From dyspnea to pulmonary embolism.

Pulmonary embolism (PE) is often evoked in patients with new-onset or worsening dyspnea, especially when it is associated with pleuritic chest pain. However, the prevalence of PE in patients with a clinical suspicion ranges from 20 % to as low as 5 %. Unfortunately, what exactly constitutes a clinical suspicion of PE in a patient with dyspnea can not be accurately standardized. The presence of risk factors for venous thromboembolism should prompt the search for PE. However, their absence does not rule out PE as the cause of the patient’s symptoms, since around 30 % of patients with a first episode of PE have no risk or precipitating factors. Once PE is suspected, the diagnostic workup can be standardized and based on a large body of evidence, combining clinical assessment by a prediction rule, D-dimer measurement and CT angiography in patients with an elevated D-dimer level or a high clinical probability of PE. Patients with obvious alternative diagnoses such as acute left heart failure, pneumonia or acut...