A 52-year-old man presents to the emergency department with chest pain. He has recently returned from Australia and has a history of a painful swollen right calf over the last couple of days. He is otherwise usually fit and well and has no known allergies. You suspect a diagnosis of a pulmonary embolism (PE).

1. What is the gold standard diagnostic test for PE?
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A computed tomography pulmonary angiogram (CTPA) will confirm the diagnosis of a PE and is the gold standard diagnostic test for a PE.

2. What other investigations can be helpful in the workup of suspected PE?
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The D-dimer is usually raised in a PE but is non-specific. Another helpful investigation in a patient presenting with a possible is a chest X-ray to exclude other pathology.

If a patient has renal failure or contrast allergy, a ventilation/ perfusion single-photon emission computed tomography (V/Q SPECT) can be used instead of a CTPA.

3. How should a patient with PE be treated?
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The treatment of PE can include the following:

  • Give supplemental oxygen as required
  • Obtain intravenous access
  • Give analgesia if necessary
  • Offer a choice of low molecular weight heparin (LMWH) or fondaparinux
  • Offer unfractionated heparin if the patient has severe renal impairment
  • Offer a vitamin K antagonist (VKA)



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