Evaluation of the nonpregnant adult with high probability of pulmonary embolism

PE: pulmonary embolism; CT: computed tomography.
* We prefer the Wells criteria to determine the pretest probability of PE, although the modified Geneva score or clinical gestalt is also appropriate. Refer to UpToDate text for details.
¶ Feasibility requires adequate scanner technology. Also the patient must be able to lie flat, to cooperate with exam breath-holding instructions, have a body habitus that can fit into scanner, and no contraindications for iodinated contrast.
Δ Repeat CT pulmonary angiography for more definitive results may be worthwhile if the factor causing poor image quality can be mitigated (eg, patient more capable of co-operating with positioning and breath-holding instructions). Repeat imaging is unlikely to prove useful if exam is nondiagnostic from factors such as scanner technology, body habitus, or indwelling metallic foreign bodies.
◊ Feasibility requires a chest radiograph demonstrating clear lungs and a patient able to lie still for >30 minutes.
§ Further testing first involves revisiting the feasibility of CT pulmonary angiography. If CT pulmonary angiography is still not feasible then lower extremity compression ultrasonography with Doppler is appropriate.