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May 1969

Pulmonary Embolism: Premonitory Signs and Recurrence After Vena Cava Ligation

Author Affiliations

West Roxbury, Mass
From the Research and Medical Services, Veterans Administration Hospital, West Roxbury, Mass, and the Department of Medicine, Harvard Medical School, Boston.

Arch Surg. 1969;98(5):671-673. doi:10.1001/archsurg.1969.01340110163025

The frequency with which the diagnosis of pulmonary embolism is made for the first time at postmortem examination has made this disease an enigma in clinical medicine. A consensus of reports puts the overall autopsy incidence consistently in the vicinity of 25%. The clinical diagnosis has been made premortem with frequencies as high as 70%1 and as low as 8%,2 with a mean frequency in the vicinity of 20% to 30%. The incidence of pulmonary embolic disease in sudden, unexpected death in a hospital population was recently noted to be 55%.3 These statistics argue strongly for the value of clinical information which might anticipate such an event or provide historical clues of diagnostic significance. A case of repeated pulmonary embolization in which the patient was able to predict the latter two of four symptomatic embolic episodes is reported. Another case in which the same symptom was elicited