DIAGNOSIS OF ACUTE PULMONARY-EMBOLISM IN THE ELDERLY

The diagnostic features of acute pulmonary embolism among 72 patients greater-than-or-equal-to years old were evaluated and compared with characteristics of pulmonary embolism among 144 patients 40 to 69 years and 44 patients < 40 years old. Syndromes characterized by either 1) pleuritic pain or hemoptysis, 2) isolated dyspnea, or 3) circulatory collapse were observed with comparable frequency among patients greater-than-or-equal-to 70 years old and younger patients. One of these presenting syndromes occurred in 64 (89%) of the 72 patients greater-than-or-equal-to 70 years old. Those who did not show these syndromes were identified on the basis of unexpected radiographic abnormalities, which may have been accompanied by tachypnea or a history of thrombophlebitis. Among the 72 patients greater-than-or-equal-to 70 years with pulmonary embolism, dyspnea or tachypnea (respirations greater-than-or-equal-to 20/min) occurred in 66 (92%), dyspnea or tachypnea or pleuritic pain in 68 (94%) and dyspnea or tachypnea or radiographic evidence of atelectasis or a parenchymal abnormality in 72 (100%). Complications of angiography were evaluated among patients with and without pulmonary embolism. Major complications of pulmonary angiography among patients greater-than-or-equal-to 70 years old (2 [1%] of 200) were not more frequent than among younger patients (6 [1.1%] of 562) (p = NS). However, renal failure (major or minor) was more frequent in patients greater-than-or-equal-to 70 years old than in younger patients (6 [3%] of 200 versus 4 [0.7%] of 562) (p < 0.05). The nonspecific manifestations of pulmonary embolism, even among patients greater-than-or-equal-to 70 years of age, are usually present. When necessary, pulmonary angiography can be performed with no greater overall frequency of complications in elderly patients, although renal failure after angiography is a problem in the elderly.