Pulmonary embolism differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] The APEX Trial Investigators; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

Pulmonary embolism must be distinguished from other life-threatening causes of chest pain including acute myocardial infarction, aortic dissection, and pericardial tamponade, as well as a large list of non-life-threatening causes of chest discomfort and shortness of breath.

Differential Diagnosis

Differential Diagnosis Based on Symptoms

Pulmonary embolism (PE) should be differentiated from other diseases presenting with chest pain, shortness of breath and tachypnea. The differentials include the following:

Diseases	Diagnostic tests			Physical Examination				Symptoms					Past medical history	Other Findings
	CT scan and MRI	EKG	Chest X-ray	Tachypnea	Tachycardia	Fever	Chest Pain	Hemoptysis	Dyspnea on Exertion	Wheezing	Chest Tenderness	Nasalopharyngeal Ulceration			Carotid Bruit
Pulmonary Embolism	On CT angiography: Intra-luminal filling defect On MRI: Narrowing of involved vessel No contrast seen distal to obstruction Polo-mint sign (partial filling defect surrounded by contrast)	Identifies causative bacteria	Imaging and culture	✔	Flank or costovertebral angle	✔	✔	✔	✔	-	- Life Threatening Differential Diagnosis Acute myocardial infarction Aortic dissection Pericardial tamponade Common Differential Diagnosis in Outpatients Among outpatients presenting with dyspnea, <4 % are diagnosed with PE. Common differential diagnoses include: Acute heart failure Pneumonia Chronic obstructive pulmonary disease exacerbation Complete List of Differential Diagnosis Acute coronary syndrome Acute heart failure Asthma acute exacerbation Acute respiratory distress syndrome Anemia Angina pectoris Anxiety disorders Aortic stenosis Atrial fibrillation (diagnosis and management) Bronchitis Cardiogenic shock Cardiac tamponade Chronic obstructive pulmonary disease exacerbation Community acquired pneumonia Cor pulmonale Costochondritis Dilated cardiomyopathy Distributive shock Emphysema Fat embolism Hemorrhagic shock Herpes zoster Hyperventilation Mediastinitis Mitral stenosis Musculoskeletal pain Myocardial infarction Myocardial ischemia Myocarditis Noncardiogenic pulmonary edema Pericarditis Pleuritis Pneumonia Pneumothorax Pulmonary hypertension, primary Pulmonary hypertension, secondary Restrictive cardiomyopathy Rib fracture Salicylate intoxication Septic shock Silicone pulmonary embolism Sudden cardiac death Superior vena cava syndrome Syncope Toxic shock syndrome Trauma to the chest Unstable angina References