Clinical Presentation of Acute Pulmonary Embolism: Survey of 800 CasesReport as inadecuate

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Pulmonary embolism PE is a common and potentially fatal disease that is still underdiagnosed. The objective of our study was to reappraise the clinical presentation of PE with emphasis on the identification of the symptoms and signs that prompt the patients to seek medical attention.

Methodology-Principal Findings

We studied 800 patients with PE from two different clinical settings: 440 were recruited in Pisa Italy as part of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis PISAPED; 360 were diagnosed with and treated for PE in seven hospitals of central Tuscany, and evaluated at the Atherothrombotic Disorders Unit, Firenze Italy, shortly after hospital discharge. We interviewed the patients directly using a standardized, self-administered questionnaire originally utilized in the PISAPED. The two samples differed significantly as regards age, proportion of outpatients, prevalence of unprovoked PE, and of active cancer. Sudden onset dyspnea was the most frequent symptom in both samples 81 and 78%, followed by chest pain 56 and 39%, fainting or syncope 26 and 22%, and hemoptysis 7 and 5%. At least one of the above symptoms was reported by 756 94% of 800 patients. Isolated symptoms and signs of deep vein thrombosis occurred in 3% of the cases. Only 7 1% of 800 patients had no symptoms before PE was diagnosed.


Most patients with PE feature at least one of four symptoms which, in decreasing order of frequency, are sudden onset dyspnea, chest pain, fainting or syncope, and hemoptysis. The occurrence of such symptoms, if not explained otherwise, should alert the clinicians to consider PE in differential diagnosis, and order the appropriate objective test.

Author: Massimo Miniati , Caterina Cenci, Simonetta Monti, Daniela Poli



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