Summary

Suspected acute pulmonary embolism in patients with and without cancer: alternative diagnoses

Gómez-Zorrilla Martín S, Riera-Mestre A, Leiva Pedraza D, Jordán Lucas S, Jacob Rodríguez J, Pujol Farriols R

Affiliation of the authors

Servicio de Medicina Interna, Servicio de Radiodiagnóstico, Servicio de Urgencias, Hospital Universitari de Bellvitge-IDIBELL, LHospitalet de Llobregat, Barcelona, Spain.

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.

 

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