Pulmonary embolism is a great masquerader. It presents with numerous non-specific signs and symptoms that may mimic a variety of other clinical conditions. Once pulmonary embolism is suspected diagnostic and therapeutic procedures are highly dependent on the clinical presentation of the patient, the local resources, and the expertise of the doctor treating the patient. Many algorithms have been established to prevent underdiagnosing and over-diagnosing the disease as both carry a substantial risk of fatality. Unfortunately a universally accepted approach to the management of pulmonary embolism is still missing.

In 1997 the British Thoracic Society (www.britthoracic.org.uk) published a practical strategy for managing suspected pulmonary embolism, to bridge the gap between clinical research and routine management.1 Over the past six years more evidence has been generated, and a major update now means that these recommendations can be converted into practical guidelines for daily use.2 Four major issues in pulmonary embolism management deserve particular attention: D-dimer testing, computed tomography pulmonary angiography, thrombolytic …