The Diagnosis and Treatment of Pulmonary Embolism

Abstract

Trials of newer anticoagulants and longer durations of anticoagulation have not yielded real improvements over heparin, inviting doubts regarding its efficacy. Thus, PE is the quintessential diagnosis of medicine not because it represents our greatest success, but because it captures all the complexity of medicine in the evidence-based era. It may serve as a metaphor for many other conditions in medicine, including coronary artery disease. New trials in the field continue to test trivialities, whereas fundamental questions are unanswered.

Subsegmental pulmonary embolism: is the emperor still naked?

“…The above mentioned considerations recently induced Prasad et al [2] to state that the story of pulmonary embolism is a story of overdiagnosis. Their view was famously anticipated by a classical paper by Robin in 1977 with the evocative title: "Overdiagnosis and overtreatment of pulmonary embolism: the emperor may have no clothes" [4].…”

“…Le EPSS sono piuttosto comuni anche nei pazienti non oncologici [13] e possono presentarsi isolatamente, in assenza di difetti di riempimento centrali o di maggiori dimensioni (probabilmente il 5% di tutte le EP rilevate [2]). …”

“…SSPE are rather common even in non-cancer patients [13] and can occur in isolation, in the absence of central or larger filling defects (probably 5% of all detected PE [2]). …”

“…Besides, based on Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II data (sensitivity 83%, specificity 96%) [34], at a disease prevalence of approximately 5%, the number of false positive patients approaches the number of true positive CTPA studies for the detection of acute PE, and this problem is probably even Prasad et al [2] at the end of their article, rightly stated that "PE captures all the complexity of medicine in the evidence-based era".…”

“…1) [2]. Poiché la radiologia è profondamente coinvolta in questa discussione, riteniamo che una breve panoramica di questo importante argomento sia di grande interesse per i lettori.…”