Pulmonary Embolism

Introduction Pulmonary Embolism is a complication of underlying venous thrombosis,

most commonly of lower extremities and rarely from pelvic, upper extremity veins or right heart chambers.

Clinical Presentation :

symptoms vary from sudden catastrophic hemodynamic collapse to gradually progressive dyspnoea

Classically present with abrupt onset of pleuritic chestpain,SOB and hypoxia.

Most patients have no obvious symptoms at presentation.

Physical Signs :

Tachypnea - 96%

Rales - 58%

Tachycardia - 44%

Fever - 43%

Diaphoresis - 36%

Lower extremity edema - 24%

Cardiac murmurs - 13%

Cyanosis - 19%

Diagnosis Lab Tests :

D Dimers

WBC

ABGs

Imaging studies :

CTPA – Gold standard investigation

Pulmonary Angiography – when CTPA not available especially

CXR

V/Q Scan – when CTPA contraindicated

ECG

MRI – Emboli show incrased signal density within pumonary artery.

Venography and Duplex U/S : to demonstrate DVT

Management Thrombolytic therapy : for Massive PE

Anticoagulation :

immediate anticoagulation is mandatory for all suspected cases of PE or DVT and diagnostic testing should not delay anticoagulation

Long term anticoagulation to prevent recurrence of PE or DVT.

Anticoagulants include heparin,LMWH,fodaparinux,Factor Xa Inhibitors and Warfarin.

Surgical Treatment :

catheter embolectomy and fragmentation

placement of IVC filters