[Clinical aspects and diagnosis of pulmonary thromboembolism]

The symptomatology of PTE is good for the suspicion of PTE only. Symptoms are mainly based on dyspnoea (respiratory rate) and pain in the chest. Clinical diagnostic procedures, on the other hand, are backed up by evaluation of specific risk factors (previous thrombosis, post-operative state, immobilisation) and search for deep venous thrombosis (DVT). Blood gas analysis is very sensitive to unravel (latent) respiratory failure, along with established routine measures (blood pressure, ECG, chest-film) and additional echocardiography. Most important in our experience is a perfusion scan at the earliest opportunity. Spiral-CT angiography is indicated in special cases only. We looked at 115 consecutive patients with suspected PTE and found close correlations between risk profiles of thrombosis, pathological BGA and high probability perfusion scans. DVT was detected in 50% only. Positive predictive values for high risk and pathological BGA were 86 and 92%, respectively. An algorithm for diagnostical/therapeutical strategies is presented. The early application of an heparin-bolus is stressed.