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The challenge of diagnosing pulmonary embolism in children, pregnant women, and elderly patients: a descriptive review of the literature.
MedLine Citation:
PMID:  22198856     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
Antonella Tufano; Mirko Di Capua; Antonio Coppola; Claudia Arturo; Paola Ieranò; Anna Maria Cerbone; Giovanni Di Minno
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Publication Detail:
Type:  Journal Article     Date:  2011-12-23
Journal Detail:
Title:  Seminars in thrombosis and hemostasis     Volume:  37     ISSN:  1098-9064     ISO Abbreviation:  Semin. Thromb. Hemost.     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-12-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0431155     Medline TA:  Semin Thromb Hemost     Country:  United States    
Other Details:
Languages:  eng     Pagination:  908-17     Citation Subset:  IM    
Copyright Information:
© Thieme Medical Publishers.
Affiliation:
Regional Reference Center for Coagulation Disorders, Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy.
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