Question

If a patient is having a pulmonary embolism what diagnostic tests should be done immediately. Please put your reference down. Thank you!!

Answer 1

Pulmonary embolism can be detected from the following diagnostic tests:

• A blood test to look for a protein called D-dimer. High levels of D-dimer in blood suggests that pieces of blood clot are loose in the bloodstream. D‐dimer levels rise in patients with an acutely formed clot. Blood tests also can measure the amount of oxygen and carbon dioxide in the blood.  A clot in a blood vessel in the lungs may lower the level of oxygen in the blood.
• Chest X-ray. Although X-rays can't diagnose pulmonary embolism and may even appear normal when pulmonary embolism exists, they can rule out conditions that mimic the disease. Or an ultrasound scan, A noninvasive test known as duplex ultrasonography (sometimes called duplex scan or compression ultrasonography) uses sound waves to scan the veins in the thigh, knee and calf, and sometimes in the arms, to check for deep vein blood clots to see for a blood clot in the leg, and tests to check how well the lungs are working.
• A computerised tomography pulmonary angiography (CTPA) to see the blood vessels in the lungs.
• A ventilation-perfusion scan, also called a V/Q scan or isotope lung scanning, to examine the flow of air and blood in the lungs. If the scan shows parts of the lungs have air in them but no blood supply, this may be the result of a pulmonary embolism.

• Pulmonary angiogram: This test provides a clear picture of the blood flow in the arteries of lungs. It's the most accurate way to diagnose pulmonary embolism, but because it requires a high degree of skill to administer and has potentially serious risks, it's usually performed when other tests fail to provide a definitive diagnosis.

• MRI is usually reserved for pregnant women (to avoid radiation to the fetus) and people whose kidneys may be harmed by dyes used in other tests.

• Ventilation/perfusion single photon emission tomography (V/Q SPECT): As its name indicates, V/Q SPECT provides tomographic (transverse, coronal, and sagittal) rather than planar images. It is performed with patient in the supine position.

References:

-https://www.blf.org.uk/support-for-you/pulmonary-embolism/diagnosis

-https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/diagnosis-treatment/drc-20354653

-https://onlinelibrary.wiley.com/doi/full/10.1111/jth.13694