Pulmonary Embolism Diagnosis and Management

Pulmonary embolism (PE) is an acute obstruction of the pulmonary arterial circulation, typically originating from thrombi in the deep veins of the lower limbs. Clinical presentation varies from silent, incidental findings to sudden cardiovascular collapse. Early and accurate diagnosis relies on assessment of clinical probability, D-dimer assays and imaging. Computed tomography pulmonary angiography (CTPA) is the diagnostic gold standard, while ventilation–perfusion (V/Q) scanning remains valuable when CTPA is contraindicated or inconclusive. Biomarkers such as troponin and natriuretic peptides aid in risk stratification by indicating right ventricular stress. Management hinges on prompt anticoagulation, most often with direct oral anticoagulants or heparin, to prevent clot propagation. In patients at high risk of haemodynamic compromise, systemic thrombolysis, catheter-directed therapies or surgical embolectomy may be warranted. Mechanical circulatory support, including veno-arterial extracorporeal membrane oxygenation, can serve as a bridge in massive PE. Recent advances encompass molecular profiling for novel plasma biomarkers, integration of artificial intelligence into imaging interpretation and protocols for safe outpatient care. Despite these developments, challenges persist in individualising therapy, reducing residual pulmonary hypertension and integrating emerging technologies into everyday practice.

Research from Nature Portfolio

Proteomic analysis has revealed Complement Factor H Related 5 protein as a potential plasma biomarker for venous thromboembolism, exhibiting associations with heightened thrombin generation and platelet activation, and offering a pathway to more precise risk prediction and early diagnosis of PE. Concurrently, advances in deep learning have produced multimodal fusion models that combine CTPA pixel data with electronic health record variables, achieving superior diagnostic accuracy for pulmonary embolism compared with single-modality approaches and pointing towards enhanced clinical decision support systems.

Pulmonary Embolism Diagnosis and Management publication trend

The graph below shows the total number of articles in pulmonary embolism diagnosis and management across all publications each year (not limited to Nature Index journals).

Technical terms

Computed tomography pulmonary angiography (CTPA): Contrast-enhanced CT imaging technique used to visualise the pulmonary arteries and detect emboli.

Ventilation–perfusion (V/Q) SPECT: Nuclear medicine method combining tomographic ventilation and perfusion scans to identify regional mismatches indicative of PE.

Direct oral anticoagulant (DOAC): A class of anticoagulant drugs, including factor Xa inhibitors, that do not require routine laboratory monitoring for dose adjustment.

Systemic thrombolysis: Intravenous administration of fibrinolytic agents to dissolve pulmonary arterial clots in high-risk PE.

References

1. Elevated plasma complement factor H related 5 protein is associated with venous thromboembolism. Nature Communications (2023).
2. Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation. Critical Care (2017).
3. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. European Journal of Nuclear Medicine and Molecular Imaging (2019).
4. The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis. Critical Care (2011).
5. Multimodal fusion with deep neural networks for leveraging CT imaging and electronic health record: a case-study in pulmonary embolism detection. Scientific Reports (2020).
6. Early discharge and home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban: an international multicentre single-arm clinical trial. European Heart Journal (2019).