[Diagnosis of chronic pulmonary embolism in patients with advanced chronic obstructive pulmonary disease]

The coexistence of chronic obstructive pulmonary disease (COPD) and chronic pulmonary embolism (PE) worsens prognosis and requires complex therapeutic procedures. However, the diagnosis COPD + PE is difficult because of similar clinical symptomatology. Pulmonary angiography was performed in 20 patients aged 60.9 (37-75) years with COPD and with clinical suspicion of chronic pulmonary embolism (PE). Of 13 patients with PE 8 had proximal PE and in 5 patients peripheral PE was found. Both groups of patients did not differ with regard to their age 60.2 +/- 7 vs 59 +/- 10 years (NS), FEV1 0.9 +/- 0.3 vs 1.1 +/- 0.4 l (NS) as well as platelet cells count, fibrinogen, hematocrit and hemoglobin. Patients with COPD + PE compared to patients with COPD had higher pH 7.38 +/- 0.05 vs 7.32 +/- 0.03 (p = 0.01), and tendency to lower PaCO2 44.3 +/- 12 vs 52.0 +/- 7 mmHg(NS), and higher mean pulmonary artery pressure 48 +/- 17 vs 36.3 +/- 9 mmHg(NS). Patients with COPD+ proximal PE compared to COPD patients had higher pH 7.4 +/- 0.05 vs 7.3 +/- 0.03 (p = 0.004) and lower paCO2 39.6 +/- 10 vs 52 +/- 7 mmHg (p = 0.03).