Morpurgo M, Schmid C
Department of Cardiology, San Carlo Borromeo Hospital, Milan, Italy.
Chest. 1995 Jan;107(1 Suppl):18S-20S. doi: 10.1378/chest.107.1_supplement.18s.
Pulmonary embolism (PE) is still underdiagnosed even in hospitalized patients. In our recent experience, out of 92 postmortem cases of massive or submassive PE, only 28% were diagnosed before death, whereas the false-positives accounted only for 3% of cases. Similar conclusions have been drawn from large-scale autopsy studies performed in Norway and in the United States. The most important causes of an incorrect diagnosis are failure to suspect PE, and the protean nature of the disease. Remarkable differences actually exist concerning the point of origin and the final localization, as well as the size and age of thromboemboli, the presence or absence of pulmonary infarction, and the underlying pathology. Often a fatal embolus is relatively small but hardly tolerated because of the underlying cardiopulmonary situation. Attention should be called to the frequent autopsy finding of multiple PEs and pulmonary infarctions of apparently different age. This finding is important since it indicates that these patients suffered successive embolizations and the eventual death might have been prevented if an early diagnosis had been made.
即使在住院患者中，肺栓塞（PE）仍存在诊断不足的情况。根据我们最近的经验，在92例大面积或次大面积PE的尸检病例中，只有28%在死亡前得到诊断，而假阳性仅占病例的3%。挪威和美国进行的大规模尸检研究也得出了类似的结论。诊断错误的最重要原因是未能怀疑PE以及该疾病的多变性质。关于血栓栓子的起源点和最终定位、大小和年龄、是否存在肺梗死以及潜在病理情况，实际上存在显著差异。通常，致命栓子相对较小，但由于潜在的心肺状况而难以耐受。应注意尸检中经常发现的多个PE和明显不同年龄的肺梗死。这一发现很重要，因为它表明这些患者遭受了连续的栓塞，如果能早期诊断，最终的死亡可能是可以避免的。
