Summary
Suspected acute pulmonary embolism in patients with and without cancer: alternative diagnoses
Affiliation of the authors
DOI
Quote
Gómez-Zorrilla Martín S, Riera-Mestre A, Leiva Pedraza D, Jordán Lucas S, Jacob Rodríguez J, Pujol Farriols R. Suspected acute pulmonary embolism in patients with and without cancer: alternative diagnoses. Emergencias. 2013;25:92-
Summary
Objectives: To determine the alternative diagnoses made in patients with and without
cancer who undergo computed tomography (CT) to confirm or rule out a suspected
diagnosis of acute pulmonary embolism in a hospital emergency department.
Methods: Retrospective study of all patients who underwent CT with a suspected
diagnosis of acute pulmonary embolism in 2006 and 2007.
Results: A total of 265 case records (for 93 patients with cancer and 172 without cancer)
were studied. In 98.5% of the patients, clinical suspicion of pulmonary embolism was
high, based on the Wells or Geneva Scales, or low-intermediate clinical suspicion and
positive D-dimer level. A diagnosis of pulmonary embolism was confirmed in 25.8% of
the cancer patients and 39.5% of the noncancer patients. When pulmonary embolism
was ruled out, an alternative diagnosis could be reached by CT in 81.2% of the cancer
patients and 67.3% of the noncancer patients. The most common alternative diagnosis
in cancer patients was tumor progression, which was even more common than the
diagnosis of pulmonary embolism. In noncancer patients, the most common alternative
diagnoses were acute heart failure, exacerbation of chronic obstructive pulmonary
disease (COPD), and pneumonia.
Conclusions: CT facilitates the differential diagnosis of a large percentage of patients
suspected of having acute pulmonary embolism. The most common alternative
diagnosis is tumor progression in patients with cancer; in noncancer patients the most
common alternative diagnoses are exacerbated COPD and acute heart failure.