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Prognosis in a patient with an initial normal pulmonary angiogram
V Bertucci1, M R Asch, M S Balter
1Department of Medicine, Mount Sinai Hospital, Toronto, Canada.
Chest
|April 1, 1994
Summary
Pulmonary embolism can be missed even with normal initial imaging. Repeated diagnostic tests are crucial for accurate diagnosis, especially when symptoms persist.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Diagnostic Imaging
Background:
- Pulmonary embolism (PE) diagnosis relies on imaging, but false negatives can occur.
- Noninvasive strategies are preferred but require careful interpretation.
Observation:
- A 58-year-old man presented with pleuritic chest pain and an indeterminate lung scan.
- Initial duplex ultrasound of lower limbs and pulmonary angiogram were normal.
Findings:
- Recurrent symptoms prompted repeat pulmonary angiography, revealing a pulmonary embolism.
- This highlights the potential for missed or delayed PE diagnosis.
Implications:
- Normal initial imaging does not exclude pulmonary embolism.
- Serial diagnostic studies are essential for patients with persistent symptoms suggestive of PE.
- This underscores the limitations of noninvasive diagnostic strategies without serial evaluation.