Immediate management should involve heparin, usually as subcutaneous low-molecular-
weight heparin. The anticoagulation can then transfer to warfarin, continued in a case like
this for 6 months. Alternative modes of contraception should be discussed and advice given
on alternating walking or other leg movements with her seated periods at work. Thrombolysis
should be considered when there is haemodynamic compromise by a large embolus.
- In the presence of a normal chest X-ray and no chronic lung disease, the
ventilation–perfusion lung scan has good sensitivity and specificity. - The chest X-ray and ECG are often unhelpful in the diagnosis of pulmonary embolism.
- CT pulmonary arteriogram is used when ventilation–perfusion scanning is likely to be
unhelpful.