Key result
Emergency CTPA confirms PE in ~21% of suspected cases and frequently reveals relevant alternative diagnoses.
Why the study?
Overlapping symptoms and reliance on non-specific biomarkers often lead to over-testing with CT pulmonary angiography for suspected acute pulmonary embolism.
What is the diagnostic yield of CTPA for acute pulmonary embolism and the frequency of alternative diagnoses in the emergency department?
Cross-Sectional (n=659)
No
What is the diagnostic yield of CTPA for acute pulmonary embolism and the frequency of alternative diagnoses in the emergency department?
CTPA in the emergency department has a diagnostic yield of 20.9% for PE but identifies alternative diagnoses in 72% of negative scans, highlighting the need for age-adjusted D-dimer thresholds to optimize resource use.
CTPA supports broad ED utility via alternative diagnoses; extends observational consensus while leaving refined selection criteria open.
Background Computed Tomography Pulmonary Angiography (CTPA) is the gold standard for diagnosing acute Pulmonary Embolism (PE). However, overlapping symptoms and reliance on non-specific biomarkers often lead to over-testing. This study provides a comprehensive analysis of CTPA utilization, evaluating diagnostic yield, biomarker performance, and the landscape of alternative thoracic diagnoses with a special focus on radioprotection. Methods A retrospective, single-centre study of 659 patients evaluated in the Emergency Department (ED) between January 2023 and November 2025. Data were extensively stratified by patient age, presenting symptoms, D-dimer thresholds, and radiological outcomes. Results The global diagnostic yield was 20.9% (138/659). Advanced age correlated linearly with PE prevalence (25.2% in patients > 70 years) but inversely with D-dimer specificity, resulting in a 42% false-positive biomarker rate in the geriatric cohort. Dyspnea was the most common presenting symptom (62%) but demonstrated limited diagnostic specificity for PE. Crucially, in the 521 PE-negative scans, CTPA provided clinically relevant alternative diagnoses in 72.0% of cases (375/521), primarily infectious consolidations and heart failure. Conclusion While clinical triage remains within optimal international benchmarks, the standard diagnostic algorithm is heavily confounded by patient age and inflammatory "PE mimics." Integrating age-adjusted D-dimer thresholds and structured pre-test probability scoring is imperative to optimize resource allocation and mitigate unnecessary radiation exposure while preserving diagnostic safety (Righini in JAMA 311:1117–1124, 2014;Konstantinides in Eur Heart J 41:543–603, 2020;).
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Lionetti et al. (2026) conducted a cross-sectional in Suspected acute Pulmonary Embolism (n=659). Computed Tomography Pulmonary Angiography (CTPA) was evaluated on Diagnostic yield (proportion of PE-positive scans) (95% CI 17.8%-24.1%). Emergency Computed Tomography Pulmonary Angiography (CTPA) for suspected pulmonary embolism yielded a positive diagnosis in 20.9% of patients, while providing clinically relevant alternative diagnoses in 72.0% of negative scans.
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