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Open Access Highly Accessed Review

Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach

Federico Lavorini1, Vitantonio Di Bello2, Maria Luisa De Rimini3, Giovanni Lucignani4, Letizia Marconi2, Gualtiero Palareti5, Raffaele Pesavento6, Domenico Prisco1, Massimo Santini7, Nicola Sverzellati8, Antonio Palla2 and Massimo Pistolesi1*

Author Affiliations

1 Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy

2 Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy

3 Nuclear Medicine Department, AO Ospedali dei Colli – Monaldi, Naples, Italy

4 Health Sciences and Centre of Molecular and Cellular Imaging (IMAGO), University of Milan, Hospital San Paolo, Milan, Italy

5 Department of Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy

6 Department of Cardiothoracic and Vascular Sciences, University of Padua Padua, Italy

7 Emergency Department, University of Pisa, Pisa, Italy

8 Department of Clinical Sciences, Section of Diagnostic Imaging, University of Parma, Parma, Italy

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Multidisciplinary Respiratory Medicine 2013, 8:75  doi:10.1186/2049-6958-8-75

Published: 19 December 2013

Abstract

The diagnosis of pulmonary embolism (PE) is frequently considered in patients presenting to the emergency department or when hospitalized. Although early treatment is highly effective, PE is underdiagnosed and, therefore, the disease remains a major health problem. Since symptoms and signs are non specific and the consequences of anticoagulant treatment are considerable, objective tests to either establish or refute the diagnosis have become a standard of care. Diagnostic strategy should be based on clinical evaluation of the probability of PE. The accuracy of diagnostic tests for PE are high when the results are concordant with the clinical assessment. Additional testing is necessary when the test results are inconsistent with clinical probability. The present review article represents the consensus-based recommendations of the Interdisciplinary Association for Research in Lung Disease (AIMAR) multidisciplinary Task Force for diagnosis and treatment of PE. The aim of this review is to provide clinicians a practical diagnostic and therapeutic management approach using evidence from the literature.

Keywords:
Anticoagulant; Clinical probability; D-dimer; Pulmonary embolism; Venous thromboembolism