Prognosis in a patient with an initial normal pulmonary angiogram

A 58-year-old man with pleuritic chest pain and an indeterminate lung scan had normal results of Duplex ultrasound studies of the lower limbs and a normal pulmonary angiogram. Recurrent symptoms led to repeated pulmonary angiography and a diagnosis of pulmonary embolism. This case emphasizes the possibility of missing an initial, or developing a subsequent, pulmonary embolism despite a normal angiogram and reinforces the need for serial studies if a noninvasive strategy for the diagnosis of pulmonary embolism is to be employed.