Clinical recognition of pulmonary embolism: problem of unrecognized and asymptomatic cases

Mayo Clin Proc. 1998 Sep;73(9):873-9. doi: 10.4065/73.9.873.


Dyspnea, pleuritic chest pain, and tachypnea are widely appreciated as common initial features of pulmonary embolism (PE). This knowledge is derived primarily from prospective studies evaluating diagnostic tests or therapeutic interventions in which the study patients are suspected to have PE based on their initial symptoms. Autopsy studies, however, continue to show that most cases of fatal PE are unrecognized and undiagnosed. Data from studies screening for PE in patients with deep venous thrombosis and in postoperative patients suggest that many patients with PE are asymptomatic and that PE is unrecognized. We believe that the current concepts regarding the initial clinical features of PE are too narrow and biased toward symptomatic cases. High clinical suspicion may be insufficient in recognizing PE. Herein we summarize the available data and explore the implications for clinical practice.

Publication types

  • Review

MeSH terms

  • Chronic Disease
  • Diagnosis, Differential
  • Humans
  • Hypertension, Pulmonary / etiology
  • Incidence
  • Mass Screening
  • Postoperative Complications / prevention & control
  • Prospective Studies
  • Pulmonary Embolism / complications
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / etiology
  • Pulmonary Embolism / prevention & control
  • Pulmonary Embolism / therapy
  • Thrombophlebitis / complications