BMJ  2006;332:364 (11 February), doi:10.1136/bmj.332.7537.364

Letter

Venous thromboembolism

Potentially dangerous diagnostic pitfalls arise from diagnostic tests

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

EDITOR—The review of venous thromboembolism by Blanna and Lip did not draw sufficient attention to the diagnostic pitfalls that are an almost inevitable consequence of the reliance that many frontline medical staff place on diagnostic tests when differentiating between three of the most life threatening chest pain syndromes.¹ These I would call the three ugly sisters—namely, pulmonary embolism, dissecting aortic aneurysm, and myocardial infarction.

Credit: JAMES KING HOLMES/SPL

 

Dissecting aneurysm simulates pulmonary embolism when it presents with chest pain and/or collapse in association with raised d-dimer concentrations of the order of > 0.5 µg/ml, so much so that "testing for d-dimer should be part of the initial assessment of patients with chest pain, especially if aortic dissection is suspected."² When pulmonary embolism presents with chest pain and raised serum cardiac troponin³ a mistaken diagnosis of myocardial infarction might lead not only to inappropriate thrombolysis but also to a . . . [Full text of this article]

Manchester M20 2RN oscarjolobe@yahoo.co.uk

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Relevant Article

Venous thromboembolism

Andrew D Blann and Gregory Y H Lip
BMJ 2006 332: 215-219. [Extract] [Full Text] [PDF]