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Differentiation of recurrent pulmonary emboli from chronic obstructive lung disease as a cause of cor pulmonale.

A patient with chronic obstructive pulmonary disease had severe dyspnea and cor pulmonale that were suspected in life and proved at autopsy to be the result of multiple small pulmonary thromboemboli. Radionuclide lung scanning and pulmonary angiography failed to diagnose the extensive peripheral embolization in this setting. The sensitivity and specificity of these diagnostic techniques are discussed, as well as the pulmonary function and gas exchange characteristics that led to the clinical suspicion of recurrent small emboli in this patient.