pulmonary embolism differential diagnosis

Judith K Amorosa, MD, FACR Clinical Professor and Program Director, Department of Radiology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School; Consulting Staff, Department of Radiology, Robert Wood Johnson University Hospital, Judith K Amorosa, MD, FACR is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, and Society of Thoracic Radiology, Michael S Beeson, MD, MBA, FACEP Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center, Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine, Kavita Garg, MD Professor, Department of Radiology, University of Colorado School of Medicine, Kavita Garg, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America, and Society of Thoracic Radiology, Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine, Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine, Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System, Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society, Gary Setnik, MD Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School, Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine, Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position; ProceduresConsult.com Royalty Other, Eric J Stern, MD Professor of Radiology, Adjunct Professor of Medicine, Adjunct Professor of Medical Education and Biomedical Informatics, Adjunct Professor of Global Health, Vice-Chair, Academic Affairs, University of Washington School of Medicine, Eric J Stern, MD is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, European Society of Radiology, Radiological Society of North America, and Society of Thoracic Radiology, Sara F Sutherland, MD, MBA, FACEP Assistant Professor of Emergency Medicine, University of Virginia Health System; Staff Physician, Department of Emergency Medicine, Martha Jefferson Hospital, Sara F Sutherland, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine, Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference, Gregory Tino, MD Director of Pulmonary Outpatient Practices, Associate Professor, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Medical Center and Hospital, Gregory Tino, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society. [Medline]. Algorithm for Evaluation of Suspected Pulmonary Embolism 2. [Medline]. Note that the patient is in the prone position in all views. 15 Supplementary data. This ultrasonogram shows a thrombus in the distal superficial saphenous vein, which is under the artery. J Pediatr Hematol Oncol. Lancet. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Fibrinolysis for patients with intermediate-risk pulmonary embolism.  Pulmonary Embolism  History and Signs/Symptoms: - Patient experiences chest pain with symptoms like dyspnoea, cough, and syncope. Büller HR, Décousus H, Grosso MA, Mercuri M, Middeldorp S, Prins MH, et al. Scherz N, Labarère J, Méan M, Ibrahim SA, Fine MJ, Aujesky D. Prognostic importance of hyponatremia in patients with acute pulmonary embolism. Posteroanterior and lateral chest radiograph findings are normal, which is the usual finding in patients with pulmonary embolism. 2008 Apr. Clinical Case, You are being redirected to For that reason, your doctor will likely discuss your medical history, do a physical exam, and order one or more of the following tests. Garcia D, Ageno W, Libby E. Update on the diagnosis and management of pulmonary embolism. [Medline]. 8(3):339-49. Symptoms include chest pain, dyspnea, and a sense of apprehension. Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzAwOTAxLWRpZmZlcmVudGlhbA==. 2014 Feb 18. [Guideline] Fesmire FM, Brown MD, Espinosa JA, Shih RD, Silvers SM, Wolf SJ, et al. Ready T. Pulmonary Emboli Overdiagnosed by CT Angiography. Also present is an infarction of the corresponding lung, which is indicated by a triangular, pleura-based consolidation (Hampton hump). Kotsakis A, Cook D, Griffith L, Anton N, Massicotte P, MacFarland K, et al. catheters, orthopedic prostheses 5.2.3. patient's arms in … 1999 Apr 24. Basic Pathology. 2009 Mar. Wiener RS, Schwartz LM, Woloshin S. When a test is too good: how CT pulmonary angiograms find pulmonary emboli that do not need to be found. D-dimer and exhaled CO2/O2 to detect segmental pulmonary embolism in moderate-risk patients. [Medline]. Wood KE. 35 (43):3033-69, 3069a-3069k. Kline JA, Hogg MM, Courtney DM, Miller CD, Jones AE, Smithline HA, et al. Conditions that need to be considered (that is, the differential diagnosis) often include heart attacks , heart failure , pericarditis , cardiac tamponade , pneumonia, and pneumothorax . Critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected pulmonary embolism. 361(24):2342-52. [Medline]. Daniel R Ouellette, MD, FCCP Associate Professor of Medicine, Wayne State University School of Medicine; Medical Director, Pulmonary Medicine General Practice Unit (F2), Senior Staff and Attending Physician, Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital [Medline]. Helical CT for the evaluation of acute pulmonary embolism. [Medline]. 163 (9):701-11. Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. [Medline]. For that reason, your doctor will likely order one or more of the following tests. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Dempfle CE, Elmas E, Link A, et al. 2012 Apr 5. Amesquita M, Cocchi MN, Donnino MW. The venous thrombi predominately originate in venous valve pockets (inset) and at other sites of presumed venous stasis. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. [Medline]. These include the original Wells score and modified Wells score, revised Geneva score, and pulmonary embolism rule-out criteria . [Medline]. 359(26):2804-13. JAMA. Am J Emerg Med. 8 Chronic treatment and prevention of recurrence. Eur Respir J. This image shows an intraluminal filling defect that occludes the anterior basal segmental artery of the right lower lobe. [Medline]. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Annie Harrington, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Chest PhysiciansDisclosure: Nothing to disclose. 342(25):1855-65. Accessed: October 28, 2013. Kline JA, Zeitouni R, Marchick MR, Hernandez-Nino J, Rose GA. Eur Heart J . AcutePE caused by thromboemboli may be spontaneous and often originates in the deep venous system of the lower extremities, upper extremities, right side of the heart, or pelvis. 2011 Jul. 2016 Aug 11. [Full Text]. Dollery CM. Oral rivaroxaban for symptomatic venous thromboembolism. 9 Pulmonary embolism and pregnancy. Pulmonary Emboli: The Differential Diagnosis Dilemma Brian A.Young, PT, DSc, OCS, FAAOMPT1 Timothy W. Flynn, PT, PhD, OCS, FAAOMPT2 Pulmonary embolism is a rare but serious medical condition, with an estimated mortality of 5% to 20%. In: Kumar V, Cotran RS, Robbins SL, eds. Long-term outcome of pulmonary embolism. Oral rivaroxaban for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN DVT and EINSTEIN PE studies [abstract 20]. Schneider D, Lilienfeld DE, Im W. The epidemiology of pulmonary embolism: racial contrasts in incidence and in-hospital case fatality. Many patients receiving … Pulmonary embolism in pediatric patients survey of CT pulmonary angiography practices and policies. The patient will also have a raised respiratory rate, crepitations, tachycardia, and fourth heart sound. Pulmonary embolism-experience at a single children's hospital. Acad Emerg Med. [Medline]. [Medline]. 343:d3867. 32(13):1657-63. Pulmonary embolism (PE) is a life-threatening condition resulting from dislodged thrombi occluding the pulmonary vasculature; right heart failure and cardiac arrest may ensue if not aggressively treated. Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois. 113(4):577-82. Ozsu S, Oztuna F, Bulbul Y, et al. 300901-overview Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society. [Medline]. [Full Text]. High D-dimer levels increase the likelihood of pulmonary embolism. Tick LW, Nijkeuter M, Kramer MH, Hovens MM, Büller HR, Leebeek FW, et al. [Medline]. Several factors increase patient susceptibility to thrombus formation. Sleep-disordered breathing in deep vein thrombosis and acute pulmonary embolism. [Full Text]. [Medline]. High-probability perfusion lung scan shows segmental perfusion defects in the right upper lobe and subsegmental perfusion defects in right lower lobe, left upper lobe, and left lower lobe. Pulmonary artery sarcoma (PAS) is a rare tumour that originates from the intimal layer of the pulmonary trunk and pulmonary arteries. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. 2011 Jun. BMJ. N Engl J Med. 60-80. 13 Gaps in the evidence. Pulmonary embolism in children. Boutitie F, Pinede L, Schulman S, Agnelli G, Raskob G, Julian J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Conditions that can cause similar symptoms to pulmonary embolism (PE) include: Rajpurkar M, Warrier I, Chitlur M, Sabo C, Frey MJ, Hollon W, et al. 368(8):699-708. [Medline]. 6th ed. Pleural effusions can be easily identified on chest radiography, physical examination findings include dullness to percussion, decreased tactile fremitus and decreased (or absent) breath sounds. Therefore, the … Am J Dis Child. Chest. Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, et al. 2012 Apr. Computed tomography venograms in a 65-year-old man with possible pulmonary embolism. 343:d4656. Burge AJ, Freeman KD, Klapper PJ, Haramati LB. Pulmonary embolism in parenteral nutrition. [Medline]. 2012 Mar 20. Value of the ventilation/perfusion scan in acute pulmonary embolism. 375 (6):534-44. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. [Medline]. Drescher FS, Chandrika S, Weir ID, et al. [Medline]. [Full Text]. Vedovati MC, Becattini C, Agnelli G, Kamphuisen PW, Masotti L, Pruszczyk P, et al. 311(23):2414-21. CT scan of the same chest depicted in Image 18. Kucher N, Printzen G, Goldhaber SZ. 39(4):919-26. Henzler T, Roeger S, Meyer M, Schoepf UJ, Nance JW Jr, Haghi D, et al. Ward MJ, Sodickson A, Diercks DB, Raja AS. N Engl J Med. The pathophysiology of pulmonary embolism. Comparison of this prospective study with an earlier … Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. Symptoms include chest pain, dyspnea, and a sense of apprehension. [Medline]. Echocardiographic Diagnosis of Acute Pulmonary Embolism in Patients with McConnell's Sign. 345:e6564. This image demonstrates a clot in the anterior segmental artery in the left upper lung (LA2) and a clot in the anterior segmental artery in the right upper lung (RA2). [Full Text]. Thromb Haemost. 103(20):2453-60. 2006 Jun 6. Circulation. Medscape Medical News. CTPA is the reference standard for the diagnosis of acute PE.. 2008 May. DeMonaco NA, Dang Q, Kapoor WN, Ragni MV. Klok FA, Mos IC, Huisman MV. 2013 Feb 7. Introduction Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease after acute coronary syndrome and stroke. [Medline]. BACKGROUND: Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common disease, affecting approximately 1-2 in 1,000 adults per year. PULMONARY EMBOLISM (PE): DIAGNOSIS OBJECTIVE: To provide a diagnostic approach to patients with suspected acute pulmonary embolism (PE). 2003 The evidence regarding diagnostic techniques, management of the disease and prognosis is limited to a small series of cases and case reports [1, 2]. 2013 Feb 21. Radiology. This website also contains material copyrighted by 3rd parties. Söhne M, Ten Wolde M, Boomsma F, Reitsma JB, Douketis JD, Büller HR. [Full Text]. Clinically important venous thromboembolism in pediatric critical care: a Canadian survey. 1993 Sep. 123(3):337-46. 2007 Mar 31. [Medline]. [21] Common differential diagnoses include:[21], Common Differential Diagnosis in Outpatients, "Westermark's and Palla's signs in acute and chronic pulmonary embolism: Still valid in the current computed tomography era", "CT Angiography of Pulmonary Embolism: Diagnostic Criteria and Causes of Misdiagnosis | RadioGraphics", "Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism", "Pulmonary Embolism: Symptoms - National Library of Medicine - PubMed Health", "Chronic heart failure: contemporary diagnosis and management", "Symptom distress and quality of life in patients with advanced congestive heart failure", "Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology", "Pericardial disease: diagnosis and management", "Diagnostic approach to patients with suspected vasculitis", "Differential diagnosis of pulmonary embolism in outpatients with non-specific cardiopulmonary symptoms", "Silicone pulmonary embolism: report of 10 cases and review of the literature", https://www.wikidoc.org/index.php?title=Pulmonary_embolism_differential_diagnosis&oldid=1552285, Creative Commons Attribution/Share-Alike License, , ✔ (Relieved by sitting up and leaning forward), Polo-mint sign (partial filling defect surrounded by contrast), Late enhancement of contrast in conditions such as, Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity), Large collection of fluid inside the pericardial sac (pericardial effusion), Granulomatous vasculitides may present with, Loss of retrosternal airspace due to right ventricular enlargement, Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung, This page was last edited 22:43, 19 February 2019 by. Address correspondence to Dr G.Y. Since symptoms are a-specific and the consequences of anticoagulant treatment are considerable, objective tests to either establish or refute the diagnosis have become a standard of care. 2008 Mar 6. Sandler DA, Martin JF. 2008 Mar. [Medline]. [45], Acute Respiratory Distress Syndrome (ARDS), Idiopathic Pulmonary Arterial Hypertension, Superior Vena Cava Syndrome in Emergency Medicine. [Full Text]. Chest. 2010 Dec 23. Once pulmonary embolism is suspected in the differential diagnosis, it should be excluded for the sake of patient’s health and safety. /viewarticle/927356 Am J Respir Crit Care Med. 2008 May 30. Circulation. 2010 Sep 1. BMJ. Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, et al. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). Brain natriuretic peptide in hemodynamically stable acute pulmonary embolism. Medscape Education. 2008 Jul. Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. 2009 Dec 10. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (). Diagnosis of PAS is challenging, since it can be difficult to distinguish from a pulmonary embolism. To reach the lungs, thromboemboli travel through the right side of the heart. Wr, et al Research Institute, … pulmonary embolism presenting as Flank pain: a Canadian survey Ragni.. Patients: are we detecting enough deep vein thrombosis? W, Albers GW, CG! Acute chest Syndrome in Emergency Medicine dabigatran or warfarin and pooled analysis the right lower lobe, open-label randomised. Er diagnosis of pulmonary embolism ( PE ) should be excluded for the sake of patient ’ S health safety! 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