs Pennec and Cornily), CHU de la Cavale Blanche, Brest, France.

Correspondence to: Grégoire Le Gal, MD, PhD, Département de Médecine Interne et de Pneumologie, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest, France; e-mail: gregoire.legal@chu-brest.fr


For editorial comment see page 1264

Funding/Support: This study was partially funded by the Projet Hospitalier de Recherche Clinique 2004 (French Ministry of Health).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(6):1294-1298. doi:10.1378/chest.10-1209
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Background:  We designed a simple and integrated diagnostic algorithm for acute pulmonary embolism (PE). Diagnosis was based on clinical probability assessment, plasma D-dimer testing, then sequential testing to include lower limb venous compression ultrasonography, ventilation perfusion lung scan, and chest multidetector CT (MDCT) imaging.

Methods:  We included 321 consecutive patients presenting at Brest University Hospital in Brest, France, with clinically suspected PE and positive d-dimer or high clinical probability. Patients in whom VTE was deemed absent were not given anticoagulants and were followed up for 3 months.

Results:  Detection of DVT by ultrasonography established the diagnosis of PE in 43 (13%). Lung scan associated with clinical probability was diagnostic in 243 (76%) of the remaining patients. MDCT scan was required in only 35 (11%) of the patients. The 3-month thromboembolic risk in patients not given anticoagulants, based on the results of the diagnostic protocol, was 0.53% (95% CI, 0.09-2.94).

Conclusions:  A diagnostic strategy combining clinical assessment, d-dimer, ultrasonography, and lung scan gave a noninvasive diagnosis in the majority of outpatients with suspected PE and appeared to be safe.

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