Pulmonary embolism--a state of the clot review.

The assessment for pulmonary emboli is still Stone Age. History and physical findings are not sensitive or specific making it difficult to establish the diagnosis. PE is still potentially fatal. Death most often results from the severity of the clot, although delay in treatment may play a role. Clots, including deep venous thrombosis and pulmonary emboli, are the first disease that falls clearly under the Hospitalist specialty. An argument over what imaging is ideal continues to rage on, without any clear leader at this point. The CT scan and Ventilation/Perfusion scan are the two modalities being used most often. However without the use of a pretest probability the sensitivity and specificity can go down to less than 80%. The many new anticoagulants and oral therapies have widened the armamentarium, without increasing the success of therapy.