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
REFERENCES
atufano@unina.it
