Diagnostic Clues in Pulmonary Thrombo-embolism Evaluated by Angiographic and Ventilation-Blood Flow Studies

Abraham, Salzberg, and Balter (1954) have called pulmonary thrombo-embolism the commonest chest disease of adult patients in hospital. Routine necropsy series indicate its incidence to be as high as 25% (T'owbin, 1954). To the chagrin of clinicians its ubiquity is matched by the difficulties encountered in its antemortem diagnosis. The classical syndrome of chest pain, haemoptysis, friction rub, and ill-defined consolidation of the lung is often incomplete, vague, or obscured by such predisposing conditions as left ventricular failure (Parker and Smith, 1958). This applies not only to symptoms and signs but also to the electro- cardiogram and conventional radiographic studies (Dexter, Dock, McGuire, Hyland, and Haynes, 1960). In an effort to gain further understanding of this condition and to determine, if possible, what clinical manifestations might give us the most help in its diagnosis, we have studied 10 patients with symptoms and signs of localized pulmonary thrombo-embolism. The methods we used included the measurement of ventilatory function and lung volume subdivisions, haemo- dynamics, respiratory gas exchange,-and pul- monary angiography. Since only two of our patients came to necropsy (M. U. and E. H.) where pulmonary emboli and infarction were found, we have used the positive findings at angiography as the principal criterion for the diagnosis.