[When to suspect pulmonary embolism: a balancing act].

PubMed, vol. 168

Abstract

Pulmonary embolism (PE) is a common disease, which can present with a variety of symptoms. Optimal use of diagnostics is challenging given the tight and delicate balance between underdiagnosis and over-testing or overdiagnosis. Diagnostic delay occurs in a substantial part of patients, and seems more common in those with known cardiopulmonary disease or non-specific signs and symptoms. At the other end of the spectrum, the amount of diagnostic imaging increases. Increased use of diagnostic imaging in general leads to more harmful exposures and might result in overtreatment, as may be the case in subsegmental PE. Correct use of clinical prediction rules reduces the need for diagnostic imaging while PE can still be ruled out safely. This clinical lesson describes three cases of PE and provides an overview of factors that contribute to underdiagnosis or overdiagnosis. We provide recommendations to improve our balancing act for this challenging disease.

Authors 5

1. Hannah M la Roi-Teeuw

   University Medical Center Utrecht

   Affiliation as printed

   Universitair Medisch Centrum Utrecht, afd. Huisartsgeneeskunde en verplegingswetenschap, Utrecht

2. John B. F. de Wit Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leids Universitair Medisch Centrum

3. Frederikus Albertus Klok Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leids Universitair Medisch Centrum, afd. Interne Geneeskunde - Trombose en Hemostase, Leiden

4. Suzanne C. Cannegieter Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leids Universitair Medisch Centrum, afd. Klinische epidemiologie en afd. Trombose en Hemostase, Leiden

5. Geert‐Jan Geersing

   University Medical Center Utrecht

   Affiliation as printed

   Universitair Medisch Centrum Utrecht, afd. Huisartsgeneeskunde en verplegingswetenschap, Utrecht