Advances in the diagnosis of venous thromboembolism.

This review summarizes recent information about the diagnosis of deep venous thrombosis (DVT) and pulmonary embolism (PE) using noninvasive imaging tests, clinical assessment, and D-dimer assays, and describes how these tests can be employed in diagnostic testing algorithms for the investigation of patients with suspected DVT and PE. The clinical diagnosis of deep venous thrombosis is unreliable, but clinical prediction rules based on signs and symptoms do facilitate the categorization of patients into high, low, or medium risk categories. High sensitivity D-dimer assays further help in excluding cases but do not help in ruling in venous thromboembolism. D-dimer assays and clinical prediction rules also help in the diagnosis of pulmonary embolism. These assessments, along with objective imaging studies such as compression ultrasonography for DVT or computerized tomographic pulmonary angiograms for PE can be used in a systematic way to reliably rule in or exclude venous thromboembolism.