Curr Probl Cardiol. 2010 Jul;35(7):314-76. doi: 10.1016/j.cpcardiol.2010.03.002.
Most large or fatal pulmonary embolisms (PE) at autopsy were unsuspected ante mortem. Newly identified clinical characteristics of PE enhance our ability to identify potential patients. Because of laudable efforts to diagnose PE, about 90% of outpatient computed tomographic (CT) angiograms are negative. Overuse of CT angiography has resulted in huge expenses and exposure of many to radiation. Approximately 30% of patients with suspected acute PE would not need imaging if D-dimer is normal and clinical assessment is not a high probability, but such triage is uncommonly used. Perhaps perfusion imaging should be used more frequently. Radiation and cost with scintigraphy are less than with CT angiography. Single-photon emission computed tomography lung scans appear to be more effective than planar lung scans. Diseases associated with an increased risk of PE are being identified, but recommended prophylaxis usually is not given. Potential benefits and risks of treatment options need to be assessed.
尸检发现，大多数大型或致命性肺栓塞（PE）生前并未被怀疑。新发现的 PE 临床特征增强了我们识别潜在患者的能力。由于人们努力诊断 PE，大约 90%的门诊计算机断层扫描（CT）血管造影术结果为阴性。过度使用 CT 血管造影术导致了巨大的开支和对许多人的辐射暴露。如果 D-二聚体正常且临床评估的可能性不高，约 30%的疑似急性 PE 患者不需要进行影像学检查，但这种分诊方法并不常用。也许灌注成像应该更频繁地使用。与 CT 血管造影术相比，闪烁扫描的辐射和成本较低。单光子发射计算机断层扫描肺扫描似乎比平面肺扫描更有效。与 PE 风险增加相关的疾病正在被识别，但通常不推荐预防性治疗。需要评估治疗选择的潜在益处和风险。
