Acute pulmonary embolism (PE) is a common and sometimes fatal disease. Clinical evaluation and diagnostic testing is necessary before starting anticoagulation, which is the mainstay of therapy for PE. The approach to the evaluation should be efficient because avoiding delays in initiating therapy reduces morbidity and mortality from PE [1,2].
The clinical manifestations, evaluation, and diagnosis of PE are discussed in this topic. The pathophysiology, treatment, and prognosis of PE as well as the diagnosis of PE during pregnancy are reviewed separately. (See "Overview of acute pulmonary embolism in adults" and "Treatment of acute pulmonary embolism" and "Anticoagulation in acute pulmonary embolism" and "Fibrinolytic (thrombolytic) therapy in acute pulmonary embolism and lower extremity deep vein thrombosis" and "Pulmonary embolism in pregnancy: Epidemiology, pathogenesis, and diagnosis".)
Pulmonary embolism (PE) has a wide variety of presenting features, ranging from no symptoms to shock or sudden death [3-6]. The most common presenting symptom is dyspnea followed by pleuritic pain and cough. However, many patients, including those with large PE, have mild or nonspecific symptoms or are asymptomatic. Thus, it is critical that a high level of suspicion be maintained such that clinically relevant cases are not missed.
History and examination — The most common symptoms in patients with PE were identified in the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) study (table 1) . They include the following:
●Dyspnea at rest or with exertion (73 percent)