A 55-year-old male smoker with a history of chronic obstructive pulmonary disease (COPD) presents with worsening shortness of breath, chest pain, and a productive cough. How would you differentiate between an exacerbation of COPD and a possible pulmonary embolism?
Differentiating between COPD exacerbation and PE can be challenging as the symptoms overlap. However, PE is more likely to cause pleuritic chest pain (sharp pain that worsens with deep breaths) and is less likely to cause a productive cough. PE may also be associated with systemic symptoms such as fever and tachycardia. If the clinical suspicion of PE is high based on these features or the patient's risk factors, then further diagnostic workup with D-dimer testing and possibly CT pulmonary angiography should be undertaken.