Update in the diagnosis of deep-vein thrombosis and pulmonary embolism
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PURPOSE OF REVIEW: Diagnostic strategies for venous thromboembolism must both accurately diagnose thrombus when present, and safely exclude it when absent. This review summarizes recent data on diagnostic strategies for venous thromboembolism. RECENT FINDINGS: Noninvasive diagnostic strategies have emerged to limit the need for invasive testing for deep-vein thrombosis and pulmonary embolism. D-Dimer testing combined with clinical assessment can be used to safely exclude deep vein thrombosis, limiting the need for further testing. Extended lower limb ultrasonography also shows promise although requires further data. Spiral computed tomography has become widely used for the diagnosis of pulmonary embolism. Evidence either for the use of single-detector spiral computed tomography combined with ultrasound or for multidetector spiral computed tomography as a safe and stand-alone test, for the purpose of excluding pulmonary embolism, is finally catching up with current practice. SUMMARY: Invasive testing for venous thromboembolism can be safely avoided in the majority of patients, using diagnostic strategies combining noninvasive tests. Initial evidence suggests that multidetector spiral computed tomography is a safe stand-alone test for pulmonary embolism. Local cost and expertise with separate diagnostic tests will influence the appropriate choice of diagnostic strategies for venous thromboembolism at individual institutions.
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