Acad Radiol. 2015 Aug;22(8):985-7. doi: 10.1016/j.acra.2015.05.001. Epub 2015 Jun 19.
Jha S1.
Pulmonary embolism (PE) is a dreaded condition which nearly every physician, in practice or training, is aware about. It is a leading and avoidable cause of sudden death. That PE is now overdiagnosed, merits reflection.PE’s journey from an acute emergency which physicians feared missing, to a frequently overdiagnosed entity leading to overtreatment, is instructive at multiple levels, showcasing the inevitability of overdiagnosis and exposing barriers to its reduction.
Embolism to the pulmonary arteries, if large, can lead to right heart strain, cardiovascular collapse, and sudden death. PE is in the differential for pulseless electrical activity, a type of cardiac arrest. PE, more often, presents less dramatically and such presentations can be so nonspecific that a range of symptoms is attributable to PE. Emboli that do not cause cardiovascular collapse at their first presentation are not important for their own sake but because they herald a much larger clot burden in the future. This means that the significance of PE lies in its recurrence. That the risk of recurrence can be reduced by anticoagulation makes recurrent PE an avoidable harm