myocardial infarction - in the early stages may not be ECG changes associated with MI. Changes associated with PE eg T-wave depression in V1-3, right bundle branch block are not constant findings. If there is excessive dyspnoea without pulmonary oedema then suspect a pulmonary embolism
acute internal haemorrhage - neck veins are engorged in pulmonary embolism
acute pancreatitis or bactereamic shock have slower onsets than pulmonary embolism, and have low CVPs
cardiac tamponade - echocardiography can provide evidence of pericardial fluid
dissecting aortic aneurysm - chest radiography may show a widened aorta
pneumothorax and massive collapse of the lung - chest radiography will show characteristic changes.
generally pulmonary arteriography will normally demonstrate the obstructed zone
Reference
Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 Jan 21;41(4):543-603.
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