Initial symptoms in pulmonary embolism differ from those in pneumonia: a retrospective study during seven years.
OBJECTIVE
To compare initial symptoms in pulmonary embolism with community-acquired pneumonia and relate to C-reactive protein and pulmonary infiltrates in order to improve the clinical assessment at the emergency department.


METHODS
A retrospective review of patients with pulmonary embolism diagnosed in the clinic for infectious diseases (CID), (n=25), and a randomized sample of patients with pulmonary embolism diagnosed in the department of medicine (n=64), and a randomized sample of patients with community-acquired pneumonia (n=54) diagnosed in the clinic for infectious diseases.


RESULTS
Initial symptoms in pulmonary embolism, dominated by dyspnoea and/or pleuritic chest pain were significantly different from those in community-acquired pneumonia, dominated by fever, chills and/or cough (P<0.001). On admission, C-reactive protein and body temperature were significantly higher and pulmonary infiltrates were more common in pneumonia compared with randomized pulmonary embolism patients. Twenty-five patients with a final diagnosis of pulmonary embolism were erroneously suspected of having lung infection, owing to increased C-reactive protein, presence of pulmonary infiltrates and/or high fever. However, they had classical symptoms of pulmonary embolism.


CONCLUSIONS
Pulmonary infiltrates, high fever and a high level of C-reactive protein can deceive the physician to suspect pneumonia instead of pulmonary embolism. Classical initial symptoms ought to direct the physician in diagnosing pulmonary embolism. We emphasize a detailed patient history of initial symptoms.
Söderberg
Mårten
M
Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden [corrected] marten.soderberg@sodersjukhuset.se
Hedström
Ulla
U
Sjunnesson
Malgorzata
M
Lärfars
Gerd
G
Jorup-Rönström
Christina
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000503:physiopathology; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D013548:Sweden