Pulmonary thromboembolism (PTE) is a common clinical problem that is associated with substantial morbidity and mortality. The incidence of PTE in the United States is estimated at one case per 1,000 people per year.
Pulmonary embolism still represents the most common cause of death that is not clinically diagnosed before death. In the 1990s, clinical diagnosis of PTE was only made in one-third of all cases. Even in times of multislice computed angiography (MSCT), clinical accuracy before death is just about 59%.1 Mortality has slightly decreased during the last decades, probably due to the use of CT imaging.2 On the other hand, it has also been shown that the application of MSCT could not substantially reduce PTE mortality and that increased diagnoses may lead to overtreatment accompanied by undesirable side effects.3 Do our current diagnostic procedures include patients who are threatened by a lethal course of this disease? Obviously, we are on the horns of both a diagnostic and a therapeutic dilemma resulting from several reasons.