Intended for healthcare professionals

Practice Easily Missed?

Pulmonary embolism

BMJ 2010; 340 doi: (Published 13 April 2010) Cite this as: BMJ 2010;340:c1421
  1. Guy Meyer, MD123,
  2. Pierre-Marie Roy, MD PhD4,
  3. Serge Gilberg, MD1,
  4. Arnaud Perrier, MD5
  1. 1Université Paris Descartes, Paris, France
  2. 2Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Pneumologie et Soins Intensifs, Paris, France
  3. 3INSERM Unité 765, Paris, France
  4. 4Université d’Angers, IFR 132 et Centre Hospitalier Universitaire, Service d’accueil et traitement des urgences, Angers, France
  5. 5Division of General Internal Medicine, Geneva University Hospital, Switzerland
  1. Correspondence to: Dr G Meyer, Service de Pneumologie, Hopital Europeen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France, guy.meyer{at}
  • Accepted 21 February 2010

Complete occlusion of a peripheral pulmonary artery usually results in a pulmonary infarction with pleuritic chest pain and haemoptysis. When the blood clot is lodged in more proximal pulmonary arteries and is not occlusive, pulmonary infarction does not occur and pulmonary embolism might present as isolated dyspnoea. Massive pulmonary embolism is caused by large bilateral proximal clots resulting in haemodynamic collapse.1

Case scenario

A non-smoking, previously well woman in her 70s complained of recent onset of dyspnoea. She had no cardiovascular or thromboembolic risk factors and clinical examination was normal apart from a heart rate of 96 beats per minute. With no clear explanation for the symptoms, her general practitioner applied a decision rule (table) to evaluate the clinical probability of pulmonary embolism. The result was intermediate, prompting him to request a D-dimer level, which was raised. He referred the patient to hospital, where pulmonary embolism was confirmed on computed tomography.

View this table:

How common is it?

  • The incidence of diagnosed pulmonary embolism increases with age

  • The annual rate is about 1 in 10 000 in individuals below 40 years of age and can reach 1 in 100 in patients over 80 years2 3

  • According to autopsy studies, the disease is clinically suspected in less than half of fatal cases, so the real incidence is probably underestimated4

  • However, most episodes of pulmonary embolism carry a low mortality risk (about 1%) when properly diagnosed and treated

  • Massive …

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