Symptoms, location and prognosis of pulmonary embolism.

BACKGROUND AND OBJECTIVE: Pulmonary embolism (PE) is a common disease with variable symptoms and high overall mortality. The clinical relevance of the extent of PE is still debatable, and the role of anticoagulation in patients with subsegmental involvement has been contested. Our objective is to describe the clinical details of patients with PE in our hospital and to analyze their prognosis based on the extent of the disease. MATERIALS AND METHODS: Retrospective study of 313 patients diagnosed with PE by chest computed tomography (CT) scan at the Hospital Complex of Pontevedra in Spain for six years. Predictors of mortality were determined by multivariate analysis. RESULTS: Women accounted for 56% of patients, and patient median age was 70 years (interquartile range 53-78 years). Subsegmental PE accounted for 7% of all cases; these patients were younger and had lower comorbidity; they reported chest pain more often, performed better in blood gas analysis and none of them had proximal deep vein thrombosis (DVT). Patients with subsegmental PE had a higher survival rate. Factors independently associated with mortality were cancer diagnosis and higher comorbidity. CONCLUSIONS: Patients with subsegmental PE clinically differ from those with more proximal PE. Underlying diseases have more influence on the prognosis than the extent of the disease.

[Pulmonary thromboembolism: clinical suspicion required]. / Trombo-embolismo pulmonar: necesitamos sospecha clínica.

Venous thromboembolism (VTE) is a major health problem, with an annual incidence of 1-2 per 1,000 person-years. One in three patients with symptomatic VTE presents pulmonary embolism (PE), which is often underdiagnosed due to variable and nonspecific clinical presentation. Knowing the signs and symptoms of VTE can reduce delays in diagnosis, and thus VTE-related morbidity and mortality as well. Nevertheless, PE can present a wide clinical spectrum, ranging from being asymptomatic to shock or hemodynamic instability, which is why PE suspicion should not be limited to those patients with typical presentation. Therefore, this diagnostic possibility should not only be considered for patients with acute symptoms, but also for those with persistent respiratory symptoms.

Trombo-embolismo pulmonar: necesitamos sospecha clínica / Pulmonary thromboembolism: clinical suspicion required

La enfermedad tromboembólica venosa (ETV) es un importante problema de salud, con una incidencia anual de 1-2 casos /1.000 personas. Un tercio de los pacientes con ETV sintomática cursan con tromboembolismo pulmonar (TEP), que es frecuentemente infradiagnosticado debido a su presentación clínica variable e inespecífica. El conocimiento de los signos y síntomas de la ETV puede reducir los retrasos en el diagnóstico y, con ello, la morbimortalidad asociada. Sin embargo, el TEP se puede presentar con un amplio espectro clínico, desde apenas síntomas hasta shock o inestabilidad hemodinámica, por lo que no debemos limitar la sospecha de TEP a aquellos pacientes con presentación típica; además esta posibilidad diagnóstica debe ser considerada no sólo ante la presencia de síntomas agudos, sino también en aquellos pacientes con síntomas respiratorios de evolución prolongada(AU)

Venous thromboembolism (VTE) is a major health problem, with an annual incidence of 1-2 per 1,000 person-years. One in three patients with symptomatic VTE presents pulmonary embolism (PE), which is often under diagnosed due to variable and nonspecific clinical presentation. Knowing the signs and symptoms of VTE can reduce delays in diagnosis, and thus VTE related morbidity and mortality as well. Nevertheless, PE can present a wide clinical spectrum, ranging from being asymptomatic to shock or hemodynamic instability, which is why PE suspicion should not be limited to those patients with typical presentation. Therefore, this diagnostic possibility should not only be considered for patients with acute symptoms, but also for those with persistent respiratory symptoms(AU)