Fatal pulmonary embolism.

Abstract

Summary In 700 patients with suspected pulmonary embolism, massive embolism was the primary cause of death in seven. Of these seven, all had signs or symptoms of emboli preceding the fatal episode by 1 week or longer. At autopsy adherent emboli in major vessels or branches were present in six and correlated well with the areas of ischemia in the scan. Because lung scanning can detect ischemia produced by occlusion of vessels greater than a few millimeters in diameter and because adherence of the emboli to the intima indicates presence within the vessel for at least 4–5 days, the nonlethal embolic episodes could have been detected in time to institute prophylactic anticoagulation. Lung scanning, by early confirmation of developing pulmonary embolic disease, combined with adequate anticoagulation should materially reduce the mortality from this disorder.