Morpurgo M
Département de Cardiologie, Hôpital San Carlo Borromeo, Milan, Italie.
Ann Cardiol Angeiol (Paris). 1998 Nov;47(9):633-6.
The clinical diagnosis of pulmonary embolism (PE), even massive, remains difficult and perplexing. In our hospital, the percentage of exact clinical diagnoses has not significantly changed over recent years, with a false-negative rate of 78%, and a false-positive rate of 2%. In approximately 20% of cases, autopsy showed several emboli and pulmonary infarctions of various ages, indicating recurrent embolic episodes. The diseases most frequently associated were cardiac diseases (51%) and tumours (24%). Pneumonia considerably decreases the probability of an exact diagnosis of PE; hospitalisation in the Cardiology department or Intensive Care Unit increased the probability of this diagnosis. While the numerous diagnostic algorithms recently proposed have a limited value, the process integrating clinical and instrumental data in order to establish a prospective clinical probability, should facilitate identification of acute PE in live patients.
肺栓塞（PE）的临床诊断，即使是大面积肺栓塞，仍然困难且令人困惑。在我们医院，近年来准确临床诊断的比例没有显著变化，假阴性率为78%，假阳性率为2%。在大约20%的病例中，尸检显示有多个不同时期的栓子和肺梗死，提示反复发生栓塞事件。最常伴发的疾病是心脏病（51%）和肿瘤（24%）。肺炎会显著降低PE准确诊断的概率；入住心内科或重症监护病房会增加这种诊断的概率。虽然最近提出的众多诊断算法价值有限，但整合临床和检查数据以建立前瞻性临床概率的过程，应有助于识别存活患者中的急性PE。
