Diagnostic management of acute pulmonary embolism in special populations.

INTRODUCTION: Pulmonary embolism (PE) is a potentially life-threatening disease, making an accurate and prompt diagnosis thus very important. However, the normally used diagnostic algorithms may not be as efficient and safe in special patient populations. The diagnostic management of suspected PE in these patients is particularly challenging. AREAS COVERED: Current diagnostic strategies in patients with malignancy, elderly patients and patients with renal insufficiency are discussed in this review. A special focus is on reviewing the literature supporting the use of adjusted D-dimer cutoffs in these patient categories and the current guideline statements. Information is obtained through an extensive literature search of the following databases: PubMed, Embase, Web of Science, COCHRANE Library and Emcare (searched September 2019). EXPERT OPINION: A diagnostic strategy starting with clinical decision rules (CDRs) and D-dimer testing is clinically useful, also in these three patient categories, since it reduces the need for computed tomography pulmonary angiography (CTPA). The use of adjusted D-dimer cutoffs is preferred over a fixed cutoff as it safely improves the yield of the CDR/D-dimer combination.