Can I see an X-ray showing pulmonary embolism?

From the Guidelines

I cannot provide you with an actual X-ray showing pulmonary embolism as I don't have the capability to share images. X-rays alone are actually not the preferred imaging method for diagnosing pulmonary embolism (PE) because they often appear normal even when a PE is present. The gold standard for diagnosing PE is a CT pulmonary angiogram (CTPA), which uses contrast dye to visualize blood vessels in the lungs and can clearly show clots blocking pulmonary arteries, as stated in the most recent guidelines 1. Other diagnostic tests include ventilation-perfusion (V/Q) scans, which are sometimes used when CT scans are contraindicated, and pulmonary angiography, which is more invasive. If you're concerned about a possible pulmonary embolism, it's crucial to seek immediate medical attention as this is a potentially life-threatening condition that requires prompt diagnosis and treatment, with symptoms including sudden shortness of breath, chest pain, rapid heart rate, and coughing up blood, as highlighted in 2. The diagnosis of PE has been facilitated by technical advancements and multidetector CT pulmonary angiography, which is the major diagnostic modality currently used, according to 3. In hemodynamically stable patients with a low or intermediate clinical likelihood of PE, normal results on D-dimer testing obviates the need for PE imaging, as noted in 2. Given the high morbidity and mortality associated with PE, it is essential to prioritize prompt diagnosis and treatment, as emphasized in 4. Therefore, the most appropriate course of action is to seek immediate medical attention and undergo a CT pulmonary angiogram (CTPA) if suspected of having a pulmonary embolism, as recommended by the latest guidelines 1.

Some key points to consider:

• The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel, as stated in 5.
• The diagnosis of PE is challenging due to the nonspecific nature of the clinical presentation, with associated symptoms such as chest pain, shortness of breath, and tachycardia that may mimic other pulmonary or cardiac conditions, as noted in 1.
• Clinical decision trees, most notably the Wells criteria, have been developed and validated to help guide clinicians during their evaluation of patients with suspected acute PE, as mentioned in 4.
• D-dimer levels will be elevated with any significant thrombotic process, so this test is of limited value in pregnant, postoperative, and trauma patients, as highlighted in 6.
• The use of imaging studies, such as CT pulmonary angiography, is crucial in the diagnosis of PE, especially in patients with a high pretest probability of PE, as recommended in 2.

Overall, prompt diagnosis and treatment of pulmonary embolism are critical to reducing morbidity and mortality, and the use of CT pulmonary angiography is the gold standard for diagnosis, as emphasized in the most recent guidelines 1.

From the Research

Imaging of Pulmonary Embolism

• Pulmonary embolism can be diagnosed using various imaging modalities, including computed tomography (CT) pulmonary angiography (CTPA), ventilation-perfusion (VQ) scan, magnetic resonance imaging (MRI), and catheter pulmonary angiography 7.
• CTPA is the current standard of care and provides accurate diagnosis with rapid turnaround time 7.
• Chest radiograph has limited utility in diagnosing pulmonary embolism, but can be useful in evaluating other potential causes of chest pain 7.
• Echocardiography is used for risk stratification of patients with pulmonary embolism 7.

Diagnostic Criteria

• The angiographic criteria for the diagnosis of pulmonary embolism include intraluminal vascular filling defects or an abrupt cutoff of a large vessel 8.
• Refinements in the technique of pulmonary angiography have simplified and expanded its application 8.

Clinical Presentation and Diagnosis

• Patients with pulmonary embolism may present with variable symptoms, and initial diagnosis can be challenging 9.
• A diagnostic algorithm consisting of Wells Rule, D-Dimer testing, echocardiography, and CT pulmonary angiogram can be used to diagnose pulmonary embolism 10.
• Early diagnosis by doing urgent CTPA in patients with suspected acute PE is crucial in reducing mortality 10.

Treatment and Management

• Treatment options for patients with pulmonary embolism include anticoagulation, thrombolytics, and mechanical or surgical thrombectomy 9.
• Management decisions regarding pregnancy and COVID-19 are important considerations in the treatment of pulmonary embolism 9.
• Outpatient treatment of low-risk patients with pulmonary embolism is a possible option 9.