We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

When Can Treatment Be Withheld in Patients With Suspected Pulmonary Embolism?

James E. Dalen, MD
Arch Intern Med. 1993;153(12):1415-1418. doi:10.1001/archinte.1993.00410120005001.
Text Size: A A A
Published online


OBJECTIVE TESTS are needed to confirm or exclude the diagnosis of venous thromboembolism because the accuracy of the clinical diagnosis is less than 50%.1,2 The most accurate tests available for the diagnosis of pulmonary embolism and deep venous thrombosis (DVT) are pulmonary angiography1 and contrast venographhy.3 With technically adequate studies, false-negative tests are rare. Therefore, a normal pulmonary angiogram is sufficient evidence to withhold treatment in patients with suspected pulmonary embolism,4 and a normal venogram precludes the need for therapy in patients with suspected DVT.5

Unfortunately, pulmonary angiography and venography are expensive, invasive tests that have associated morbidity, and are not available at all hospitals. Therefore, noninvasive tests play a critical role in the evaluation of patients with suspected venous thromboembolism.

Two noninvasive tests for deep venous thromboembolism, impedance plethysmography (IPG) and ultrasonography have an excellent correlation with venograms in patients with proximal DVT of


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

55 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.