24 Pulmonary embolism
Fig. 24.1A This radiograph demonstrates a very subtle area of oligaemia in the right upper zone, with a decreased vessel count. The subsequent CT pulmonary angiogram demonstrated a right-sided pulmonary embolus.
Background
Pulmonary embolism (PE) is a serious condition and a leading cause of mortality. It is important for all on-call doctors to be familiar with this condition, as it can occur in any inpatient. It is a common postoperative complication and a common reason for admission to hospital.
Algorithms for clinical assessment of PE and the role of simple tests and imaging are often poorly understood.
Clinical features
Clinical signs and symptoms are non-specific and a high index of suspicion for this condition is necessary.
Remember to seek risk factors: malignancy, immobility, coagulopathies, recent surgery (this list is not exhaustive).
Symptoms
Symptoms include dyspnoea, pleuritic chest pain and haemoptysis; their onset is usually sudden.
Differential diagnosis
The following conditions should be excluded – some can be diagnosed using simple tests before asking for a CT pulmonary angiogram:
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