Teaching Points
- The role of a chest Xray in suspected Pulmonary Embolism (PE) is to exclude other causes that may mimic PE and to guide further investigations
- Prior to imaging, one must clinically calculate the probability of PE. This is based on the validated 'Wells Criteria'
- Clinical signs and symptoms of Deep Vein Thrombosis (DVT)
- PE as or more likely than an alternative diagnosis
- Previous history of DVT
- Active cancer
- Recent immobilisation
- Tachycardia
- Haemoptysis
- Patients who are at low probability for PE should have a D-Dimer. A negative D-Dimer in a low probability case of suspected PE rules out the diagnosis and no further investigatioin is indicated
- Patients with moderate to high pre-test probability of PE should have further imaging
- The choice of imaging is reliant on a 'Normal' CXR and whether the patient has a history of a chronic underlying lung disease
- Patients with a normal CXR and no history of lung disease should proceed to Radionuclide scan
- Patients with an abnormal CXR or history of lung disease should proceed to CTPA
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