Choosing Wisely:

Don’t image for suspected pulmonary embolism (PE) without moderate or high pretest probability.

Rationale and Comments: While deep venous thrombosis (DVT) and PE are relatively common clinically, they are rare in the absence of elevated blood D-dimer levels and certain specific risk factors. Imaging, particularly CT pulmonary angiography, is a rapid, accurate, and widely available test, but has limited value in patients who are very unlikely, based on serum and clinical criteria, to have significant value. Imaging is helpful to confirm or exclude PE only for such patients, not for patients with low pretest probability of PE.
Sponsoring Organizations:
  • American College of Radiology
  • Sources:
  • European Society of Cardiology guidelines
  • American College of Emergency Physicians guidelines
  • Disciplines:
  • Pulmonary medicine
  • References: • Torbicki A, et al. Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2008;29(18):2276-315.
    • Neff MJ. ACEP releases clinical policy on evaluation and management of pulmonary embolism. Am Fam Physician. 2003;68(4):759-60.
    • Stein PD, et al. Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II Investigators. Radiology. 2007;242(1):15–21.

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