ACR Appropriateness Criteria® Management of Acute Pulmonary Embolism

Acute pulmonary embolism (PE) is a subclass of venous thromboembolism, which can be associated with significant morbidity and mortality. Risk stratification algorithms classify PE into high-risk (massive), intermediate-risk (submassive), and low-risk groups, with management guidelines determined based on clinical risk. For high-risk PE, first-line treatment options may include anticoagulation, systemic thrombolysis, catheter-directed therapies, and surgical embolectomy. For intermediate-risk PE, management may involve anticoagulation and catheter-directed therapies, whereas for low-risk PE, management typically involves anticoagulation alone. Special case scenarios, such as a clinical contraindication to thrombolysis or right atrial thrombus-in-transit, may require a modified treatment approach. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.