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Semin Thromb Hemost 2011; 37(8): 908-917
DOI: 10.1055/s-0031-1297370
© Thieme Medical Publishers

The Challenge of Diagnosing Pulmonary Embolism in Children, Pregnant Women, and Elderly Patients: A Descriptive Review of the Literature

Antonella Tufano1 , Mirko Di Capua1 , Antonio Coppola1 , Claudia Arturo1 , Paola Ieranò1 , Anna Maria Cerbone1 , Giovanni Di Minno1
  • 1Regional Reference Center for Coagulation Disorders, Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy
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Publikationsdatum:
23. Dezember 2011 (online)

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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.

KEYWORDS

Diagnosis - pulmonary embolism - elderly - pregnancy - pediatric patient

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Antonella TufanoM.D. Ph.D. 

Regional Reference Centre for Coagulation Disorders, Department of Clinical and Experimental Medicine, Federico II University of Naples

Via S. Pansini, 5 - 80131 Naples, Italy

eMail: atufano@unina.it