Frederikus A. Klok
,Jelmer E. Vahl
,Menno V. Huisman
enPaul R.M. van Dijkman
This supplementary information is presented as submitted by the corresponding author. It has not been copy-edited by NTvG.
Two male patients aged 57 and 73 were referred to the cardiologist because of a 4-week history of progressive dyspnea. In one patient, the general practitioner had earlier adopted an expectative policy because of a clean chest X-ray. At presentation, the patient was diagnosed with and treated for acute coronary syndrome because of minor ECG abnormalities. Nonetheless, CT-scanning was performed to rule out acute pulmonary embolism (PE), showing a large saddle embolus and right ventricular overload. Despite adequate treatment, the patient suffered an electric asystole and died. The other patient was subjected to ECG, CT-coronary-calcium score, bicycle ergometry, MRI-adenosine, echocardiography and lung function tests over a period of 5 weeks before PE was diagnosed. Both patients had evidence of acute and chronic pulmonary emboli, possibly caused by the diagnostic delay. We discuss the most incident symptoms, risk factors and results from routine diagnostic tests associated with PE and argue that PE at least should be considered whenever a patient presents with acute or worsening breathlessness, chest pain, circulatory collapse or coughing, particularly in the presence of known thrombotic risk factors or when there is no clear alternative.
Reacties
Acute longembolie, gemiste diagnose