Imaging recommendation · Chest

Acute dyspnea or pleuritic chest pain

Q: What's the alternative imaging for acute dyspnea or pleuritic chest pain when pregnancy?

US — Bilateral LE Doppler → V/Q if negative (no contrast).

Q: What's the alternative imaging for acute dyspnea or pleuritic chest pain when already on therapeutic anticoag, low concern?

Often no imaging needed (no contrast).

Recommended: CT Pulmonary Angiogram (CTPA) is the preferred imaging study for acute dyspnea or pleuritic chest pain. Risk-stratify with Wells / PERC and d-dimer before imaging.

Recommended study

CT Pulmonary Angiogram (CTPA)

CT IV contrast Preferred Chest EmergencyAcute inpatient Reviewed 2026-04

Risk-stratify with Wells / PERC and d-dimer before imaging. CTPA is the modality of choice when imaging is indicated.

If the default doesn't apply

Pregnancy

US Bilateral LE Doppler → V/Q if negative No contrast

Iodinated contrast contraindicated

NM V/Q scan No contrast

Already on therapeutic anticoag, low concern

Often no imaging needed No contrast

Watch-outs

PERC negative / Wells low

Do not image — d-dimer first or no work-up.

Hemodynamically unstable

Consider bedside echo over delayed CTPA; activate massive PE pathway.

Pearls

Subsegmental PE on CTPA — incidence rising with detector resolution; clinical context dictates treatment.
20G antecubital IV or larger required for CTPA bolus timing.