BMJ  2005;330:452-453 (26 February), doi:10.1136/bmj.38331.602384.8F (published 31 January 2005)

Paper

Reproduction of chest pain by palpation: diagnostic accuracy in suspected pulmonary embolism

Grégoire Le Gal, physician1, Ariane Testuz, resident2, Marc Righini, physician2, Henri Bounameaux, physician2, Arnaud Perrier, physician2

1 Equipe d'accueil 3878 (GETBO), Brest University Hospital, 29609 Brest, France, 2 Division of General Internal Medicine, Department of Internal Medicine, Geneva Faculty of Medicine, Geneva University Hospital, CH-1211 Geneva, Switzerland.

Correspondence to: G Le Gal gregoire.legal@chu-brest.fr

The first 150 words of the full text of this article appear below.

Introduction

Chest pain associated with pulmonary embolism is usually sharp and worsens with deep inspiration, cough, and movement, resulting from pleural inflammation in peripheral emboli (pleuritic pain).1 Conversely, chest pain that is reproduced by palpation is thought to be caused by pathology of the musculoskeletal chest wall and may prompt clinicians to discard pulmonary embolism as the cause, although cases of pulmonary embolism with isolated pain in the chest wall have been described.2 Managing patients with chest pain is challenging because signs and symptoms of pulmonary embolism lack specificity, because it requires ruling out other life threatening conditions, and because a sizeable proportion of patients have musculoskeletal or pleural syndromes that require symptomatic treatment only.3 We assessed whether chest pain that can be reproduced by palpation is likely to be more indicative of an absence of pulmonary embolism than chest pain caused by breathing, cough, or movement.

Participants, methods, and results

We analysed a database . . . [Full text of this article]

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