Contribution and limits of the combination of lung scan and venous duplex in the management of pulmonary embolism

Purpose.-To assess the accuracy of diagnostic strategy of pulmonary embolism (PE) based on clinical examination, lung scan and venous duplex US findings. Methods.-1,819 patients have been included in a prospective study (mean age: 66, range: 6-102, F 54% H 46%) over a 13 month period. Results.-To decide the opportunity of anticoagulant therapy, lung scan alone is decisive in 30.6% of the cases. When taking into account clinical examination, lung scan and venous duplex US findings in a combined diagnostic strategy, a therapeutic decision can be made for 74.2% of the patients. The decisive characteristics of this strategy were influenced by two factor: age (therapeutic decision can be reached for 83% of the patients aged 30 to 50 vs 65% when they are over 85, p < 0.01); history of heart or pulmonary disease (therapeutic decision reached in 62% of the cases with history vs 78% without, p < 0.01). Conclusion.-Pulmonary angiography seems theoretically necessary in less than 26% of the patients with suspected PE when they have undergone lung scan and venous duplex US. In this case, and when these strategies are not very decisive, it would be important to assess the diagnostic value of spiral spiral CT scaning.