[Scepticism is warranted or when the CT scan reveals to be a pitfall].
We report the case of a 72-year old woman with known metastatic breast cancer who presented to the emergency department with progressive dyspnea on exertion and chest pain. The diagnosis of pulmonary embolism could be established by pulmonary scintigraphy after computed tomography and ultrasound of the lower extremities had been negative in spite of a moderate clinical pretest probability (Wells score). This case shows that even if we manage suspected pulmonary embolism using algorithms combining clinical probability, computed tomography and ultrasound we must remain aware of eventually missing the diagnosis and carry on investigating cases with elevated clinical probability.
Hurni
E
E
Klinik und Poliklinik für Allgemeine Innere Medizin, Inselspital Bern. eva.hurni@insel.ch
Bürgi
U
U
Oestmann
A
A
D000368:Aged; D000465:Algorithms; D000792:Angiography; D001943:Breast Neoplasms / Q000150:complications*; D003951:Diagnostic Errors; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D010257:Paraneoplastic Syndromes / Q000000981:diagnostic imaging; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D019851:Thrombophilia / Q000150:complications; D036542:Tomography, Spiral Computed