Pulmonary Embolism

WAEL ALHALABI

DEFINITION

• Pulmonary thromboembolism results from disruption of a deep venous thrombosis

• or local stasis, causing blockage of pulmonary blood flow beyond the embolus.

• Very large PEs that impede blood flow in both the right and left pulmonary arteries are called saddle emboli.

RISK FACTORS

• Immobilization

• Leg fracture or leg surgery

• Hypercoagulable state (malignancy, pregnancy, genetic)

• Proximal leg deep venous thrombosis

• Stroke

• Orthopedic surgery hip or knee replacement.

• Obesity.

• Owman more than 30 + ocps + smokers

SYMPTOMS/SIGNS

• Tachycardia

• Dyspnea, cough

• Tachypnea

• Pleuritic chest pain

• Hemoptysis

• Hypoxia

FINDINGS/TESTS

• ECG: S exaggerated in lead I, Q exaggerated and inverted T waves in lead III, or may show diffuse ST changes, and tachycardia

• Chest film: May show an infiltrate or may be normal ( hamptonshump sign , westermarks sign) .

• ABGs: Usually reveal hypoxemia, hypocapnia, and respiratory alkalosis

• D-dimer: Measures products of fibrin degradation (will be elevated)

• Leg ultrasonography (venous duplex): To detect DVT

• Ventilation–perfusion scan (V/Q scan): To look for perfusion defects at

• site of PE

• Helical (spiral) CT: To look for embolus in the pulmonary vasculature.

• Does not detect small emboli.

• Pulmonary angiogram: The gold standard for detection of PE. Invasive test.

hamptons hump sign

westermarks sign

Angiography is the goldstandard in thediagnosis of:

• Deep venous thrombosis

• Dissecting aortic aneurysm

• Ischemic bowel syndrome

• Pulmonary embolism

• Remember, if the CXR of a patient with hypoxia is normal you should consider PE.

Diagnosis of PE is difficult,

and a high clinical suspicion

should be maintained.

TREATMENT

• Acute treatment of PE includes:

• 1. Most common choice is anticoagulation with heparin or low-molecular-

• weight heparin

• 2. Thrombolysis if hemodynamically unstable or echo shows right venticular strain.

• 3. Interventional pulmonary angiography: Mechanical disintegration or

• local thrombolysis

• 4. Surgery: Embolectomy

• Prolonged treatment:

• 1. Patients with DVTs are orally anticoagulated for 6 months.

• 2. Patients with PEs are orally anticoagulated for 1 year.