Controversies and Enigmas in Thrombophlebitis and Pulmonary Embolism

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Abstract
Increased criticism concerning the alleged misdiagnosis and overdiagnosis of deep vein thrombophlebitis (DVT) in the lower extremities, and of pulmo nary embolism, is being leveled at clinicians when unequivocal documentation by venography, lung scanning, and pulmonary angiography is lacking. The ex cessive adoption of this attitude by audit and utilization committees could prove dangerous for patients with these conditions, particularly when rigid cri teria intimidate the physician and override his clinical judgment and experi ence. The matter assumes added importance in view of the increasing magni tude of DVT and pulmonary embolism. The following pertinent issues will be discussed: 1. Failure to consider DVT and pulmonary embolism in the appropriate clinical settings, especially when they are still minor and atypical. 2. Deficiencies in the physical examination. 3. Failure to recognize the inherent limitations of existing diagnostic meth ods. 4. The perpetuation of diagnostic bias and dogma by teachers and the liter ature. 5. Confusion introduced by coexisting disorders. The combination of these insights, greater confidence in clinical skills, and newer noninvasive diagnostic methods promise to help resolve this heated con troversy.

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