Pulmonary Embolism—A Clinical and Autopsy Study

This paper reports 2 retrospective 5-year studies. A clinical review of 120 cases of pulmonary embolism at the Western General Hospital, Edinburgh, between 1965 and 1969 is followed by a review of 303 cases of embolism detected at 2291 routine autopsies in the Edinburgh Northern Hospital Group between 1967 and 1971. The main conclusions drawn from the studies are: 1. Venous thrombo-embolic disease is a major cause of morbidity and mortality in the Edinburgh Northern Group of Hospitals; 2. Greater use should be made of special diagnostic techniques in thrombo-embolic disease; 3. Oral anticoagulants do not protect from further embolism; 21 per cent of patients had recurrent emboli whilst on anticoagulant treatment; 4. The fatal episode in those patients with an otherwise good prognosis had been preceded by a clinically recognised minor episode in 27 per cent. At autopsy 52 per cent of patients dying of embolism showed evidence of previous smaller episodes. Minor embolism must be regarded as heralding major embolism unless phlebography proves otherwise; and 5. Every hospital should have a policy for the management of pulmonary embolism.