CLINICAL RECOGNITION OF PULMONARY-EMBOLISM - PROBLEM OF UNRECOGNIZED AND ASYMPTOMATIC CASES

Dyspnea, pleuritic chest pain, and tachypnea are widely appreciated as common initial features of pulmonary embolism (PE), This knowledge is derived primarily from prospective studies evaluating diagnostic test s or therapeutic interventions in which the study patients are suspect ed to have PE based on their initial symptoms. Autopsy studies, howeve r, continue to show that most eases of fatal PE are unrecognized and u ndiagnosed. Data from studies screening for PE in patients with deep v enous thrombosis and in postoperative patients suggest that many patie nts with PE are asymptomatic and that PE is unrecognized, We believe t hat the current concepts regarding the initial clinical features of PE are too narrow and biased toward symptomatic cases, High clinical sus picion may be insufficient in recognizing PE, Herein we summarize the available data and explore the implications for clinical practice.