IS THE CLINICAL DIAGNOSIS OF PULMONARY EMBOLISM BETTER THAN ALL THE INVESTIGATIONS?
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
1. In case of pulmonary embolism it is well known that ECG might not show changes of acute cor pulmonale.
2. Regarding blood gas studies - SPO2 might not be low if the embolus is very small.
3. Even when the patientís X-ray chest is normal, but the patient has a report of mis-matched ventilation perfusion scan - very often such findings are not due to pulmonary embolism.
Coming to the clinical diagnosis of pulmonary embolism ó
1. If the patient has got signs of deep vein thrombosis, specially involving the large veins.
2. If the patient is a known chronic cardiac case
3. Patient is a known case of any chronic lung or any other illness or is a post-operative patient-
If such a patient complains of acute pleural type of chest pain (one side of the chest)/or develop tachypnoea and dyspnoea, there are more than 90% chances that he has pulmonary embolism. The cough with a blood stained sputum may or may not be present. The attack may present as a syncope.
In short the clinical symptoms are more important than investigations worth thousands of rupees.