Pulmonary embolism (PE)

Diagnostic and therapeutic approach


Probability of pulmonary embolism

If high probability do CT scan.

Low or intermediate probability dose D-dimers. If D-dimers normal no treatment if D-dimers augmented CT scan or echocardiography.

If diagnosis of pulmonary embolism confirmed or probable estimate the risk to start treatment.

  • BP > 90 mm Hg, biomarkers and echo negatives, low risk.
  • BP > 90 mm Hg, biomarkers high (BNP, troponine) and positive echocardiography, intermediate risk.
  • BP < 90 mm Hg, shock, resuscitation high risk.

Predisposing factors

High risk

  • Bone leg fracture, hip or knee surgery.
  • History of venous thrombosis or MI in the last 3 months.
  • Major general trauma or vertebral trauma.
  • Atrial flutter or heart failure.

Intermediate risk

  • Post-partum, Thrombophilia, Contraception, Infection, Superficial venous thrombosis.
  • CVA, Cancer, Colic inflammatory disease.

Risque faible

  • Diabetes, Hypertension, Status varicose.
  • Advanced age, Pregnancy, Obesity.
  • Laparoscopy, Bed rest > 3 days.