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Reliable, easy-to-read patient information on common medical conditions โ€” written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Pulmonary embolism differential diagnosis

Introduction

Overview

Overview

Pulmonary embolism must be distinguished from other life-threatening causes of chest pain including acute myocardial infarction, aortic dissection, and pericardial tamponade, as well as a large list of non-life-threatening causes of chest discomfort and shortness of breath.

Differential Diagnosis

Differential Diagnosis

Differential Diagnosis Based on Symptoms

Pulmonary embolism (PE) should be differentiated from other diseases presenting with chest pain, shortness of breath and tachypnea. The differentials include the following:[1]_RadioGraphics-2|[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]

Diseases Diagnostic tests Physical Examination Symptoms Past medical history Other Findings
CT scan and MRI EKG Chest X-ray Tachypnea Tachycardia Fever Chest Pain Hemoptysis Dyspnea on Exertion Wheezing Chest Tenderness Nasalopharyngeal Ulceration Carotid Bruit
Pulmonary embolism
  • On CT angiography:
    • Intra-luminal filling defect
  • On MRI:
    • Narrowing of involved vessel
    • No contrast seen distal to obstruction
    • Polo-mint sign (partial filling defect surrounded by contrast)
 โœ” โœ” โœ” (Low grade) โœ” โœ” (In case of massive PE) โœ” – – – –
Congestive heart failure
  • Goldberg’s criteria may aid in diagnosis of left ventricular dysfunction: (High specificity)
    • SV1 or SV2 + RV5 or RV6 โ‰ฅ3.5 mV
    • Total QRS amplitude in each of the limb leads โ‰ค0.8 mV
    • R/S ratio <1 in lead V4
 โœ” โœ” โœ” – – โœ” – – – –
Percarditis
  • ST elevation
  • PR depression
  • Large collection of fluid inside the pericardial sac (pericardial effusion)
  • Calcification of pericardial sac
 โœ” โœ” โœ” (Low grade) โœ” (Relieved by sitting up and leaning forward) – โœ” – – – –
  • May be clinically classified into:
    • Acute (< 6 weeks)
    • Sub-acute (6 weeks – 6 months)
    • Chronic (> 6 months)
Pneumonia โœ” โœ” โœ” โœ” – โœ” โœ” – – –
Vasculitis

Homogeneous, circumferential vessel wall swelling

โœ” โœ” โœ” โœ” โœ” โœ” – โœ” โœ” โœ”
Chronic obstructive pulmonary disease (COPD)
  • On CT scan:
  • On MRI:
    • Increased diameter of pulmonary arteries
    • Peripheral pulmonary vasculature attentuation
    • Loss of retrosternal airspace due to right ventricular enlargement
    • Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung
 โœ” โœ” – – – โœ” โœ” – – –

Life Threatening Differential Diagnosis

Common Differential Diagnosis in Outpatients

Among outpatients presenting with dyspnea, <4ย % are diagnosed with PE.[21] Common differential diagnoses include:[21]

Complete List of Differential Diagnosis

References

  1. โ†‘ Brenes-Salazar JA (2014). “Westermark’s and Palla’s signs in acute and chronic pulmonary embolism: Still valid in the current computed tomography era”. J Emerg Trauma Shock. 7 (1): 57โ€“8. doi:10.4103/0974-2700.125645. PMCย 3912657. PMIDย 24550636.
  2. _RadioGraphics_2-0|โ†‘ “CT Angiography of Pulmonary Embolism: Diagnostic Criteria and Causes of Misdiagnosis | RadioGraphics”.
  3. โ†‘ Bฤ•lohlรกvek J, Dytrych V, Linhart A (2013). “Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism”. Exp Clin Cardiol. 18 (2): 129โ€“38. PMCย 3718593. PMIDย 23940438.
  4. โ†‘ “Pulmonary Embolism: Symptoms – National Library of Medicine – PubMed Health”.
  5. โ†‘ Ramani GV, Uber PA, Mehra MR (2010). “Chronic heart failure: contemporary diagnosis and management”. Mayo Clin. Proc. 85 (2): 180โ€“95. doi:10.4065/mcp.2009.0494. PMCย 2813829. PMIDย 20118395.
  6. โ†‘ Blinderman CD, Homel P, Billings JA, Portenoy RK, Tennstedt SL (2008). “Symptom distress and quality of life in patients with advanced congestive heart failure”. J Pain Symptom Manage. 35 (6): 594โ€“603. doi:10.1016/j.jpainsymman.2007.06.007. PMCย 2662445. PMIDย 18215495.
  7. โ†‘ Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ (2009). “Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology”. Eur. J. Heart Fail. 11 (2): 130โ€“9. doi:10.1093/eurjhf/hfn013. PMCย 2639415. PMIDย 19168510.
  8. โ†‘ Takasugi JE, Godwin JD (1998). “Radiology of chronic obstructive pulmonary disease”. Radiol. Clin. North Am. 36 (1): 29โ€“55. PMIDย 9465867.
  9. โ†‘ Wedzicha JA, Donaldson GC (2003). “Exacerbations of chronic obstructive pulmonary disease”. Respir Care. 48 (12): 1204โ€“13, discussion 1213โ€“5. PMIDย 14651761.
  10. โ†‘ Nakawah MO, Hawkins C, Barbandi F (2013). “Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome”. J Am Board Fam Med. 26 (4): 470โ€“7. doi:10.3122/jabfm.2013.04.120256. PMIDย 23833163.
  11. โ†‘ Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, Oh JK (2010). “Pericardial disease: diagnosis and management”. Mayo Clin. Proc. 85 (6): 572โ€“93. doi:10.4065/mcp.2010.0046. PMCย 2878263. PMIDย 20511488.
  12. โ†‘ Bogaert J, Francone M (2013). “Pericardial disease: value of CT and MR imaging”. Radiology. 267 (2): 340โ€“56. doi:10.1148/radiol.13121059. PMIDย 23610095.
  13. โ†‘ Gharib AM, Stern EJ (2001). “Radiology of pneumonia”. Med. Clin. North Am. 85 (6): 1461โ€“91, x. PMIDย 11680112.
  14. โ†‘ Schmidt WA (2013). “Imaging in vasculitis”. Best Pract Res Clin Rheumatol. 27 (1): 107โ€“18. doi:10.1016/j.berh.2013.01.001. PMIDย 23507061.
  15. โ†‘ Suresh E (2006). “Diagnostic approach to patients with suspected vasculitis”. Postgrad Med J. 82 (970): 483โ€“8. doi:10.1136/pgmj.2005.042648. PMCย 2585712. PMIDย 16891436.
  16. โ†‘ Stein PD, Dalen JE, McIntyre KM, Sasahara AA, Wenger NK, Willis PW (1975). “The electrocardiogram in acute pulmonary embolism”. Prog Cardiovasc Dis. 17 (4): 247โ€“57. PMIDย 123074.
  17. โ†‘ Warnier MJ, Rutten FH, Numans ME, Kors JA, Tan HL, de Boer A, Hoes AW, De Bruin ML (2013). “Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease”. COPD. 10 (1): 62โ€“71. doi:10.3109/15412555.2012.727918. PMIDย 23413894.
  18. โ†‘ Stein PD, Matta F, Ekkah M, Saleh T, Janjua M, Patel YR, Khadra H (2012). “Electrocardiogram in pneumonia”. Am. J. Cardiol. 110 (12): 1836โ€“40. doi:10.1016/j.amjcard.2012.08.019. PMIDย 23000104.
  19. โ†‘ Hazebroek MR, Kemna MJ, Schalla S, Sanders-van Wijk S, Gerretsen SC, Dennert R, Merken J, Kuznetsova T, Staessen JA, Brunner-La Rocca HP, van Paassen P, Cohen Tervaert JW, Heymans S (2015). “Prevalence and prognostic relevance of cardiac involvement in ANCA-associated vasculitis: eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis”. Int. J. Cardiol. 199: 170โ€“9. doi:10.1016/j.ijcard.2015.06.087. PMIDย 26209947.
  20. โ†‘ Dennert RM, van Paassen P, Schalla S, Kuznetsova T, Alzand BS, Staessen JA, Velthuis S, Crijns HJ, Tervaert JW, Heymans S (2010). “Cardiac involvement in Churg-Strauss syndrome”. Arthritis Rheum. 62 (2): 627โ€“34. doi:10.1002/art.27263. PMIDย 20112390.
  21. โ†‘ 21.0 21.1 21.2 21.3 21.4 Squizzato A, Luciani D, Rubboli A, Di Gennaro L, Gennaro LD, Landolfi R; et al. (2013). “Differential diagnosis of pulmonary embolism in outpatients with non-specific cardiopulmonary symptoms”. Intern Emerg Med. 8 (8): 695โ€“702. doi:10.1007/s11739-011-0725-1. PMIDย 22094406.
  22. โ†‘ Restrepo CS, Artunduaga M, Carrillo JA, Rivera AL, Ojeda P, Martinez-Jimenez S; et al. (2009). “Silicone pulmonary embolism: report of 10 cases and review of the literature”. J Comput Assist Tomogr. 33 (2): 233โ€“7. doi:10.1097/RCT.0b013e31817ecb4e. PMIDย 19346851.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] The APEX Trial Investigators; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]