The diagnosis and treatment of pulmonary embolism, with its attendant 30 per cent mortality in untreated patients, is predicated on the physician's suspicion, although a paucity of signs and symptoms may be present. An algorithmic approach utilizing non-invasive screening tests and invasive pulmonary angiography when appropriate, together with the judicious use of supportive care, anticoagulation, thrombolytic therapy, and surgical thromboembolectomy, has been shown to produce significant reductions in morbidity and mortality. When indicated, selective use of caval filters is also effective prophylaxis for recurrent embolization. Future diagnostic studies may include CT in chronic embolizations and single-photon-emission CT (SPECT) scanning, although their role in supplanting angiography has not been fully elucidated.
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