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July 1961

A Study of Pulmonary Embolism: Part I. A Clinicopathological Investigation of 100 Cases of Massive Embolism of the Pulmonary Artery; Diagnosis by Physical Signs and Differentiation from Acute Myocardial Infarction

Author Affiliations


From the Department of Pathology, New York Hospital-Cornell Medical Center.; Research Associate in the Department of Pathology; Research Consultant, Goldwater Memorial Hospital, First Research Service of the College of Physicians and Surgeons, Columbia University; Professor of Medicine (Emeritus), Albany Medical College of Union University; Director (Emeritus) of the Public Health Research Institute of the City of New York, Inc.

Arch Intern Med. 1961;108(1):8-22. doi:10.1001/archinte.1961.03620070010003

No condition is less often diagnosed correctly than massive pulmonary embolism. The purpose of this communication is to show that (1) a high percentage of diagnotic errors is made in it, (2) that there are definite reasons for these mistakes, and (3) that there appears to be a possibility of increasing general diagnostic accuracy by systematic examination of the patient for certain physical signs.

Until Herrick's1 classical description of acute myocardial infarction in 1912, sudden deaths were frequently and often erroneously attributed to massive pulmonary embolism. In recent years the pendulum has swung in the other direction. Sudden deaths occurring at the present time are prone to be ascribed to acute myocardial infarction. It is true that in any large series of sudden deaths, as Hamman2 has pointed out, 40% will be found to have myocardial infarcts, and only 5% pulmonary emboli. The odds, therefore, are 8 to

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