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Pulmonary embolism: an internist's perspective.

D Nicholson1

  • 1Department of Medicine, University of Arkansas for Medical Sciences, Little Rock 72205.

Journal of Thoracic Imaging
|October 1, 1989
PubMed
Summary
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Pulmonary embolism (PE) was highly prevalent, found in over half of autopsies, yet often missed clinically. This study highlights the significant underdiagnosis of PE, even decades ago.

Area of Science:

  • Pathology
  • Cardiovascular Medicine
  • Pulmonary Medicine

Background:

  • Thromboembolism, specifically pulmonary embolism (PE), was underrecognized historically.
  • Retrospective studies suggested a high incidence of PE, but clinical awareness lagged.
  • Many PE episodes were likely missed due to a lack of overt clinical signs.

Purpose of the Study:

  • To prospectively evaluate the incidence of pulmonary emboli in a defined patient cohort.
  • To assess the contribution of PE to mortality.
  • To underscore the historical underappreciation of PE prevalence and its clinical manifestations.

Main Methods:

  • A prospective autopsy study was conducted on 263 right lungs from patients over 10 years old.
  • Autopsies were performed at United Oxford Hospitals between 1964 and 1965.

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  • Data from retrospective studies were reviewed to contextualize findings.

    • Main Results:

    • Pulmonary emboli were identified in 136 out of 263 autopsies (51.7%).
    • Pulmonary embolism was determined to be the primary cause of death in 37 cases (27% of those with PE).
    • The findings indicate a substantial and often clinically silent burden of PE.

    Conclusions:

    • The incidence of pulmonary embolism is significantly higher than previously appreciated, even in the mid-20th century.
    • Clinical diagnosis of PE was frequently missed, emphasizing the need for improved diagnostic strategies.
    • This study reinforces the importance of considering PE in autopsy findings and clinical practice.