title: Acute cardiac disorder or pneumonia and concomitant presence of pulmonary embolism.
abstract: OBJECTIVE
  To determine the frequency of apparent acute pulmonary embolism (PE) and of concomitant disease in computed tomography pulmonary angiography (CTPA); to compare the frequency of PE in patients with pneumonia or acute cardiac disorder (acute coronary syndrome, tachyarrhythmia, acute left ventricular heart failure or cardiogenic shock), with the frequency of PE in patients with none of these alternative chest pathologies (comparison group).
  
  
  METHODS
  Retrospective analysis of all patients who received a CTPA at the emergency department (ED) within a period of four years and 5 months.
  
  
  RESULTS
  Of 1275 patients with CTPA, 28 (2.2%) had PE and concomitant radiologic evidence of another chest disease; 3 more (0.2%) had PE and an acute cardiac disorder without radiological evidence of heart failure. PE was found in 11 of 113 patients (10%) with pneumonia, in 5 of 154 patients (3.3%) with an acute cardiac disorder and in 186 of 1008 patients (18%) in the comparison group. After adjustment for risk factors for thromboembolism and for other relevant patient's characteristics, the proportion of CTPAs with evidence of PE in patients with an acute cardiac disorder or pneumonia was significantly lower than in the comparison group (OR 0.13, 95% CI 0.05-0.33, p<0.001 for patients with an acute cardiac disorder, and OR 0.45, 95% CI 0.23-0.89, p = 0.021 for patients with pneumonia).
  
  
  CONCLUSIONS
  The frequency of PE and a concomitant disease that can mimic PE was low. The presence of an acute cardiac disorder or pneumonia was associated with decreased odds of PE.
authors.affiliation: Department of Emergency Medicine, Inselspital, University Hospital Bern, Bern, Switzerland. martin.rohacek@gmail.com
authors.forename: Martin
authors.initials: M
authors.lastname: Rohacek
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Szucs-Farkas
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Pfortmüller
authors.forename: Heinz
authors.initials: H
authors.lastname: Zimmermann
authors.forename: Aristomenis
authors.initials: A
authors.lastname: Exadaktylos
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications* / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed