Prognosis in a patient with an initial normal pulmonary angiogram

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.