Pulmonary Embolism (cont.)

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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 health care professional will take a history of the chest pain, including its characteristics, its onset, and any associated symptoms that may direct the diagnosis to pulmonary embolism. It may include asking about risk factors for deep vein thrombosis.

Coughing up blood sputum may be a sign of pulmonary embolism.

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), 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 examining an extremity, looking for signs of a DVT, including warmth, redness, tenderness, and swelling.

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.

Medically Reviewed by a Doctor on 6/6/2012

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