The Challenge of Diagnosing Pulmonary Embolism in Children, Pregnant Women, and Elderly Patients: A Descriptive Review of the Literature
ABSTRACT The prompt and accurate diagnosis of pulmonary embolism (PE) greatly influences patient outcomes. However, diagnosing PE is one of the most difficult challenges confronting physicians, even more so when the clinical suspicion is addressed in children, during pregnancy, or in elderly patients. In these patient groups, symptoms and signs from concomitant conditions or diseases may mimic PE and make difficult defining clinical probability categories for PE as usually applied to general adult patients. Moreover, the diagnostic techniques show wider, specific limitations in these settings. PE is considered rare in children. The diagnostic management of a child with suspected PE is largely extrapolated from the knowledge achieved in adult patients. An increased risk of venous thromboembolism is reported in all trimesters of pregnancy and in the puerperium. An accurate diagnosis of PE in pregnancy has important implications, including the need for prolonged anticoagulation, delivery planning, and prophylaxis during future pregnancies, as well as concerns about future oral contraceptive use and estrogen therapy. Although incidence, morbidity, and mortality increase steadily with age, PE remains an underdiagnosed disease in elderly patients. About 40% of PE found at necropsy were not suspected antemortem. In the present article, challenges in diagnosing PE in children, during pregnancy, and in the elderly will be discussed, reviewing the available clinical, laboratory, and instrumental diagnostic strategies.
- Seminars in Thrombosis and Hemostasis 11/2011; 37(8):859-62. DOI:10.1055/s-0031-1297363 · 3.69 Impact Factor
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ABSTRACT: Venous thromboembolism is one of the leading cause of maternal mortality worldwide. The incidence of venous thromboembolism is estimated at 0.76 to 1.72 per 100.000 pregnancies which is four times as great as the risk in nonpregnant women. The purpose of this article is to raise awareness of this frequent problem in pregnancy and provide a practical approach for the diagnosis, management, and prevention of venous thromboembolism during pregnancy and delivery. A number of risk factors for the development venous thromboembolism have been identified. The two most important risk factors for venous thromboembolism in pregnancy are thrombophilia and previous venous thromboembolism. Deep venous thrombosis in the majority of cases occurs in the lower extremities and pelvis. As the clinical diagnosis of venous thromboembolism is unreliable, the women who are suspected of having deep venous thrombosis or pulmonary embolism should be examined promptly using imaging diagnostics. The first diagnostic method is Doppler ultrasound. Where available, individual authors recommend magnetic resonance venography, pulmonary angiography or computed tomography. Unfractionated heparin or low-molecular-weight heparin has a central place in the prevention and treatment of venous thromboembolism in pregnancy because they do not pass through the placenta, thus avoiding the risks likely to be induced by warfarin. The prevention of venous thromboembolism must focus on the patients known to be at high risk bearing in mind that the recommendations for prophylaxis, even in high-risk patients, are based on the limited data.Medicinski pregled 01/2013; 66(9-10):417-23. DOI:10.2298/MPNS1310417S