Pulmonology Book

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Pulmonary Embolism High Probability EvaluationAka: PE High Probability Evaluation, High PE Probability

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  1. See Also
    1. Pulmonary Embolism
    2. Pulmonary Embolism Diagnosis
    3. Pulmonary Embolism Low Probability Evaluation
    4. Pulmonary Embolism Moderate Probability Evaluation
  2. Technique
    1. Based on PE Probability (See PE Diagnosis)
    2. Consider Alternative Diagnosis
      1. See Chest Pain Causes
      2. See Dyspnea Causes
      3. See Leg Pain Causes
  3. Step 1: Imaging Study
    1. Ventilation Perfusion Scan (V/Q Scan)
      1. Normal Probability V/Q Scan
        1. No further evaluation needed
        2. Evaluate for alternative diagnosis
      2. Low or Intermediate Probability VQ Scan
        1. Jump to Step 2 below
      3. High Probability V/Q Scan
        1. Treat with Pulmonary Embolism Management
    2. CT Pulmonary Angiogram (Spiral or helical chest CT)
      1. Spiral Chest CT suggestive for PE (Positive)
        1. Treat with Pulmonary Embolism Management
      2. Spiral Chest CT not suggestive for PE (Negative)
        1. Jump to step 2 below
  4. Step 2: Obtain Lower Extremity Compression Ultrasound
    1. Negative compression ultrasound
      1. Jump to step 3 below
    2. Positive compression ultrasound
      1. Treat with Pulmonary Embolism Management
  5. Step 3: Obtain pulmonary angiogram
    1. Pulmonary angiogram suggestive for PE (Positive)
      1. Treat with Pulmonary Embolism Management
    2. Pulmonary angiogram not suggestive for PE (Negative)
      1. No further evaluation needed
      2. Evaluate for alternative diagnosis
  6. References
    1. Ramzi (2004) Am Fam Physician 69:2829
    2. Wells (1998) Ann Intern Med 129(12):997

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