Clinically Deceptive Massive Pulmonary Embolism

¹ Formerly Chief, Department of Medicine, Walter Reed General Hospital; Prsently Clinical Professor of Medicine, Medical University of Sooth Carolina; Director of Medical Education, Spartanburg General Hospital, Spartanburg, South Carolina
² Formerly Chief, Pulmonary Function Laboratory, Walter Reed General Hospital; Presently Assistant Professor of Medicine, Washington University School of Medicine, St. Louis
³ Formerly Assistant, Medical and Cardiology Service, Walter Reed General Hospital
⁴ Chief, Radioisotope Section, Walter Reed General Hospital, Washington, D.C.

The difficulty of determining the severity of thromboembolic pulmonary vascular obstruction by the usual clinical methods is illustrated by the reporting of four patients that had suffered massive pulmonary embolism yet presented benign clinical manifestations. Since the most effective therapeutic management may depend upon a reliable assessment of the degree of impairment of pulmonary blood flow, the radioisotope photoscan and the pulmonary arteriogram proved of critical value in guiding therapy. In patients of this type, one of the surgical procedures of inferior vena cava interruption in addition to anticoagulant therapy will serve to prevent further clinical deterioration and serve as an alternative to pulmonary embolectomy either as an elective procedure or subsequently as an emergency procedure.