Menditto Vincenzo G, Mei Federico, Postacchini Laura, Manfredi Lucia, Tedesco Silvia, Pomponio Giovanni, Gabrielli Armando, Salvi Aldo
Department of Internal Medicine, Ospedali Riuniti di Ancona, Italy.
Clinica Medica, Università Politecnica delle Marche, Ancona, Italy.
Recenti Prog Med. 2019 Feb;110(2):93-97. doi: 10.1701/3112.31005.
Natural history and outcomes of patients with pulmonary embolism (PE) without typical symptoms (atypical PE) remain unclear. The aim of the study is to compare the clinical characteristics and the prognosis between typical PE and atypical PE.
We retrospectively analyzed data from consecutive patients admitted to the Emergency Department (ED) because of a diagnosis of PE and classified them in two groups: typical PE and atypical PE. We defined PE to be typical in presence of almost one of the following symptoms or signs: dyspnea, chest pain, hemoptysis or signs of deep vein thrombosis.
Of the 191 patients with PE, 154 (81%) had typical PE and 37 (19%) had atypical PE. Patients with atypical and typical PE seemed to had similar prognostic factor such as high risk sPESI (73% vs 65%, p=0.3), right ventricular dysfunction (30% vs 26%, p=0.6) and central PE at chest CT scan (38% vs 36%, p=0.8). The rate of 30 day mortality was 7% in the typical group and 8% in the atypical group (p=0.8). The length of stay in hospital was the same in the two groups (6 days; p=0.2).
We found that atypical and typical PE seem to be related diseases with a similar short term prognosis. Therefore, we could speculate that a missed diagnosis of PE in ED could expose the patients to a worsen prognosis. Further perspective studies are required for better investigate this diagnostic challenge.
无典型症状的肺栓塞（PE）患者的自然病史和预后仍不明确。本研究的目的是比较典型PE和非典型PE的临床特征及预后。
我们回顾性分析了因诊断为PE而入住急诊科（ED）的连续患者的数据，并将他们分为两组：典型PE组和非典型PE组。如果存在以下几乎任何一种症状或体征，我们将PE定义为典型：呼吸困难、胸痛、咯血或深静脉血栓形成的体征。
在191例PE患者中，154例（81%）为典型PE，37例（19%）为非典型PE。非典型和典型PE患者似乎有相似的预后因素，如高危简化肺栓塞严重指数（sPESI）（73%对65%，p = 0.3）、右心室功能障碍（30%对26%，p = 0.6）以及胸部CT扫描显示的中央型PE（38%对36%，p = 0.8）。典型组30天死亡率为7%，非典型组为8%（p = 0.8）。两组住院时间相同（6天；p = 0.2）。
我们发现非典型和典型PE似乎是短期预后相似的相关疾病。因此，我们可以推测急诊科对PE的漏诊可能会使患者预后恶化。需要进一步的前瞻性研究来更好地探究这一诊断挑战。
