Showing papers by "Gaurav Sharma published in 1977"

Diagnosis of pulmonary embolism

Abstract: Although there is an increasing recognition of pulmonary embolism (PE) as a major contributory factor to the mortality and morbidity of hospitalized patients, the disease continues to present difficult diagnostic problems. Recent clinical studies employing perfusion lung scan and selective pulmonary angiogram as diagnostic screening tests indicate that fatal PE occurs in about 5 patients per 1000 inpatients ( 1) and nonfatal PE in 20 per 1000 inpatients (2). On an annual basis, this incidence rate yields a total of approximately 140,000 fatal and 560,000 nonfatal pulmonary­ embolism cases each year. While the mortality of untreated PE is high, ranging from 18% (3) to 38% (4), that of treated PE is relatively low-8% (5). It is therefore important that the clinician be aware of the implication of the above observations and institute appropriate measures for early diagnosis and treatment in the sus­ pected patient. Diagnosis, however, may often be difficult, and at times, impossible. The diagnosis of PE can be made at the clinical level if a patient with no prior heart or lung disease presents with a history of thrombophlebitis, sudden onset of dyspnea, pleuritic pain, hemoptysis, and has minimal findings on physical examination and a "normal-looking" plain chest X ray. The clinical diagnosis may be confirmed by documentation of arterial hypoxemia and characteristic perfusion defect(s) on lung scanning. Such a presentation is so "typical" that further confirmation by selective pulmonary angiography may even be considered unnecessary. Unfortunately, how­ ever, the manifestations of pulmonary embolic disease are rarely so typical and the diagnosis rarely so easy. In the great majority of patients, the disease presents in an