Clinical analysis of 124 pulmonary thromboembolism

Abstract

Objective To retrospectively analyse the clinical characteristics of 124 pulmonarythromboembolism(PTE) patients adimitted in the hospital from 1998 to 2006. Methods A total of 178 PTEpatients were diagnosed in the hospital, of which 124 cases had complete medical documents. All the casesmet the criteria set by the respiratory division of Chinese Medical Society. The clinical characteristics, resultsof auxiliary examinations such as ECG, chest x-ray, blood gas analysis, ultrasound of lower limb deep veins,echocardiograph,CTPA and V/Q scan were recorded and analysed. Results PTE patients increased year byyear. Massive, submassive and non-massive area eases were 83 (66.9%), 20(16.1%), 21 (16.9%). Amongthe patients, the main risk factors were DVT (70 cases), surgery(40 cases), immobility( 65 cases), tumor(6cases), connective tissue disease ( 3 cases), OSAS ( 1 case). The main symptoms were dyspnea ( 100%),palpitation( 90 cases), chest pain ( 30 cases), haemoptysis ( 19 cases), cough ( 40 cases), syncope ( 16 cases),cardiac-respiratory arrest(5 cases) by turns. The main findings of physical examinations were rapid breathrate(>20 times/min) (86 cases),rapid heart beating( >100 beats/min)(112 cases),cyanosis(65 cases),dryand wet rales(22 cases). The main meaningful findings of lab tests were: PaO > 35 mm Hg(32 cases);ECG:sinus tachycardia:112 cases,S Q T (25 cases),CRBBB 26 cases,non-specific S-T changes 42 cases,sinus bradyeardia(<60 beats/min)5 cases;chest x-ray: Wedge shape(20 cases),positive result of CTPA( 105 cases), high probobility of V/Q scan (18cases); echocardiograph: right ventricular dilatation, pulmonary hypertension 91 cases, 20 cases, only 8patients had a normal echocardiograph examination. Only 72 patients got confirmed diagnosis in the first 24hours of admission, other 52 patients were diagnosed in 2-60 days, 30% (37 cases), and the misdiagnosis wasmost were as coronary heart disease, acute heart failure or pneumonia, etc. 83 patients received boththrombolysis and anticoagulation therapies,41 patients received anticoagulation therapy alone,the death was8 patients(6.5%). Conclusions Morbidity of PTE tends to increase yearly, partly due to the progress madein the diagnosis means and improvement of the pyhsians' awareness of this disease. PTE should be suspectedwhen a patient has symptoms such as dyspnea, syncope, ete, especially combined with some risk factors suchas cancer or connective tissue disease. PTE trilogy of chest pain,haemoptysis and dyspnea is not common asit is supposed to be. Improvement of awareness of PTE helps the most for the physicans avoid themisdiagnosis. Key words: Pulmonary thromboembolism; Misdiagnosis; Prevention