Pulmonary Embolism (cont.)
How is pulmonary embolism diagnosed?
History and physical examination
There always needs to be a high a level of suspicion that a pulmonary embolus
may be the cause of chest pain or shortness of breath. The healthcare provider
will take a history of the type of chest pain, including its onset and
associated symptoms that may direct the diagnosis to pulmonary embolism. It may
include asking about risk factors for deep vein thrombosis.
Physical examination will concentrate initially on the heart and lungs, since
chest pain and shortness of breath may also be the presenting complaints for
heart attack, pneumonia, pneumothorax (collapsed lung), and dissection of an
aortic aneurysm, among others.
With pulmonary embolism, the chest examination is often normal, but if there is some associated inflammation on the surface of the lung (the pleura), a rub may be heard (pleura inflammation may cause friction which can be heard with a stethoscope). The surfaces of the lung and the inside of the chest wall are covered by a membrane (the pleura) that is full of nerve endings. When the pleura becomes inflamed, as can occur in pulmonary embolus, a sharp pain can result that is worsened by breathing, so-called pleurisy or pleuritic chest pain.
The physical examination may include looking for signs of a deep vein thrombosis in an
extremity:
- warmth,
- swelling,
- redness, and
- tenderness.
It is important to note, however, that the signs associated with deep vein
thrombosis may be completely absent even in the presence of a clot. Again, risk
factors for clotting must be taken into consideration when making an assessment.
Next: Basic testing (CBC, electrolytes, BUN, creatinine blood test, chest
x-ray, EKG) »
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