title: [Acute pulmonary embolism: beware of the wolf in sheep's clothing].
abstract: Two male patients aged 57 and 73 were referred to the cardiologist because of progressive dyspnoea. In one patient, the general practitioner had previously adopted an expectative policy because of a clean chest X-ray. At presentation after 4 weeks, the patient was diagnosed with and treated for acute coronary syndrome because of minor ECG abnormalities. Additional CT scanning showed a large saddle embolus. Despite adequate treatment, the patient suffered an electrical asystole and died. The other patient underwent ECG, bicycle ergometry, MRI adenosine, echocardiography and lung function tests over a period of 5 weeks before pulmonary embolism (PE) was diagnosed. As the signs and symptoms of PE are largely non-specific, diagnostic delay is common, with risk of poor clinical outcome. PE should at least be considered whenever a patient presents with acute or worsening breathlessness, chest pain, circulatory collapse or coughing, particularly in the presence of known thrombotic risk factors or when there is no clear alternative.
authors.affiliation: Ziekenhuis Bronovo, afd. Cardiologie Den Haag, the Netherlands. f.a.klok@lumc.nl
authors.forename: Frederikus A
authors.initials: FA
authors.lastname: Klok
authors.forename: Jelmer E
authors.initials: JE
authors.lastname: Vahl
authors.forename: Menno V
authors.initials: MV
authors.lastname: Huisman
authors.forename: Paul R M
authors.initials: PR
authors.lastname: van Dijkman
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000473:pathology; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012307:Risk Factors