Clinical Features

The patient commonly presents with pleuritic chest pain, which may be associated with haemoptysis (uncommon) and/or dyspnoea. It is usually in this low risk group of patients where most diagnostic difficulty exists. The differential diagnosis on this group of patients includes musculoskeletal pain, pleurisy, viral and bacterial infections, pericarditis and a pneumothorax.

Recognised clinical features found in patients with a PE are shown below:

Table 1: Clinical features of PE
Clinical features of PE in descending order of frequency:
1 Dyspnoea (70% of patients)
2 Tachypnoea (RR>20)
3 Pleuritic chest pain
4 Apprehension
5 Tachycardia (>100bpm)
6 Cough
7 Haemoptysis
8 Leg pain
9 Clinically evident DVT (10% of patients)

Less than 10% of patients with PE have none of the top three symptoms of dyspnoea, tachypnoea and pleuritic chest pain. However, none of these typical presenting features are pathognomic of pulmonary embolus and some patients with PE present with more subtle symptoms or atypical symptoms such as syncope or postural hypotension.

With subacute PEs the diagnosis is particularly difficult to make as the patient may complain of gradually increasing dyspnoea or worsening exercise tolerance, rather than sudden acute symptoms.