Pulmonary Embolism High Probability Evaluation

Pulmonary Embolism High Probability Evaluation, PE High Probability Evaluation, High PE Probability, High Clinical Suspicion for Pulmonary Embolism

See Also

Technique

Based on PE Probability (See PE Diagnosis)
Consider Alternative Diagnosis
1. See Chest Pain Causes
2. See Dyspnea Causes
3. See Leg Pain Causes
4. See Tachypnea
5. See Hypoxia
6. See Sinus Tachycardia

Evaluation
Step 1 - Imaging Study

CT Pulmonary Angiogram (Spiral or helical chest CT, preferred)
1. Spiral Chest CT suggestive for PE (Positive)
  1. Treat with Pulmonary Embolism Management
2. Spiral Chest CT not suggestive for PE (Negative)
  1. Jump to step 2 below
Ventilation Perfusion Scan (V/Q Scan)
1. Indicated if CT Angiography contraindicated
2. Normal Probability V/Q Scan
  1. No further evaluation needed
  2. Evaluate for alternative diagnosis
3. Low or Intermediate Probability VQ Scan
  1. Jump to Step 2 below
4. High Probability V/Q Scan
  1. Treat with Pulmonary Embolism Management

Evaluation
Step 2 - Obtain Lower Extremity Compression Ultrasound

Negative Compression Ultrasound
1. Positive D-Dimer
  1. Jump to step 3 below OR
  2. Treat empirically as VTE and repeat the Ultrasound in 1 week
2. Negative D-Dimer
  1. Consider alternative diagnosis
Positive Compression Ultrasound
1. Treat with Pulmonary Embolism Management

Evaluation
Step 3 - Obtain pulmonary angiogram

Pulmonary angiogram suggestive for PE (Positive)
1. Treat with Pulmonary Embolism Management
Pulmonary angiogram not suggestive for PE (Negative)
1. No further evaluation needed
2. Evaluate for alternative diagnosis

References