- Brandon MaughanAssociate Professor1,
- Angela Jarmanassistant teacher2,
- Alexa Redmondmedical student3,
- Geert-Jan Geersinggeneral practitioner and associate professor4,
- Jeffrey A Klineprofessor and vice president of research5
- 1Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA.
- 2Department of Emergency Medicine, University of California Davis, Sacramento, CA
- 3Oregon Health and Science University, Portland, Oregon
- 4Julius Center for Health Sciences and Primary Care, Utrecht University Medical Center, Utrecht University, Utrecht, The Netherlands
- 5Department of Emergency Medicine, Wayne State College of Medicine, Detroit, MI
- Correspondence to B Maughan
What you need to know
The diagnosis of pulmonary embolism (PE) is often overlooked. It is estimated that between 12% and 36% of PD patients are misdiagnosed during initial evaluation in emergency departments or primary care clinics.
Delayed and missed diagnoses are more common in older adults, in patients with chronic cardiopulmonary disease, those at low risk for PD before testing, and in patients presenting with gradual onset of cough or dyspnea. Most patients with PE do not have symptoms of deep vein thrombosis, and many do not have chest pain.
The use of age- or probability-adjusted D-dimer thresholds may reduce false-positive results and rates of CT pulmonary angiography.
A 71-year-old woman with hypertension, coronary artery disease, and heart failure presents to her primary care physician with fatigue and shortness of breath at rest for the past 10 days. She reports a mild nonproductive cough and occasional sore throat during this time, and says that breathing deeply makes her chest feel “heavy.” She has had no fever, chest pain, abdominal pain, leg pain, or other abnormal symptoms, other than a brief episode of near-syncope a few days ago that resolved without intervention. Her heart rate is 96 beats/min, blood pressure 148/78, respiratory rate 22 breaths/min and she has an oxygen saturation level of 92% on room air; She is feverish.
On examination, he had mild tachypnea but no jugular venous distension, no heart murmur, and normal lung sounds. He has traces of swelling in both legs and normal distal pulses. An electrocardiogram (ECG) shows sinus rhythm with no evidence of ischemia. Point-of-care testing for Covid-19 and influenza is negative. The doctor suspects that the patient may have mild heart failure or viral bronchitis and advises her to double her dose of furosemide for the next three days.
The woman calls the clinic four days later because she continues not to breathe. She is referred to…