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Chest wall tenderness does not exclude pulmonary embolism
  1. S M Menzies
  1. Specialist Registrar in Respiratory Medicine, Churchill Hospital, Oxford, UK; drsmenzieshotmail.com

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Pulmonary embolism (PE) is usually associated with pleuritic chest pain, and the presence of chest pain that is reproducible by palpation may lead a clinician to discard this diagnosis. This study assessed whether palpable chest pain predicted the likely absence of a PE in individuals in whom the diagnosis was suspected (acute shortness of breath or chest pain without another obvious aetiology).

Patients (n = 965) were recruited from the database of another study looking at diagnosis of PE. Predictive variables of a PE (the Geneva score) were recorded and whether the pain was reproducible by palpation. A PE was ruled out if the d-dimer concentration was <500 μg/l or if proximal venous ultrasonography and helical computed tomography were both negative. If clinical probability was high, a negative pulmonary angiogram was also required. The overall prevalence of PE was 23%. This was not significantly lower in patients with pain reproducible by palpation (19.9% v 23.8%, p = 0.25). 17% of patients with a PE had palpable chest pain.

In these patients with a suspected PE, chest pain reproducible by palpation was not associated with a lower prevalence of an embolism. Physicians must be cautious not to discount this diagnosis in patients who present with this atypical feature.

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