• Extremely common and highly lethal condition that is a leading cause of death in all ages. 650,000 cases occurring annually. 100,000 deaths attributed annually to PE.
• Arise from DVT anywhere in the body Risk does increase with age
• Prompt diagnosis and treatment dramatically reduces the mortality rate and morbidity of the disease

Clinical Indications

• Chest pain
• Chest wall tenderness
• Back pain
• Shoulder pain
• Upper abdominal pain
• Syncope
• Hemoptysis
• Shortness of breath
• Painful respiration
• New onset of wheezing
• Arrhythmia
• Phlebitis
• Lower extremity swellings, cords, tenderness
• Any other unexplained symptom referable to the thorax

ICD-9 Diagnosis Codes

• Chest pain - 786.50
• Chest wall tenderness - 786.52
• Back Pain - 724.5
• Low back pain - 724.2
• Shoulder pain - 719.41
• Upper abdominal pain - 789.0
• Syncope - 780.2
• Hemoptysis - 786.3
• Shortness of breath - 786.05
• Painful respiration - 786.52
• New onset of wheezing - 786.07
• Arrhythmia -427.9
• Phlebitis
• 451.19 - (lower extremity deep vessels)
• 451.11 - (femoral vein)
• Lower extremity swellings, cords, tenderness - 729.81
• Any other unexplained symptom referrable to the thorax - 519.9

Pulmonary Embolism

1. Chest x-ray may be normal in some cases but more often than not, there will be one of the following findings:atelectasis, pleural effusion or prominent central pulmonary arteries.

2. Nuclear scintig raphic ventilation-perfusion (V/Q scan). Utilize whenever there is any suspicion of PE. V/Q should be considered for those patients with DVT that are asymptomatic. Repeat V/Q is indicated prior to stopping anticoagulation in patients with irreversible risk factors for DVT and PE.

3. CT Chest (relatively new procedure). Hight resolution CT with IV contrast material. ORDERS MUST SPECIFY CT CHEST WITH PE PROTOCOL. Patient will need at least a 20 guage needle for injection of the contrast material. Utilize when the V/Q is equivocal or does not agree with the clinical findings for high probability of PE.

4. Duplex Ultrasound (diagnosis of PE can be proven by demonstrating the presence of a DVT. The Duplex study is positive in 40% of the patients with PE, however, a negative study does not rule out the presence of PE>

5. Pulmonary Angiography is reserved for patients that can't undergo the CAT protocol or if after CT there is still some doubt about the presence of PE.