The recent editorial by Paul Stein1 raises some important points about the clinical significance of silent pulmonary embolism (PE). I believe that the answer to his question as to whether silent PE may result in death is already evident in the pathology literature. Pathologists have often observed that in many if not most cases, a fatal PE is the terminal event in a series of emboli that have not been recognized.2 Pathologists have also noted for the last 40 years or more that most fatal embolisms are an unexpected postmortem finding (ie, clinically silent).3 Fatal PE occurs commonly in the setting of serious comorbidity, when it is often a terminal event. Many cases also occur among patients with dementia or aphasia who cannot give a history, and hence these are also "silent." In systematic screening studies of the type described by Meignan et al,4 silent PE has generally been 4 or 5 times as common as symptomatic PE.5
Egermayer P. Silent Pulmonary Embolism. Arch Intern Med. 2000;160(14):2218. doi:
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