Ep 114 Pulmonary Embolism Challenges in Diagnosis 2 – Imaging, Pregnancy, Subsegmental PE

This podcast episode addresses the challenges and nuances in diagnosing and managing pulmonary embolism (PE). It highlights the importance of pretest probability in interpreting CT scan results, noting that a negative CT doesn't always rule out PE, especially in high-risk patients. The discussion emphasizes treating the patient's clinical presentation rather than solely relying on the clot burden or location seen on CT. VQ-SPECT is presented as a promising alternative to CT scans for younger patients to reduce radiation exposure, while the complexities of diagnosing PE in pregnant patients are explored, including the limited evidence for D-dimer use and the risks associated with CT and VQ scans. The panel further examines the controversial topic of subsegmental PEs, questioning the routine use of anticoagulation due to bleeding risks and the potential for overdiagnosis. The need for clinical decision support and institutional policies to improve PE diagnosis and management in emergency departments is also examined.