Problems in the diagnosis and management of pulmonary embolism

Abstract

Despite advances in instrumentation and techniques used to diagnose pulmonary embolism, clinical and postmortem data continue to indicate that it is still grossly underdiagnosed. Reasons for this revolve around problems relating to the clinical picture, laboratory studies, electrocardiography, radiography, lung scanning, and pulmonary angiography. The primary difficulty in the diagnosis of pulmonary embolism concerns the protean nature of the disease which permits it to masquerade as virtually any cardiopulmonary disorder. Once suspicion is aroused, the problem of diagnosis is compounded by the lack of specific laboratory tests. Routine chest radiography may show a number of nonspecific changes although the complete picture is exceptional. Electrocardiography may be useful, but it lacks both specificity and sensitivity. Radionuclide lung scanning, despite its lack of specificity, is currently the most useful diagnostic screening procedure because of its simplicity and safety. Selective pulmonary angiography, with its limitations of resolution, remains the only specific means for diagnosing pulmonary embolism. The limitations of both clinical and laboratory techniques, therefore, constitute the major problem in pulmonary embolism detection. An awareness of these problems should lead to earlier and more frequent identification of the patient with pulmonary embolic disease.