Pulmonary Embolism: A Most Underdiagnosed and Untreated Disorder*

Pulmonary embolism is a serious and highly lethal disorder which is greatly underdiagnosed and undertreated. In elderly patients it is a common and often fatal complication of thrombotic disease. It is not described in the ancient literature, nor thereafter until the chair became universally used in our civilization. Present habits of prolonged sitting, as during travel, entertainment, study, and certain forms of work, contribute to venous stasis and secondary pulmonary embolism. Etiologic factors are reviewed and new iatrogenic factors discussed. Modern techniques increase the accuracy of diagnosis, but a strong index of suspicion on the part of the physician and a careful history still play a major role. Prophylactic and treatment measures are highly effective if used early and adequately. The prevention of venous stasis is important in prophylaxis. Anticoagulant drugs, notably heparin and the coumarin compounds, are the most effective weapons in the majority of cases.