Pulmonary Embolism Diagnosis After Surgery

A patient presenting with breathlessness on the third post-operative day after bariatric surgery raises suspicion for pulmonary embolism (PE).

Confirming Pulmonary Embolism

The primary goal is to rapidly and accurately confirm or exclude PE. CT pulmonary angiography (CTPA) is the investigation of choice for diagnosing PE in most patients.

Evaluation of Diagnostic Options:

• Echocardiography: Primarily assesses cardiac function. It can show signs of right heart strain suggestive of PE but is not diagnostic on its own.
• Duplex Venography: Used to detect deep vein thrombosis (DVT), the common source of PE. However, it is invasive and does not directly visualize the lungs.
• CT Pulmonary Angiography (CTPA): This imaging technique directly visualizes the pulmonary arteries and is the gold standard for confirming PE by identifying blood clots.
• MR Angiography: Can detect PE but is often less readily available, more time-consuming, and may be less sensitive than CTPA in emergency settings.

Recommended Investigation

Given the high suspicion of PE based on symptoms (breathlessness) in a post-operative patient, CT pulmonary angiography is the most appropriate next investigation to confirm the diagnosis.