Challenges in the Diagnosis Acute Pulmonary Embolism
Abstract The state of the art of diagnostic evaluation of hemodynamically stable patients with suspected acute pulmonary embolism was reviewed. Diagnostic evaluation should begin with clinical assessment using a validated prediction rule in combination with measurement of D-dimer when appropriate. I...
Gespeichert in:
| Veröffentlicht in: | The American journal of medicine 2008-07, Vol.121 (7), p.565-571 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 571 |
|---|---|
| container_issue | 7 |
| container_start_page | 565 |
| container_title | The American journal of medicine |
| container_volume | 121 |
| creator | Stein, Paul D., MD Sostman, H. Dirk, MD Bounameaux, Henri, MD Buller, Harry R., MD Chenevert, Thomas L., PhD Dalen, James E., MD Goodman, Lawrence R., MD Gottschalk, Alexander, MD Hull, Russell D., MBBS, MSc Leeper, Kenneth V., MD Pistolesi, Massimo, MD Raskob, Gary E., PhD Wells, Philip S., MD Woodard, Pamela K., MD |
| description | Abstract The state of the art of diagnostic evaluation of hemodynamically stable patients with suspected acute pulmonary embolism was reviewed. Diagnostic evaluation should begin with clinical assessment using a validated prediction rule in combination with measurement of D-dimer when appropriate. Imaging should follow only when necessary. Although with 4-slice computed tomography (CT) and 16-slice CT, the sensitivity for detection of pulmonary embolism was increased by combining CT angiography with CT venography, it is not known whether CT venography increases the sensitivity of 64-slice CT angiography. Methods to reduce the radiation exposure of CT venography include imaging only the proximal leg veins (excluding the pelvis) and obtaining discontinuous images. Compression ultrasound can be used instead. In young women, radiation of the breasts produces the greatest risk of radiation-induced cancer. It may be that scintigraphy is the imaging test of choice in such patients, but this pathway should be tested prospectively. A patient-specific approach to the diagnosis of pulmonary embolism can be taken safely in hemodynamically stable patients to increase efficiency and decrease cost and exposure to radiation. |
| doi_str_mv | 10.1016/j.amjmed.2008.02.033 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69266371</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002934308002532</els_id><sourcerecordid>69266371</sourcerecordid><originalsourceid>FETCH-LOGICAL-c472t-b386133840b5a3ec5bddff12ee55bacc9bb634fab5d2b2e7f60f47a0955a4f5b3</originalsourceid><addsrcrecordid>eNqFkV1r1TAYgIMo7mz6D0SKsN215rvtjTCO8wMGCup1SNI3W2qazqQV9u9NOYdzsRuvkpDn_XpehN4Q3BBM5Pux0dM4wdBQjLsG0wYz9gztiBCibomkz9EOY0zrnnF2hs5zHssT90K-RGekE12PBd4hvr_XIUC8g1z5WC33UH30-i7O2efq2q4LVN_XMM1Rp8fqZjJz8Hl6hV44HTK8Pp4X6Nenm5_7L_Xtt89f99e3teUtXWrDOkkY6zg2QjOwwgyDc4QCCGG0tb0xknGnjRioodA6iR1vdelRaO6EYRfo6pD3Ic1_VsiLmny2EIKOMK9ZyZ5KyVpSwHdPwHFeUyy9KcooI63ktED8ANk055zAqYfkpzKXIlhtStWoDkrVplRhqorSEvb2mHs1298p6OiwAJdHQGerg0s6Wp9PHMW8530rCvfhwEFR9tdDUtl6iBYGn8Auapj9_zp5msAGH32p-RseIZ9GJiqXAPVjW_-2fdyViyge_gHbf6m8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>232317642</pqid></control><display><type>article</type><title>Challenges in the Diagnosis Acute Pulmonary Embolism</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Stein, Paul D., MD ; Sostman, H. Dirk, MD ; Bounameaux, Henri, MD ; Buller, Harry R., MD ; Chenevert, Thomas L., PhD ; Dalen, James E., MD ; Goodman, Lawrence R., MD ; Gottschalk, Alexander, MD ; Hull, Russell D., MBBS, MSc ; Leeper, Kenneth V., MD ; Pistolesi, Massimo, MD ; Raskob, Gary E., PhD ; Wells, Philip S., MD ; Woodard, Pamela K., MD</creator><creatorcontrib>Stein, Paul D., MD ; Sostman, H. Dirk, MD ; Bounameaux, Henri, MD ; Buller, Harry R., MD ; Chenevert, Thomas L., PhD ; Dalen, James E., MD ; Goodman, Lawrence R., MD ; Gottschalk, Alexander, MD ; Hull, Russell D., MBBS, MSc ; Leeper, Kenneth V., MD ; Pistolesi, Massimo, MD ; Raskob, Gary E., PhD ; Wells, Philip S., MD ; Woodard, Pamela K., MD</creatorcontrib><description>Abstract The state of the art of diagnostic evaluation of hemodynamically stable patients with suspected acute pulmonary embolism was reviewed. Diagnostic evaluation should begin with clinical assessment using a validated prediction rule in combination with measurement of D-dimer when appropriate. Imaging should follow only when necessary. Although with 4-slice computed tomography (CT) and 16-slice CT, the sensitivity for detection of pulmonary embolism was increased by combining CT angiography with CT venography, it is not known whether CT venography increases the sensitivity of 64-slice CT angiography. Methods to reduce the radiation exposure of CT venography include imaging only the proximal leg veins (excluding the pelvis) and obtaining discontinuous images. Compression ultrasound can be used instead. In young women, radiation of the breasts produces the greatest risk of radiation-induced cancer. It may be that scintigraphy is the imaging test of choice in such patients, but this pathway should be tested prospectively. A patient-specific approach to the diagnosis of pulmonary embolism can be taken safely in hemodynamically stable patients to increase efficiency and decrease cost and exposure to radiation.</description><identifier>ISSN: 0002-9343</identifier><identifier>EISSN: 1555-7162</identifier><identifier>DOI: 10.1016/j.amjmed.2008.02.033</identifier><identifier>PMID: 18589050</identifier><identifier>CODEN: AJMEAZ</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Acute Disease ; Biological and medical sciences ; Computed tomography angiography ; D-dimer ; Decision Support Techniques ; Diagnostic Imaging ; Fibrin Fibrinogen Degradation Products - analysis ; General aspects ; Human exposure ; Humans ; Internal Medicine ; Lung - pathology ; Medical diagnosis ; Medical sciences ; Pneumology ; Pulmonary embolism ; Pulmonary Embolism - diagnosis ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Radiation ; Respiratory diseases ; Systematic review ; Thromboembolism ; Tomography ; Ventilation-perfusion scintigraphy</subject><ispartof>The American journal of medicine, 2008-07, Vol.121 (7), p.565-571</ispartof><rights>Elsevier Inc.</rights><rights>2008 Elsevier Inc.</rights><rights>2008 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. Jul 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c472t-b386133840b5a3ec5bddff12ee55bacc9bb634fab5d2b2e7f60f47a0955a4f5b3</citedby><cites>FETCH-LOGICAL-c472t-b386133840b5a3ec5bddff12ee55bacc9bb634fab5d2b2e7f60f47a0955a4f5b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002934308002532$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20494975$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18589050$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stein, Paul D., MD</creatorcontrib><creatorcontrib>Sostman, H. Dirk, MD</creatorcontrib><creatorcontrib>Bounameaux, Henri, MD</creatorcontrib><creatorcontrib>Buller, Harry R., MD</creatorcontrib><creatorcontrib>Chenevert, Thomas L., PhD</creatorcontrib><creatorcontrib>Dalen, James E., MD</creatorcontrib><creatorcontrib>Goodman, Lawrence R., MD</creatorcontrib><creatorcontrib>Gottschalk, Alexander, MD</creatorcontrib><creatorcontrib>Hull, Russell D., MBBS, MSc</creatorcontrib><creatorcontrib>Leeper, Kenneth V., MD</creatorcontrib><creatorcontrib>Pistolesi, Massimo, MD</creatorcontrib><creatorcontrib>Raskob, Gary E., PhD</creatorcontrib><creatorcontrib>Wells, Philip S., MD</creatorcontrib><creatorcontrib>Woodard, Pamela K., MD</creatorcontrib><title>Challenges in the Diagnosis Acute Pulmonary Embolism</title><title>The American journal of medicine</title><addtitle>Am J Med</addtitle><description>Abstract The state of the art of diagnostic evaluation of hemodynamically stable patients with suspected acute pulmonary embolism was reviewed. Diagnostic evaluation should begin with clinical assessment using a validated prediction rule in combination with measurement of D-dimer when appropriate. Imaging should follow only when necessary. Although with 4-slice computed tomography (CT) and 16-slice CT, the sensitivity for detection of pulmonary embolism was increased by combining CT angiography with CT venography, it is not known whether CT venography increases the sensitivity of 64-slice CT angiography. Methods to reduce the radiation exposure of CT venography include imaging only the proximal leg veins (excluding the pelvis) and obtaining discontinuous images. Compression ultrasound can be used instead. In young women, radiation of the breasts produces the greatest risk of radiation-induced cancer. It may be that scintigraphy is the imaging test of choice in such patients, but this pathway should be tested prospectively. A patient-specific approach to the diagnosis of pulmonary embolism can be taken safely in hemodynamically stable patients to increase efficiency and decrease cost and exposure to radiation.</description><subject>Acute Disease</subject><subject>Biological and medical sciences</subject><subject>Computed tomography angiography</subject><subject>D-dimer</subject><subject>Decision Support Techniques</subject><subject>Diagnostic Imaging</subject><subject>Fibrin Fibrinogen Degradation Products - analysis</subject><subject>General aspects</subject><subject>Human exposure</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Lung - pathology</subject><subject>Medical diagnosis</subject><subject>Medical sciences</subject><subject>Pneumology</subject><subject>Pulmonary embolism</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</subject><subject>Radiation</subject><subject>Respiratory diseases</subject><subject>Systematic review</subject><subject>Thromboembolism</subject><subject>Tomography</subject><subject>Ventilation-perfusion scintigraphy</subject><issn>0002-9343</issn><issn>1555-7162</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkV1r1TAYgIMo7mz6D0SKsN215rvtjTCO8wMGCup1SNI3W2qazqQV9u9NOYdzsRuvkpDn_XpehN4Q3BBM5Pux0dM4wdBQjLsG0wYz9gztiBCibomkz9EOY0zrnnF2hs5zHssT90K-RGekE12PBd4hvr_XIUC8g1z5WC33UH30-i7O2efq2q4LVN_XMM1Rp8fqZjJz8Hl6hV44HTK8Pp4X6Nenm5_7L_Xtt89f99e3teUtXWrDOkkY6zg2QjOwwgyDc4QCCGG0tb0xknGnjRioodA6iR1vdelRaO6EYRfo6pD3Ic1_VsiLmny2EIKOMK9ZyZ5KyVpSwHdPwHFeUyy9KcooI63ktED8ANk055zAqYfkpzKXIlhtStWoDkrVplRhqorSEvb2mHs1298p6OiwAJdHQGerg0s6Wp9PHMW8530rCvfhwEFR9tdDUtl6iBYGn8Auapj9_zp5msAGH32p-RseIZ9GJiqXAPVjW_-2fdyViyge_gHbf6m8</recordid><startdate>20080701</startdate><enddate>20080701</enddate><creator>Stein, Paul D., MD</creator><creator>Sostman, H. Dirk, MD</creator><creator>Bounameaux, Henri, MD</creator><creator>Buller, Harry R., MD</creator><creator>Chenevert, Thomas L., PhD</creator><creator>Dalen, James E., MD</creator><creator>Goodman, Lawrence R., MD</creator><creator>Gottschalk, Alexander, MD</creator><creator>Hull, Russell D., MBBS, MSc</creator><creator>Leeper, Kenneth V., MD</creator><creator>Pistolesi, Massimo, MD</creator><creator>Raskob, Gary E., PhD</creator><creator>Wells, Philip S., MD</creator><creator>Woodard, Pamela K., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Sequoia S.A</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20080701</creationdate><title>Challenges in the Diagnosis Acute Pulmonary Embolism</title><author>Stein, Paul D., MD ; Sostman, H. Dirk, MD ; Bounameaux, Henri, MD ; Buller, Harry R., MD ; Chenevert, Thomas L., PhD ; Dalen, James E., MD ; Goodman, Lawrence R., MD ; Gottschalk, Alexander, MD ; Hull, Russell D., MBBS, MSc ; Leeper, Kenneth V., MD ; Pistolesi, Massimo, MD ; Raskob, Gary E., PhD ; Wells, Philip S., MD ; Woodard, Pamela K., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c472t-b386133840b5a3ec5bddff12ee55bacc9bb634fab5d2b2e7f60f47a0955a4f5b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Acute Disease</topic><topic>Biological and medical sciences</topic><topic>Computed tomography angiography</topic><topic>D-dimer</topic><topic>Decision Support Techniques</topic><topic>Diagnostic Imaging</topic><topic>Fibrin Fibrinogen Degradation Products - analysis</topic><topic>General aspects</topic><topic>Human exposure</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Lung - pathology</topic><topic>Medical diagnosis</topic><topic>Medical sciences</topic><topic>Pneumology</topic><topic>Pulmonary embolism</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</topic><topic>Radiation</topic><topic>Respiratory diseases</topic><topic>Systematic review</topic><topic>Thromboembolism</topic><topic>Tomography</topic><topic>Ventilation-perfusion scintigraphy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stein, Paul D., MD</creatorcontrib><creatorcontrib>Sostman, H. Dirk, MD</creatorcontrib><creatorcontrib>Bounameaux, Henri, MD</creatorcontrib><creatorcontrib>Buller, Harry R., MD</creatorcontrib><creatorcontrib>Chenevert, Thomas L., PhD</creatorcontrib><creatorcontrib>Dalen, James E., MD</creatorcontrib><creatorcontrib>Goodman, Lawrence R., MD</creatorcontrib><creatorcontrib>Gottschalk, Alexander, MD</creatorcontrib><creatorcontrib>Hull, Russell D., MBBS, MSc</creatorcontrib><creatorcontrib>Leeper, Kenneth V., MD</creatorcontrib><creatorcontrib>Pistolesi, Massimo, MD</creatorcontrib><creatorcontrib>Raskob, Gary E., PhD</creatorcontrib><creatorcontrib>Wells, Philip S., MD</creatorcontrib><creatorcontrib>Woodard, Pamela K., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stein, Paul D., MD</au><au>Sostman, H. Dirk, MD</au><au>Bounameaux, Henri, MD</au><au>Buller, Harry R., MD</au><au>Chenevert, Thomas L., PhD</au><au>Dalen, James E., MD</au><au>Goodman, Lawrence R., MD</au><au>Gottschalk, Alexander, MD</au><au>Hull, Russell D., MBBS, MSc</au><au>Leeper, Kenneth V., MD</au><au>Pistolesi, Massimo, MD</au><au>Raskob, Gary E., PhD</au><au>Wells, Philip S., MD</au><au>Woodard, Pamela K., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Challenges in the Diagnosis Acute Pulmonary Embolism</atitle><jtitle>The American journal of medicine</jtitle><addtitle>Am J Med</addtitle><date>2008-07-01</date><risdate>2008</risdate><volume>121</volume><issue>7</issue><spage>565</spage><epage>571</epage><pages>565-571</pages><issn>0002-9343</issn><eissn>1555-7162</eissn><coden>AJMEAZ</coden><abstract>Abstract The state of the art of diagnostic evaluation of hemodynamically stable patients with suspected acute pulmonary embolism was reviewed. Diagnostic evaluation should begin with clinical assessment using a validated prediction rule in combination with measurement of D-dimer when appropriate. Imaging should follow only when necessary. Although with 4-slice computed tomography (CT) and 16-slice CT, the sensitivity for detection of pulmonary embolism was increased by combining CT angiography with CT venography, it is not known whether CT venography increases the sensitivity of 64-slice CT angiography. Methods to reduce the radiation exposure of CT venography include imaging only the proximal leg veins (excluding the pelvis) and obtaining discontinuous images. Compression ultrasound can be used instead. In young women, radiation of the breasts produces the greatest risk of radiation-induced cancer. It may be that scintigraphy is the imaging test of choice in such patients, but this pathway should be tested prospectively. A patient-specific approach to the diagnosis of pulmonary embolism can be taken safely in hemodynamically stable patients to increase efficiency and decrease cost and exposure to radiation.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>18589050</pmid><doi>10.1016/j.amjmed.2008.02.033</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9343 |
| ispartof | The American journal of medicine, 2008-07, Vol.121 (7), p.565-571 |
| issn | 0002-9343 1555-7162 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_69266371 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Acute Disease Biological and medical sciences Computed tomography angiography D-dimer Decision Support Techniques Diagnostic Imaging Fibrin Fibrinogen Degradation Products - analysis General aspects Human exposure Humans Internal Medicine Lung - pathology Medical diagnosis Medical sciences Pneumology Pulmonary embolism Pulmonary Embolism - diagnosis Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Radiation Respiratory diseases Systematic review Thromboembolism Tomography Ventilation-perfusion scintigraphy |
| title | Challenges in the Diagnosis Acute Pulmonary Embolism |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T08%3A11%3A46IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Challenges%20in%20the%20Diagnosis%20Acute%20Pulmonary%20Embolism&rft.jtitle=The%20American%20journal%20of%20medicine&rft.au=Stein,%20Paul%20D.,%20MD&rft.date=2008-07-01&rft.volume=121&rft.issue=7&rft.spage=565&rft.epage=571&rft.pages=565-571&rft.issn=0002-9343&rft.eissn=1555-7162&rft.coden=AJMEAZ&rft_id=info:doi/10.1016/j.amjmed.2008.02.033&rft_dat=%3Cproquest_cross%3E69266371%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=232317642&rft_id=info:pmid/18589050&rft_els_id=S0002934308002532&rfr_iscdi=true |