Algorithm of Gossage for Diagnosis of Massive Pulmonary Embolism

Description

Gossage proposed a clinical algorithm for evaluating a patient suspected of having a massive pulmonary embolism.

Parameters:

(1) patient’s clinical condition

(2) clinical suspicion for pulmonary embolus

(3) imaging study findings

Clinically Stable

Suspicion	Imaging Studies	Management
any	VPS high probability	treat for massive PE
any	VPS nondiagnostic	perform alternative test
high	VPS normal	perform alternative test
low or intermediate	VPS normal	pursue other diagnosis

where:

• VPS indicates ventilation perfusion scan.

• Alternative tests include pulmonary angiography, spiral CT angiography, and lower extremity Doppler.

NOTE: I have modified the algorithm slightly to include additional studies if a high clinical suspicion is present and the ventilation-perfusion scan is normal. This was based on the editorial by Gallagher EJ in Annals of Emergency Medicine (2000; 35: 181-187).

Clinically Unstable

Transthoracic Echocardiogram or PA Catheterization	Imaging Studies	Management
right ventricular overload	transesophageal echocardiogram shows clot	treat for massive PE
right ventricular overload	transesophageal echocardiogram negative	consider further testing
normal		consider further testing or pursue other diagnosis
other diagnosis		treat other disorder

where:

• PA = pulmonary artery

• If the clinical suspicion was high I would include alternative tests for pulmonary embolus if further testing is recommended.

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Description

Specialty

ICD-10