Diagnosis and management of pulmonary embolism

#### Summary points Pulmonary embolism is one manifestation of venous thromboembolism, the other being deep vein thrombosis. Pulmonary embolism occurs when a deep vein thrombosis breaks free, passes through the right side of the heart, and lodges in the pulmonary arteries. About 90% of pulmonary emboli come from the legs, with most involving the proximal (popliteal or more central) veins. Prevention of pulmonary embolism therefore requires both prevention of venous thromboembolism and effective treatment of deep vein thrombosis when it occurs. There is a wealth of high quality individual studies and meta-analyses to guide the diagnosis and treatment of pulmonary embolism, and we provide an overview and synthesis of that evidence in this review. #### Sources and selection criteria We searched Medline and the Cochrane Collaboration for up to date systematic reviews, meta-analyses, and high quality randomised controlled trials pertaining to the epidemiology, diagnosis, and treatment of pulmonary embolism. We also drew on the recently published guidelines on diagnosis and treatment of pulmonary embolism from the National Institute for Health and Clinical Excellence (NICE) and on treatment for venous thromboembolism from the American College of Chest Physicians. Symptomatic venous thromboembolism occurs in 1–2 per 1000 adults each year, with about a third …