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Noninvasive Diagnosis of Pulmonary Embolism

  • Pierre-Yves Salaun
    Affiliations
    Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France

    Université de Brest, CHU de la Cavale Blanche, Brest, France

    Service de médecine nucléaire, CHU de la Cavale Blanche, Brest, France
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  • Francis Couturaud
    Affiliations
    Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France

    Université de Brest, CHU de la Cavale Blanche, Brest, France

    Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France
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  • Alexandra Le Duc-Pennec
    Affiliations
    Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France

    Université de Brest, CHU de la Cavale Blanche, Brest, France

    Service de médecine nucléaire, CHU de la Cavale Blanche, Brest, France
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  • Karine Lacut
    Affiliations
    Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France

    Université de Brest, CHU de la Cavale Blanche, Brest, France

    Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France
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  • Pierre-Yves Le Roux
    Affiliations
    Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France

    Université de Brest, CHU de la Cavale Blanche, Brest, France

    Service de médecine nucléaire, CHU de la Cavale Blanche, Brest, France
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  • Philippe Guillo
    Affiliations
    Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France

    Université de Brest, CHU de la Cavale Blanche, Brest, France

    Service de médecine nucléaire, CHU de la Cavale Blanche, Brest, France
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  • Pierre-Yves Pennec
    Affiliations
    Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France

    Université de Brest, CHU de la Cavale Blanche, Brest, France

    Département de cardiologie, CHU de la Cavale Blanche, Brest, France
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  • Jean-Christophe Cornily
    Affiliations
    Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France

    Université de Brest, CHU de la Cavale Blanche, Brest, France

    Département de cardiologie, CHU de la Cavale Blanche, Brest, France
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  • Christophe Leroyer
    Affiliations
    Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France

    Université de Brest, CHU de la Cavale Blanche, Brest, France

    Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France
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  • Grégoire Le Gal
    Correspondence
    Correspondence to: Grégoire Le Gal, MD, PhD, Département de Médecine Interne et de Pneumologie, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest, France
    Affiliations
    Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France

    Université de Brest, CHU de la Cavale Blanche, Brest, France

    Département de médecine interne et de pneumologie, CHU de la Cavale Blanche, Brest, France
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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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      Linked Article

      • Retro Is the Rage!: Ventilation-Perfusion Scanning Is Alive and Well in the Diagnosis of Pulmonary Embolism
        CHESTVol. 139Issue 6
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          In the past 2 decades, we have seen a changing pattern in the use of CT pulmonary angiography (CTPA) vs lung perfusion scintigraphy (ventilation-perfusion ratio [ ] scanning) in the investigation of pulmonary embolism (PE). scanning was the imaging modality of choice, but it has largely been supplanted by CTPA in recent years.1 CTPA has been shown to be accurate and safe when used as part of a diagnostic algorithm for suspected PE.2–5 Further, CTPA can lead to additional diagnoses for patients who do not have PE, can provide prognostic information by focusing on the right ventricle, and is available 24 h a day at most institutions.
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