[Pulmonary embolism: the past and . . . the future]

Area of Science:

• Cardiology and Pulmonary Medicine
• Medical History
• Diagnostic Imaging

Context:

• The understanding and management of pulmonary embolism (PE) have evolved over two centuries, with significant contributions from European scientists.
• Early observations linked venous thrombosis to PE, leading to the concept of venous thromboembolic disease.
• The development of diagnostic tools, from early X-rays to advanced CT and MRI, has been crucial but diagnosis remains a challenge.

Purpose:

• To provide a historical overview of pulmonary embolism, highlighting key milestones in its understanding, diagnosis, and treatment.
• To underscore the persistent challenges in diagnosing PE accurately and efficiently in clinical practice.
• To discuss the historical progression and current dilemmas in therapeutic strategies, including anticoagulation and thrombolysis for venous thromboembolism.

Summary:

• The history of pulmonary embolism (PE) reveals a long journey from initial descriptions to modern medicine, with diagnostic capabilities significantly advancing through various imaging techniques.
• Despite technological progress, diagnosing PE remains difficult due to the lack of a single, ideal diagnostic test combining power, availability, and cost-effectiveness.
• Treatment strategies, including anticoagulation and thrombolysis, have evolved but clear criteria for their selection and optimal duration of secondary prophylaxis are still debated.

Impact:

• Highlights the critical need for improved diagnostic accuracy and cost-effective tools for pulmonary embolism.
• Emphasizes the ongoing debate and lack of consensus on optimal treatment strategies for venous thromboembolism.
• Suggests that future research must address these persistent challenges to improve patient outcomes in pulmonary embolism management.