II. Technique
- Based on PE Probability (See PE Diagnosis)
- Consider Alternative Diagnosis
- See Chest Pain Causes
- See Dyspnea Causes
- See Leg Pain Causes
- See Tachypnea
- See Hypoxia
- See Sinus Tachycardia
III. Evaluation: Step 1 - Imaging Study
- CT Pulmonary Angiogram (Spiral or helical chest CT, preferred)
- Spiral Chest CT suggestive for PE (Positive)
- Treat with Pulmonary Embolism Management
- Spiral Chest CT not suggestive for PE (Negative)
- Jump to step 2 below
- Spiral Chest CT suggestive for PE (Positive)
-
Ventilation Perfusion Scan (V/Q Scan)
- Indicated if CT Angiography contraindicated
- Normal Probability V/Q Scan
- No further evaluation needed
- Evaluate for alternative diagnosis
- Low or Intermediate Probability VQ Scan
- Jump to Step 2 below
- High Probability V/Q Scan
- Treat with Pulmonary Embolism Management
IV. Evaluation: Step 2 - Obtain Lower Extremity Compression Ultrasound
- Negative Compression Ultrasound
- Positive D-Dimer
- Jump to step 3 below OR
- Treat empirically as VTE and repeat the Ultrasound in 1 week
- Negative D-Dimer
- Consider alternative diagnosis
- Positive D-Dimer
- Positive Compression Ultrasound
- Treat with Pulmonary Embolism Management
V. Evaluation: Step 3 - Obtain pulmonary angiogram
- Pulmonary angiogram suggestive for PE (Positive)
- Treat with Pulmonary Embolism Management
- Pulmonary angiogram not suggestive for PE (Negative)
- No further evaluation needed
- Evaluate for alternative diagnosis