A 37-year-old with suspected pulmonary embolism presents with cough and anxiety. What is the next best test to perform?

The best next test to perform in the case of a suspected pulmonary embolism is helical CT pulmonary angiography. This imaging modality is highly effective in diagnosing pulmonary embolism due to its ability to visualize the pulmonary arteries directly. It provides detailed images and can quickly identify any blockages or clots present in these vessels, which is critical for timely diagnosis and management.

Helical CT pulmonary angiography is favored not only for its diagnostic accuracy but also for its availability and rapid execution, making it the preferred choice in acute settings. Additionally, this test can be performed with contrast material, which enhances the visibility of blood vessels, helping to confirm the presence of emboli.

The other options, such as spirometry, MRI, and contrast venography, do not provide the same level of specificity or practicality for diagnosing pulmonary embolism. Spirometry is used to assess lung function but does not evaluate the vascular aspects of the lungs. MRI, while useful in some contexts, is not typically a first-line test for pulmonary embolism due to longer acquisition times and limited availability in emergency settings. Contrast venography has largely fallen out of favor for diagnosing deep vein thrombosis, which is often the source of pulmonary emboli, as it is more invasive and less effective than