Trombo-embolismo pulmonar: necesitamos sospecha clínica

Autores/as

  • M.T. García-Sanz Hospital do Salnés
  • C. Pena-Álvarez Complejo Hospitalario de Pontevedra
  • F.J. González-Barcala Complejo Hospitalario Universitario de Santiago

Palabras clave:

Tromboembolismo pulmonar. Diagnóstico diferencial. Síndromes clínicos. Síntomas frecuentes. Retraso diagnóstico.

Resumen

La enfermedad tromboembólica venosa (ETV) es un importante problema de salud, con una incidencia anual de 1-2 casos /1.000 personas. Un tercio de los pacientes con ETV sintomática cursan con tromboembolismo pulmonar (TEP), que es frecuentemente infradiagnosticado debido a su presentación clínica variable e inespecífica. El conocimiento de los signos y síntomas de la ETV puede reducir los retrasos en el diagnóstico y, con ello, la morbimortalidad asociada. Sin embargo, el TEP se puede presentar con un amplio espectro clínico, desde apenas síntomas hasta shock o inestabilidad hemodinámica, por lo que no debemos limitar la sospecha de TEP a aquellos pacientes con presentación típica; además esta posibilidad diagnóstica debe ser considerada no sólo ante la presencia de síntomas agudos, sino también en aquellos pacientes con síntomas respiratorios de evolución prolongada.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

OGER E. Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 2000; 83: 657-660.

https://doi.org/10.1055/s-0037-1613887

2. SILVERSTEIN M, HEIT J, MOHR D, PETTERSON TM, O'FALLON WM, MELTON III LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158: 585-593.

https://doi.org/10.1001/archinte.158.6.585

3. WHITE R. The epidemiology of venous thromboembolism. Circulation 2003; 107: 14-18.

https://doi.org/10.1161/01.CIR.0000078468.11849.66

4. MONREAL M, RUIZ J, FRAILE M, BONET M, DAVANT E, MACHART J et al. Prospective study on the usefullness of lung scan in patients with deep vein thrombosis of de lower limbs. Thromb Haemost 2001; 85: 771-774.

https://doi.org/10.1055/s-0037-1615716

5. IRIBARREN-SARRÍAS J, MARTÍNEZ-RIERA A. Tromboembolismo pulmonar. Medicine 2001; 8: 2587-2592.

https://doi.org/10.1016/S0304-5412(01)70488-X

6. ELLIOT C, GOLDHABER S, JENSEN R. Delays in diagnosis of deep vein thrombosis and pulmonary embolism. Chest 2005; 128: 3372-3376.

https://doi.org/10.1378/chest.128.5.3372

7. DALEN J. Pulmonary embolism: what have we learned since Virchow? Chest 2002; 122: 1440-1446.

https://doi.org/10.1378/chest.122.4.1440

8. BERGHAUS T, VONSCHEIDT W, SCHWAIBLMAIR M. Time between first symptoms and diagnosis in patients with acute pulmonary embolism: era patients with recurrent episodes diagnosed earlier? Clin Res Cardiol 2011; 100: 117-119.

https://doi.org/10.1007/s00392-010-0217-8

9. STEIN P, BEEMATH A, MATTA F, WEG J, YUSEN R, HALES C et al. Clinical characteristic of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120: 871-879.

https://doi.org/10.1016/j.amjmed.2007.03.024

10. HEIT J, O'FALLON W, PETTERSON T, LOHSE C, SILVERSTEIN M, MOHR D et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 2002; 162: 1245-1248.

https://doi.org/10.1001/archinte.162.11.1245

11. POLLACK C, SCHREIBER D, GOLDHABER S, SLATERRY D, FANIKOS J, O'NEIL B et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department. J Am Coll Cardiol 2011; 57: 700-706.

https://doi.org/10.1016/j.jacc.2010.05.071

12. AGARWAL R, VARMA S. Acute pulmonary embolism. Eastern Journal of Medicina 2009; 14: 57-68.

13. URESANDI F, BLANQUER J, CONGET F, GREGORIO MD, LOBO J, OTERO R et al. Guía para el diagnóstico, tratamiento y seguimiento de la tromboembolia pulmonar. Arch Bronconeumol 2004; 40: 580-594.

https://doi.org/10.1016/S0300-2896(04)75596-9

14. LEGAL G, TESTUZ A, RIGHINI M, BOUNAMEAUX H, PERRIER A. Reproduction of chest pain by palpation: diagnostic accuracy in suspected pulmonary embolism. BMJ 2005; 330: 452-453.

https://doi.org/10.1136/bmj.38331.602384.8F

15. STEIN P, WILLIS P, DEMETS D. History and physical examination in acute pulmonary embolism in patients without preexisting cardiac or pulmonary disease. Am J Cardiol 1981; 47: 218-223.

https://doi.org/10.1016/0002-9149(81)90388-X

16. STEIN P, TERRIN M, HALES C, PALEVSKY HI, SALTZMAN HA, THOMPSON BT et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 1991; 100: 598-603.

https://doi.org/10.1378/chest.100.3.598

17. STEIN P, HENRY J. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997; 112: 974-979.

https://doi.org/10.1378/chest.112.4.974

18. RENDINA D, BONIS SD, GALLOTTA G, PIEDIMONTE V, MOSSETTI G, FILIPPO GD et al. Clinical, historical and diagnostic findings asociated with right ventricular dysfuntion in patients with central and non-massive pulmonary embolism. Intern Emerg Med 2010; 5: 53-59.

https://doi.org/10.1007/s11739-009-0330-8

19. LOBO J, ZORRILLA V, AIZPURU F, URESANDI F, GARCÍA-BRAGADO F, CONGET F et al. Clinical syndromes and clinical outcome in patients with pulmonary embolism. Findings from the RIETE Registry. Chest 2006; 130: 1817-1822.

https://doi.org/10.1378/chest.130.6.1817

20. LOBO-BERISTAIN J, SANTAOLALLA CE. Síndromes clínicos de embolia pulmonar. Semin Fund Esp Reumatol 2006; 7: 139-146.

https://doi.org/10.1016/S1577-3566(06)75092-8

21. TAPSON V. Acute pulmonary embolism. N Engl J Med 2008; 358: 1037-1052.

https://doi.org/10.1056/NEJMra072753

22. PENGO V, LENSING A, PRINS M, MARCHIORI A, DAVIDSON BL, TIOZZO F et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 250: 2257-2264.

https://doi.org/10.1056/NEJMoa032274

23. KUCHER N, LUDER C, DORNHOFER T, WINDECKER S, MEIER B, HESS O. Novel management strategy for patients with suspected pulmonary embolism. Eur Heart J 2003; 24: 366-376.

https://doi.org/10.1016/S0195-668X(02)00476-1

24. TORBICKI A, PERRIER A, KONSTANTINIDES S, AGNELLI G, NAZZARENO G, PRUSZCZYK P et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29: 2276-2315.

https://doi.org/10.1093/eurheartj/ehn310

25. ALONSO-MARTÍNEZ J, SÁNCHEZ F, ECHEZARRETA M. Delay and misdiagnosis in sub-massive and non-massive acute pulmonary embolism. Eur J Intern Med 2010; 21: 278-282.

https://doi.org/10.1016/j.ejim.2010.04.005

26. MARSHALL P, MATTHEWS K, SIEGEL M. Diagnosis and management of life-threatening pulmonary embolism. J Intensive Care Med 2011; 26: 275-294.

https://doi.org/10.1177/0885066610392658

27. PIAZZA G, GOLDHABER S. Management of submasive pulmonary embolism. Circulation 2010; 122: 1124-1129.

https://doi.org/10.1161/CIRCULATIONAHA.110.961136

28. BLONDON M, GAL GL, RIGHINI M. Stratégie diagnostique et intérêt comparatif des scores cliniques pour le diagnostic démbolie pulmonaire. Rev Med Interne 2010; 31: 742-749.

https://doi.org/10.1016/j.revmed.2010.07.012

29. CERIANI E, COMBESCURE C, LE GAL G, NENDAZ M, PERNEGER T, BOUNAMEAUX H et al. Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis. J Thromb Haemost 2010; 8: 957-970.

https://doi.org/10.1111/j.1538-7836.2010.03801.x

30. KLOK F, KRUISMAN E, SPAAN J, NIJKEUTER M, RIGHINI M, AUJESKY D et al. Comparison of the revised Geneva score with the Wells rule for assessing clinical probability of pulmonary embolism. J Thromb Haemost 2008; 6: 40-44.

https://doi.org/10.1111/j.1538-7836.2007.02820.x

31. SQUIZZATO A, LUCIANI D, RUBBOLI A, GENNARO L, LANDOLFI R, LUCA CD et al. Differential diagnosis of pulmonary embolism in outpatients with non-specific cardiopulmonary symptoms. Intern Emerg Med 2011 Nov 18. [Epub ahead of print].

https://doi.org/10.1007/s11739-011-0725-1

32. BULBUL Y, AYIK S, OZTUNA F, OZLU T, SAHIN S. The relationship between socio-demographic characteristics of patients and diagnostic delay in acute pulmonary thromboembolism. Ups J Med Sci 2011; 116: 72-76.

https://doi.org/10.3109/03009734.2010.530701

33. BULBUL Y, OSZU S, KOSUCU P, OZTUNA F, OZLU T. Time delay between onset of symptoms and diagnosis in pulmonary embolism. Respiration 2009; 78: 36-41.

https://doi.org/10.1159/000167409

34. AGENO W, AGNELLI G, IMBERTI D, MOIA M, PALARETI G, PISTELLI R et al. Factors associated with the timing of diagnosis of venous thromboembolism: results from the MASTER registry. Thromb Res 2008; 121: 751-756.

https://doi.org/10.1016/j.thromres.2007.08.009

35. OZSU S, OZTUNA F, BULBUL Y, TOPBAS M, OZLU T, KOSUCU P et al. The role of risk factors in delayed diagnosis of pulmonary embolism. Am J Emerg Med 2011; 29: 26-32.

https://doi.org/10.1016/j.ajem.2009.07.005

36. BERGAUS T, THILO C, SCHIDT WV, SCHWAIBLMAIR M. The impact of age on the delay in diagnosis in patients with acute pulmonary embolism. Clinical and applied Thrombosis/Hemostasis 2011. DOI: 10.1177/1076029611404218.

https://doi.org/10.1177/1076029611404218

Descargas

Archivos adicionales

Publicado

02-05-2012

Cómo citar

1.
García-Sanz M, Pena-Álvarez C, González-Barcala F. Trombo-embolismo pulmonar: necesitamos sospecha clínica. An Sist Sanit Navar [Internet]. 2 de mayo de 2012 [citado 6 de diciembre de 2025];35(1):115-20. Disponible en: https://recyt.fecyt.es/index.php/ASSN/article/view/14831

Número

Sección

Revisiones

Artículos más leídos del mismo autor/a

Artículos similares

<< < 34 35 36 37 38 39 40 41 42 43 > >> 

También puede Iniciar una búsqueda de similitud avanzada para este artículo.