Goldhaber S Z, Hennekens C H, Evans D A, Newton E C, Godleski J J
Am J Med. 1982 Dec;73(6):822-6. doi: 10.1016/0002-9343(82)90764-1.
Difficulties persist in the accurate clinical diagnosis of major pulmonary embolism despite the availability of lung scans and pulmonary angiography. To evaluate factors associated with the correct antemortem diagnosis of pulmonary embolism, we reviewed all 1,455 autopsy reports at the Peter Bent Brigham Hospital from 1973 to 1977. Of 54 patients identified with anatomically major pulmonary embolism at autopsy, 16 (30 percent) had correct antemortem diagnosis. Accuracy was far greater in postoperative patients (64 percent) (p = 0.02) and in patients with autopsy-proved venous thrombosis (55 percent) (p = 0.005). Lung scanning (82 percent) (p = 0.0002) and pulmonary angiography (80 percent) (p = 0.05) during the 10 days prior to death were also associated with an increased tendency to correct clinical diagnosis of pulmonary embolism. In contrast, among 21 patients with autopsy-proved major pulmonary embolism who also had pneumonia, no pulmonary embolism was diagnosed before death (p = 0.0001). Furthermore, among patients 70 years of age or older, only 10 percent with pulmonary embolism at postmortem examination had a correct diagnosis prior to death (p = 0.02). In patients with pneumonia or in elderly patients, an increased awareness of the possibility of pulmonary embolism and more frequent use of lung scanning and pulmonary angiography may increase the accurate clinical diagnosis of pulmonary embolism.
尽管有肺部扫描和肺血管造影等手段，但对主要肺栓塞进行准确的临床诊断仍存在困难。为了评估与肺栓塞生前正确诊断相关的因素，我们回顾了1973年至1977年彼得·本特·布里格姆医院的所有1455份尸检报告。在尸检中确定为解剖学上主要肺栓塞的54例患者中，16例（30%）生前诊断正确。术后患者的诊断准确率要高得多（64%）（p = 0.02），尸检证实有静脉血栓形成的患者也是如此（55%）（p = 0.005）。死亡前10天内进行肺部扫描（82%）（p = 0.0002）和肺血管造影（80%）（p = 0.05）也与肺栓塞临床诊断正确的倾向增加有关。相比之下，在21例尸检证实有主要肺栓塞且同时患有肺炎的患者中，生前未诊断出肺栓塞（p = 0.0001）。此外，在70岁及以上的患者中，尸检时有肺栓塞的患者只有10%在死亡前得到了正确诊断（p = 0.02）。对于患有肺炎的患者或老年患者，提高对肺栓塞可能性的认识以及更频繁地使用肺部扫描和肺血管造影可能会提高肺栓塞的临床诊断准确性。
