The diagnosis of pulmonary embolism

Abstract

The diagnosis of pulmonary embolism is challenging, and autoptic series have demonstrated that a high percentage of cases are not recognized ante-mortem. A number of predisposing factors, symptoms and signs associated with pulmonary embolism have been recognized, and should be used to raise the suspicion of the disease. These include immobilization, recent surgery, active cancer, previous thromboembolism, syncope, dyspnoea, chest pain, haemoptysis, signs of deep vein thrombosis, hypocarbic hypoxemia. Once pulmonary embolism is suspected, the clinical probability of the disease should be assessed; to this end, three clinical rules have been proposed and validated (the revised Geneva score, the Wells score and the PISA-PED score) while others await clinical validation. In case of low clinical probability, a negative a D-dimer test is sufficient to rule out the diagnosis, while if the clinical probability is high, or the D-dimer test is positive, further tests are necessary. Computer tomography angiography or perfusion lung scan are the imaging tests of choice, depending on local availability and experience. If the clinical probability and the results of the imaging test are concordant, a definitive diagnosis can be obtained; if the results are discordant, further testing is necessary. In particular, in the specific case of a small clot (i.e. segmental or subsegmental) incidentally recognized at a computer tomography obtained for other reasons in a patient without a clinical suspicion of pulmonary embolism, an occurrence whose frequency is rapidly increasing in clinical practice, a final diagnosis cannot be made without further confirmatory testing.

Can Neutrophil Lymphocyte Ratio Predict the Thrombus Localization in Patient with Acute Pulmonary Embolism?

“…Duru et al (18) conducted a study on 205 patients and they found thrombi in the main PA at a rate of 14.6%. In another study, 30.8% of 31 patients had thrombi in the main PA (13). In our study, the mean NLR of the patients having the thrombus in the main PA was higher compared to the NLR found in the lobar and distal arteries groups.…”

“…Our study results were similar to those reported in the literature, finding out that immobilization and having undergone a recent surgery were the two most common risk factors at rates of 21.4% and 19.2%, respectively. Using the risk factors mentioned above, some scoring systems such as Wells and Geneva are used in calculating the clinical probability, but these scoring systems cannot predict the thrombus localization precisely (13). Massive PE manifests itself as persistent hypotension and/or bradycardia together with syncope or sudden cardiovascular arrest and these clinical manifestations usually occur in association with proximally located thrombi.…”

Epidemiology of Pulmonary Embolism in Apulia from analysis of current data

“…This situation has brought a certain lack of confidence in the application of this rigorous approach, likely limiting its use in clinical practice. Furthermore, the continuous attempts to modify, improve and simplify these scores make it difficult to complete and compare the prospective validation studies that are much needed for a widespread diffusion of this approach [19].…”

Maximum Likelihood Probabilistic Model for Pulmonary Embolism Nodule Detection (ML-PPED) using Computer Vision

“…PE is one of the most chronic disease, a study shows that this disease affects 500,000 to 600,000 people per year and causes 200,000 to 300,000 deaths per year in United States [2]. Another study presented in [3] shows that 100 new cases/100,000 are estimated per year in Italy [3]. According to the study presented in [4], the PE disease will become the third most chronic and mortality disease by 2030.…”