Clinical characteristics of pulmonary embolism with concomitant pneumonia

Abstract

Although pneumonia is associated with an increased risk of venous thromboembolism, patients with pulmonary embolism and concomitant pneumonia are uncommon. The aim of the present study was to investigate the clinical features of pulmonary embolism with coexisting pneumonia. We retrospectively compared clinical, radiologic and laboratory parameters between patients with pulmonary embolism and concomitant pneumonia (pneumonia group) and those with unprovoked pulmonary embolism (unprovoked group), and then between the pneumonia group and those with pulmonary infarction (infarction group). Of 794 patients with pulmonary embolism, 36 (5%) had coexisting pneumonia and six (1%) had no provoking factor other than pneumonia. Stroke was significantly more common in the pneumonia group, than either the unprovoked group or the infarction group. In the pneumonia group, fever was significantly more common and serum C-reactive protein levels were significantly higher. By contrast, central pulmonary embolism and right ventricular dilation on computed tomography were significantly less frequent in the pneumonia group. In addition, an adverse outcome due to pulmonary embolism was less common in the pneumonia group than in either of the other two groups. The coexistence of pulmonary embolism and pneumonia is rarely encountered in clinical practice, especially without the presence of other factors that could provoke venous thromboembolism and is commonly associated with stroke. It is characterized by lower incidences of central pulmonary embolism and right ventricular dilation and by a lower rate of adverse outcomes due to pulmonary embolism itself.

Clinical symptoms and related risk factors in pulmonary embolism patients and cluster analysis based on these symptoms

“…The diagnosis of PE remains challenging, particularly due to the absence of commonly associated symptoms and signs in this disease. The majority of well-known symptoms in our sample are similar in prevalence to those described in prior studies 2 , 5 , 6 , 18 – 23 . However, the results are still inconsistent across previous studies.…”

“…The prognosis of PE relies on timely and accurate diagnosis, reasonable risk stratification, and well-monitored anticoagulation 3 . However, PE remains largely underdiagnosed due to the vague and nonspecific clinical manifestations 4 – 6 . Prompt diagnosis and recognition of PE patients has been shown to reduce mortality and morbidity 7 .…”

“…In fact, the classic clinical symptoms (e.g. the triad syndrome including hemoptysis, dyspnea, and pleuritic pain) were not common and not easily recognized during current clinical practice 6 . The overall presentation could be easily confused with systemic disorders or other cardio-pulmonary diseases 9 .…”

“…However, few studies had focused on this topic and no studies were found to cluster PE symptoms and patients to date. Few related studies were all based on Western populations 6 , 16 , and Chinese patients might have different characteristics due to racial differences 17 , 18 .…”

Anatomic and clinical risk factors for pulmonary embolism in patients with deep venous thrombosis of the lower extremity

“…Although patients with PE and concomitant pneumonia are uncommon, pneumonia is associated with an increased risk of PE. In one study, 36 of 794 patients (5%) had coexisting pneumonia [14]. In a retrospective cohort study, 724 of 2,378 patients (30.3%) hospitalized with community acquired pneumonia displayed increased D-dimer levels [15].…”