Pulmonary thromboembolism: clinical suspicion required
Keywords:
Tromboembolismo pulmonar. Diagnóstico diferencial. Síndromes clínicos. Síntomas frecuentes. Retraso diagnóstico.Abstract
Venous thromboembolism (VTE) is a major health problem, with an annual incidence of 1-2 per 1,000 person-years. One in three patients with symptomatic VTE presents pulmonary embolism (PE), which is often underdiagnosed due to variable and nonspecific clinical presentation. Knowing the signs and symptoms of VTE can reduce delays in diagnosis, and thus VTE-related morbidity and mortality as well. Nevertheless, PE can present a wide clinical spectrum, ranging from being asymptomatic to shock or hemodynamic instability, which is why PE suspicion should not be limited to those patients with typical presentation. Therefore, this diagnostic possibility should not only be considered for patients with acute symptoms, but also for those with persistent respiratory symptoms.Downloads
References
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.
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2012 Anales del Sistema Sanitario de Navarra
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
