**12.2.4 Laboratory findings**

A chest x-ray, an ECG, and arterial blood gas values should be obtained. If pulmonary embolism is still considered to be likely, the next step is usually to obtain a ventilationperfusion lung scan. If the lung scan is likely to be indeterminate (because of underlying lung disease), spiral chest CT scans may be useful. Finding deep vein thrombosis with ultrasonography indicates the need for anticoagulation and usually eliminates the need for further testing for pulmonary emboli. The gold standard for diagnosing pulmonary embolism is pulmonary angiography.

**Chest x-rays:** Results of chest x-rays may be normal or may show nonspecific abnormalities, eg, atelectasis, an elevated hemidiaphragm, pleural effusion, or an infiltrate.

**ECG:** ECG findings are usually nonspecific; 33% of patients with pulmonary embolism have a normal ECG.

BNP (brain natriuretic peptid) and echocardiography may be also useful determinants of the short-term outcome for patiens with PE (Sanchez et al., 2010).

**d-Dimer:** Levels of d-dimer, a fibrin-specific product, are increased in patients with acute thrombosis (Douma et al., 2010; Kabrhel et al. 2010). About 60% of patients < 50 who are suspected of having a pulmonary embolus have an abnormal d-dimer result. In contrast, 92% of patients > 70 have abnormal d-dimer levels, probably due to comorbid conditions (Douketis

Pulmonary Embolism in the Elderly – Significance and Particularities 59

knee or hip replacement and in abdominal surgery (Bottaro et al., 2008). For total hip replacement, some investigators find that 4 to 6 weeks of LMWH postoperatively may be

The approach to older patients should be consistently individualised. New diagnostic methods and therapeutic algorithms used in acute geriatric wards together enable us to treat successfully also multi-morbid patients in advanced age admitted by hospital's doctors. Modern iatrotechniques make possible also the treatment (including recovery) and protect self-sufficiency and preserve quality of life in the elderly being

Physicians committed to the care of elderly patients, are challenged with the diagnosis of venous thrombembolism due to a higher incidence, co-morbidities masking signs and

We would like to emphasize the need to permanently think of the possibility of PE in elderly persons with present risk factors and in suspected cases the use of pretest probability scale as Wells or Geneva score as soon as possible (Carrier et al., 2009` Pasha et al., 2010). The requirement of correctly assessed diagnosis and starting of therapeutic procedures is crucial and essential proceeding for giving the hope to patient and generally, from the professional

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more effective (Kanaan et al., 2007).

symptoms and burdening referrals (Siccama et al., 2011).

viewpoint, improvement of the prognosis.

**13. Conclusion** 

acutely ill.

**14. References** 

9746

et al., 2010). Therefore, if d-dimer test results are negative, deep vein thrombosis or pulmonary embolism is unlikely to be present, but positive test results are not useful in patients > 70.

The use of d-dimers as a secondary strategy to exclude the diagnosis of VTE has been recommended because the test has a high sensitivity, although a low specificity. False positives may occur in patients with recent trauma or surgery, malignancy, pregnancy, severe infections, and liver disease.
