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Pulmonary Embolism Diagnosis
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Ultrasound of the lower limbs
Compression ultrasonography of the lower limbs is used to detect deep vein thrombosis (DVT), which can be a source of pulmonary embolism.
Electrocardiography (ECG)
An ECG in the context of PE might show signs such as S1Q3T3 pattern, right heart strain, and tachycardia, but these findings are not specific and are only present in a minority of cases.
Legionella and Pneumococcal Urinary Antigen Tests
While not directly diagnosing PE, these tests can help rule out certain types of pneumonia that could present with similar symptoms, thereby focusing the diagnosis towards a potential PE.
Pulmonary angiography
This invasive procedure involves injecting dye into the pulmonary arteries and taking x-rays to detect blockages. It was the previous gold standard before the widespread use of CTPA.
Chest X-ray
While chest X-rays are not diagnostic for PE, they can help to exclude other differential diagnoses or might show non-specific findings sometimes associated with PE, such as a Westermark sign or a Hampton's hump.
Computed Tomographic Pulmonary Angiography (CTPA)
CTPA is an imaging test that combines computed tomography (CT) scanning and angiography to visualize the pulmonary arteries. It is the gold standard for diagnosing PE as it can directly show the presence of a clot.
Wells Criteria
The Wells Criteria is a clinical prediction rule that stratifies patients with suspected pulmonary embolism (PE) into different probability categories to guide further testing. For PE, scores are summed and categorized as low, moderate, or high probability.
Troponin
Elevated troponin levels suggest myocardial injury which may occur with significant PE due to increased strain on the right heart.
Echocardiography
Echocardiography can identify right ventricular dysfunction or evidence of a clot in transit in patients with PE. It is particularly useful when hemodynamic instability is present.
Ventilation-Perfusion (V/Q) Scan
A V/Q scan is a nuclear medicine scan that uses radiolabeled substances to assess airflow (ventilation) and blood flow (perfusion) in the lungs. Mismatched areas can suggest PE.
Brain Natriuretic Peptide (BNP) or N-terminal pro-BNP
Elevated levels of BNP or NT-proBNP are biomarkers that can indicate strain on the right heart, which is a consequence of a significant pulmonary embolism.
D-dimer testing
D-dimer is a fibrin degradation product, and high levels can indicate clot formation and breakdown. In patients with a low probability of PE, a negative D-dimer test can rule out PE.
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