[Clinical diagnosis of pulmonary embolism]

Pulmonary embolism, a major complication of thromboembolic disease, remains an important cause of mortality, both in surgical and medical practice. In recent literature, one finds two different currents: the first one asserts that pulmonary embolism is overdiagnosed and, therefore, "overtreated" with iatrogenic hemorrhagic complications, when other authors assert that pulmonary embolism is underdiagnosed and "undertreated". It is obvious that clinical diagnosis of non massive, acute pulmonary embolism remains difficult and that the classical triad pleuritic chest pain, hemoptysis and signs of deep venous thrombosis is not frequently found. The clinician should be attentive to the different symptoms and clinical signs which might arouse a suspicion of pulmonary embolism. A large range of investigations is available to confirm the clinical diagnosis. In deep venous thrombosis preceding or accompanying pulmonary embolism, treatment should be instituted at the first signs of venous attack. A precise diagnosis will secondarily be confirmed by phlebography. Any delay in effective early treatment of thromboembolic disease will increase the risk of pulmonary embolism and of the mortality inherent in this dreadful complication.