Inspite of considerable progress in prevention diagnosis and treatment pulmonary embolism
has remained a threat to the patient and a challenge for the physician both in conservative as
well as in operative disciplines. Pulmonary embolism is according to pathology observations
still the most frequently overlooked clinical diagnosis. In 1-5 per 100 autopsies clinically
unexpected pulmonary emboli are found. In addition the sequelae of recurrent pulmonary emboli
the syndrome of pulmonary hypertension with or without right heart failure continues to
present a therapeutic dilemma - and no progress is in sight. In intensive care medicine
pulmonary embolism either acute massive and or recur rent continues to be both a
therapeutic as well as a preventive challenge mobilizing pharmacotherapeutic
catheter-interventional and operative resources. Diagnostic therapeutic and preventive
strategies are currently in use. Their basis however seems surprisingly thin as far as our
knowledge on the natural course of this chameleon-like illness with and without fibrinolytic
anticoagulative catheter or opera tive treatment is concerned. A large European multicenter
register has been initiated by Professors Kasper and Geibel with the help of Boehringer
Ingelheim Pharmaceutics in order to better describe the natural course of pulmonary embolism
under current treat ment modalities. Furthermore recently the clinical significance of the
valve patent foramen ovale as a source of paradoxical emboli is beginning to be better
understood. Many concepts therefore require revision.
