2007 Mar 31. Stein PD, Matta F, Keyes DC, Willyerd GL. [Medline]. 2014 Apr 10. Schulman S, Kakkar AK, Goldhaber SZ, Schellong S, Eriksson H, Mismetti P, et al. Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, et al. Anuj Mediratta M.D. [Medline]. N Engl J Med. New York, NY: McGraw-Hill; 1955:. Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test. 347:f3368. Lancet. Kearon C, Ginsberg JS, Douketis J, Turpie AG, Bates SM, Lee AY, et al. Such missed diagnoses occur in approximately 400,000 patients in the United States per year; approximately 100,000 deaths could be prevented with proper diagnosis and treatment. Lower-extremity venogram shows a nonocclusive chronic thrombus. [Medline]. [Full Text]. Comprehensive analysis of the results of the PIOPED Study. Natriuretic peptides in acute pulmonary embolism: a systematic review. N Engl J Med. A segmental ventilation perfusion mismatch is evident in a left anterior oblique projection. 2011 May 24. Comparison of 8 biomarkers for prediction of right ventricular hypokinesis 6 months after submassive pulmonary embolism. Regional wall motion abnormality of the left ventricle on echocardiography. J Pediatr. [Medline]. 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. [Medline]. Hypoxemia, dehydration, and fever lead to intravascular sludging within pulmonary (among others) vasculature. 2011 Apr 26. 2008 Dec. 34(12):2147-56. Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic SocietyDisclosure: Nothing to disclose. [Medline]. [Medline] . [Medline]. [Medline]. If residual thromboemboli incorporated into the pulmonary arterial wall or in the distal small segments are visible, differential diagnosis of PE versus primary pulmonary hypertension (PPH) can be made without open-chest pulmonary biopsy. 2012 Feb. 141 (2 Suppl):7S-47S. [Medline]. If you log out, you will be required to enter your username and password the next time you visit. [Full Text]. Am J Med. Sandler DA, Martin JF. Boggs W. Bedside Echo Could Facilitate ER Diagnosis of Pulmonary Embolism. Pulmonary embolism differential diagnosis and mimics that can be diagnosed on CT: Pericarditis, Acute myocardial infarction, Aortic dissection. Meyer T, Binder L, Hruska N, Luthe H, Buchwald AB. Pulmonary artery sarcoma (PAS) is a rare tumour that originates from the intimal layer of the pulmonary trunk and pulmonary arteries. 28(3):370-2. Share cases and questions with Physicians on Medscape consult. 2016 Feb. 149 (2):315-52. Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. Courtesy of Justin Wong, MD. Expert Rev Cardiovasc Ther. Radiology. Arterioscler Thromb Vasc Biol. Remy-Jardin M, Remy J, Deschildre F, Artaud D, Beregi JP, Hossein-Foucher C, et al. CT scan of the same chest depicted in Image 18. Posteroanterior and lateral chest radiograph findings are normal, which is the usual finding in patients with pulmonary embolism. [Full Text]. 2014 Apr 10. This is a close-up view. N Engl J Med. 2014 Feb 18. Annie Harrington, MD Fellow in Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center The Hospitalized Patient With Infection: How to Prevent VTE? 2008 May. 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. [Medline]. [Medline]. Sleep-disordered breathing in deep vein thrombosis and acute pulmonary embolism. J Comput Assist Tomogr. [Medline]. Ann Emerg Med. Differential Diagnosis of Chest Pain ... PT implications: - Refer to physician to get medications to treat pneumonia. Fibrinolysis of pulmonary emboli--steer closer to Scylla. [Medline]. The value of ischemia-modified albumin compared with d-dimer in the diagnosis of pulmonary embolism. BMJ. 2010 Dec. 17(12):1543-9. . Such missed diagnoses occur in approximately 400,000 patients in the United States per year; approximately 100,000 deaths could be prevented with proper diagnosis and treatment. Eur Respir J. The variability of presentation for pulmonary embolism (PE) sets the patient and clinician up for potentially missing the diagnosis. Hampton hump is a rare and nonspecific finding. Pulmonary Embolism History and Signs/Symptoms: - Patient experiences chest pain with symptoms like dyspnoea, cough, and syncope. Aksay E, Yanturali S, Kiyan S. Can elevated troponin I levels predict complicated clinical course and inhospital mortality in patients with acute pulmonary embolism?. N Engl J Med. A chest infection is often the presenting symptom. 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. 2007 Nov. 245(2):315-29. Causes and outcomes of the acute chest syndrome in sickle cell disease. [Medline]. BMJ. J Intern Med. The accurate incidence of the condition is unknown, but it is estimated that 200,000 to 500,000 182(9):1178-83. A chest radiograph with normal findings in a 64-year-old woman who presented with worsening breathlessness. [Medline]. 2016 Aug 11. Accessed: April 19, 2014. [Diagnosis of lung embolism. Apixaban for extended treatment of venous thromboembolism. 359(26):2804-13. [Medline]. This image shows acute deep venous thrombosis with intraluminal filling defects in the bilateral superficial femoral veins. In: Marx JA, Hockenberger RS, Walls RM, eds. Medscape Education. 2008 Apr. Differential diagnosis, Diagnosis, Pulmonary embolism, CKS. Kline JA, Zeitouni R, Marchick MR, Hernandez-Nino J, Rose GA. Radiology. 163 (9):701-11. Acute pulmonary embolism. N Engl J Med. Br J Haematol. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. [Medline]. [Full Text]. JAMA. Am J Med. Cavallazzi R, Nair A, Vasu T, Marik PE. Cohen AT, Spiro TE, Büller HR, Haskell L, Hu D, Hull R, et al. Prospective Investigation of Pulmonary Embolism Diagnosis Study. . [Medline]. Pulmonary Embolism: 11: Clinical Features in the Diagnosis of Pleural Effusions and Identifying Etiology: 1,2. The diagnostic challenge is that the "classic" presentation of the condition, with abrupt onset of pleuritic chest pain, shortness of breath, and hypoxia, is rarely seen. Am J Respir Crit Care Med. 103(20):2453-60. Symptoms of a blood clot in the leg may also be present, such as a red, warm, swollen, and painful leg. Thromb Haemost. 2006 Jan 31. 2008 Aug 15. , Acute Respiratory Distress Syndrome (ARDS), Idiopathic Pulmonary Arterial Hypertension, Superior Vena Cava Syndrome in Emergency Medicine. Although the chronic clot is not obstructive after it recanalizes, it effectively causes the venous valves to adhere in an open position, predisposing the patient to reflux in the involved segment. 2008 Aug. 264(2):195-200. [Medline]. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). Additional problems to be considered include the following: Silicone pulmonary embolism 9:49. In: Kumar V, Cotran RS, Robbins SL, eds. , Sickle cell disease often creates a diagnostic difficulty with regard to pulmonary embolism. Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients. Lower-extremity venogram shows outlining of an acute deep venous thrombosis in the popliteal vein with contrast enhancement. 1993 Sep. 123(3):337-46. Pulmonary embolism was identified as the cause of death in a patient who developed shortness of breath while hospitalized for hip joint surgery. 2013 Feb 21. [Medline]. [Medline]. Accessed: October 28, 2013. 2003
Consider: 1. pulmonary artery sarcoma 2. pulmonary artery vasculitis e.g. AJR Am J Roentgenol. Anterior views of perfusion and ventilation scans are shown here.  Common differential diagnoses include:, 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. 2008 May. 2006 Dec. 98(12):1967-72. 2003 May 27. 2008 May 30. [Guideline] Witt DM, Nieuwlaat R, Clark NP, Ansell J, Holbrook A, Skov J, et al. 353(9162):1386-9. Ready T. Pulmonary Emboli Overdiagnosed by CT Angiography. [Full Text]. An evaluation of D-dimer in the diagnosis of pulmonary embolism: a randomized trial. Differential diagnosis and treatment approach to pulmonary artery sarcoma: a case report and literature review To the Editor: Pulmonary artery sarcoma (PAS) is a rare tumour that originates from the intimal layer of the pulmonary trunk and pulmonary arteries. [Guideline] Bettmann MA, Baginski SG, White RD, Woodard PK, Abbara S, Atalay MK, et al. 2009 Mar-Apr. Circulation. [Medline]. Prompt diagnosis is necessary to improve survival. 82(4):203-5. [Medline]. This image was obtained at the level of the lower lobes and shows perivascular segmental enlarged lymph nodes as well as prominent extraluminal soft tissue interposed between the artery and the bronchus. [Medline]. Henzler T, Roeger S, Meyer M, Schoepf UJ, Nance JW Jr, Haghi D, et al. Circulation. 1999 Apr 24. Ann Emerg Med. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. Practice bulletin no. 50(5):1062-4. Effectiveness and acceptability of a computerized decision support system using modified Wells criteria for evaluation of suspected pulmonary embolism. 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. : the continued treatment study ( EINSTEIN-extension study ) Heuvel-Eibrink MM, Courtney DM Miller! Will make the noted defects in the differential diagnoses are extensive, and pulmonary embolism associated..., Rimm E, Szalai JP single test of spiral computed tomography angiography in a 55-year-old man possible! Chen E, Galeano-Valle F, Bulbul Y, Jain P, Martinez-Jimenez S, Atalay MK, et.! 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