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Thorax 2007;62:121-125 doi:10.1136/thx.2006.065557
  • Chronic obstructive pulmonary disease

Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease?

  1. Olivier T Rutschmann1,
  2. Jacques Cornuz2,
  3. Pierre-Alexandre Poletti3,
  4. Pierre-Olivier Bridevaux2,
  5. Olivier W Hugli4,
  6. Salah D Qanadli5,
  7. Arnaud Perrier1
  1. 1Division of General Internal Medicine, Department of Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
  2. 2Policlinique médicale universitaire, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
  3. 3Division of Radiodiagnosis and Interventional Radiology, Department of Medical Radiology and Informatics, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
  4. 4Emergency Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
  5. 5Cardiovascular and Metabolic Diseases Centre, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
  1. Correspondence to:
    Dr O T Rutschmann
    Division of General Internal Medicine, Geneva University Hospitals, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland;olivier.rutschmann{at}hcuge.ch
  • Received 16 May 2006
  • Accepted 6 October 2006
  • Published Online First 13 November 2006

Abstract

Background: The cause of acute exacerbation of chronic obstructive pulmonary disease (COPD) is often difficult to determine. Pulmonary embolism may be a trigger of acute dyspnoea in patients with COPD.

Aim: To determine the prevalence of pulmonary embolism in patients with acute exacerbation of COPD.

Methods: 123 consecutive patients admitted to the emergency departments of two academic teaching hospitals for acute exacerbation of moderate to very severe COPD were included. Pulmonary embolism was investigated in all patients (whether or not clinically suspected) following a standardised algorithm based on d-dimer testing, lower-limb venous ultrasonography and multidetector helical computed tomography scan.

Results: Pulmonary embolism was ruled out by a d-dimer value <500 μg/l in 28 (23%) patients and a by negative chest computed tomography scan in 91 (74%). Computed tomography scan showed pulmonary embolism in four patients (3.3%, 95% confidence interval (CI), 1.2% to 8%), including three lobar and one sub-segmental embolisms. The prevalence of pulmonary embolism was 6.2% (n = 3; 95% CI, 2.3% to 16.9%) in the 48 patients who had a clinical suspicion of pulmonary embolism and 1.3% (n = 1; 95% CI, 0.3% to 7.1%) in those not suspected. In two cases with positive computed tomography scan, the venous ultrasonography also showed a proximal deep-vein thrombosis. No other patient was diagnosed with venous thrombosis.

Conclusions: The prevalence of unsuspected pulmonary embolism is very low in patients admitted in the emergency department for an acute exacerbation of their COPD. These results argue against a systematic examination for pulmonary embolism in this population.

Footnotes

  • Published Online First 13 November 2006

  • Funding: This project was supported by the Swiss National Fund for Scientific Research Grant # 3200-068146. The researchers are independent from funders.

  • Competing interests: None declared.

This Article

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  4. All versions of this article:
    1. thx.2006.065557v1
    2. 62/2/121 most recent

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