Analysis of Causes of Diagnostic Difficulties and Features of Clinical Course of Pulmonary Embolism

Abstract

Aim of the study is to determine the frequency of intravital diagnosis of pulmonary embolism (PE) in patients who were examined and the diagnosis was confirmed during the autopsy. Sixty-nine (69) case histories of patients with PE undergoing treatment at the Main Military Clinical Hospital in the period of 2013-2017 were processed. All patients were divided into two groups: group I – patients diagnosed intravital (21 patients), and group II – patients who were diagnosed post mortem (48 patients). Clinical analytical (analysis of case histories), laboratory (coagulation profile, determination of D-dimer), and instrumental methods (chest radiography, electrocardiography (ECG), echocardiography, computed tomography of the chest) were used. Most often, PE was diagnosed with echocardiography. Out of the 69 individuals, an intravital diagnosis was made in 30.4% of the patients. An intravital diagnosis reduces the mortality, as it is evidenced by the ratio of deaths from PE among the people of the group I – 2.9±1%, and patients the group II – 21.7±4%, р < 0,05. The main reasons of diagnostic difficulties include the elderly patients (69,4±11,3); the presence of severe concomitant pathology; the development of PE with the agony of the body; inability to perform specific laboratory tests (D-dimer and others) in a hospital laboratory. Ischemic heart disease in 31% of patients and thrombophlebitis of the lower extremities in 7% of patients, which show as positive results in a number of laboratory studies (troponin-T, coagulation profile, myoglobin), may interfere with laboratory diagnostics of PE.