Pulmonary Embolism (Blood Clot in the Lung) - Diagnosis

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How is pulmonary embolism diagnosed?

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 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 questions 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 major complaints for heart attack, pneumonia, pneumothorax (collapsed lung), dissection of an aoritc aneurysm, among other conditions.

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.

Return to Pulmonary Embolism (Blood Clot in the Lung)

See what others are saying

Comment from: Macca, 55-64 Male (Patient) Published: June 02

I had a CT scan done and when I went to collect them the receptionist advised me to go straight to hospital as the radiologist had spoken to the doctor. I was admitted and stayed 1 night for pulmonary embolism.

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Comment from: LuckyMeg, 45-54 Female (Patient) Published: October 31

I had chest pain for about a week and it eased up. Then it came back again a few days later, along with difficulty in breathing. I went to the emergency room. My EKG was very off (more than its usual abnormality due to prior heart attack.) My D-dimer was negative. I was admitted to the hospital and cardiac enzymes were tested every 6 hours for the next day. They gave me oxygen and nitroglycerine and I felt better but was referred to my cardiologist. The chest pain did not get better while I was on nitro prophylactically so I was scheduled for a cardiac catheterization. My cardiologist was shocked at how good my heart looked and said there was something else going on. Within two days my leg was swollen and painful and I again went to the emergency room on my cardiologist's advice where they did ultrasounds of my veins and arteries and found DVT (deep vein thrombosis) in both major veins of my leg extending into my pelvis. It wasn't until this point they realized my prior chest pain and trouble breathing was a pulmonary embolism. I was immediately put on Lovenox injections, had an ilio-femoral thrombectomy and after a few days sent home on Xarelto, indefinitely. They suspect I have antiphospholipid antibodies based on preliminary tests but have to wait until I'm off anticoagulants to confirm. My hematologist has prolonged the treatment from the planned 6 months saying knowing what caused the clots is not as important as preventing more clots.

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