III. Evaluation: Step 1 - Imaging Study

  1. CT Pulmonary Angiogram (Spiral or helical chest CT, preferred)
    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
  2. Ventilation Perfusion Scan (V/Q Scan)
    1. Indicated if CT Angiography contraindicated
    2. Normal Probability V/Q Scan
      1. No further evaluation needed
      2. Evaluate for alternative diagnosis
    3. Low or Intermediate Probability VQ Scan
      1. Jump to Step 2 below
    4. High Probability V/Q Scan
      1. Treat with Pulmonary Embolism Management

IV. Evaluation: Step 2 - Obtain Lower Extremity Compression Ultrasound

  1. Negative Compression Ultrasound
    1. Positive D-Dimer
      1. Jump to step 3 below OR
      2. Treat empirically as VTE and repeat the Ultrasound in 1 week
    2. Negative D-Dimer
      1. Consider alternative diagnosis
  2. Positive Compression Ultrasound
    1. Treat with Pulmonary Embolism Management

V. Evaluation: 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

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window