Pulmonary embolism: a diagnostic approach.

The diagnosis of pulmonary embolism (PE) has always been a major challenge to hospital practice. As a consequence of the significant failure in diagnosis using clinical criteria alone, more advanced methods like lung scintigraphy and angiography--although unavailable at many clinical centres--have definitely improved the diagnosis efficiency in PE. The author briefly reviews the utility of clinical, analytical, electrocardiographic, radiologic, echocardiographic and phlebographic approaches to PE diagnosis. Emphasizing the risks of empiric anticoagulation, the necessity of precise diagnosis using lung scan and arteriography is discussed. The use of two alternative algorithmic approaches is suggested as a guide for diagnosis of PE, depending on the availability of sophisticated diagnostic methods in medical units. In a final overview, the author reviews some of the new methods used in the diagnosis of PE, already established as clinically useful or in ways of becoming so.