pulmonary embolism radiology

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  1. 1. Pulmonary Embolism D R . A N I S H C H O U D H A R Y J R I I I , M D ( R A D I O L O G Y ) B V D U M C P U N E
  2. 2. Pulmonary embolism (PE) is a blockage of the main artery of the lung, or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (embolism). PE most commonly results from deep vein thrombosis (a blood clot in the deep veins of the legs or pelvis) that breaks off and migrates to the lung, a process termed venous thromboembolism (VTE). A small proportion of cases are caused by the embolization of air, fat, or talc in drugs of intravenous drug abusers.
  3. 3. The obstruction of the blood flow through the lungs and the resultant pressure on the right ventricle of the heart leads to the symptoms and signs of PE. The risk of PE is increased in various situations, such as cancer or prolonged bed rest.
  4. 4. Most Common Symptoms of PE (PIOPED Study) Dyspnea (73%) Pleuritic chest pain (66%) Coughing (37%) Hemoptysis (13%) Atypical Presentations of PE Abdominal/pelvic pain Decreasing level of consciousness Fever Productive cough Seizures Syncope Wheezing
  5. 5. Common Risk Factors for DVT and PE AIDS Antithrombin III deficiency Bechet disease Blood type A Burns Indwelling venous catheters, Pacemaker Chemotherapy CHF, myocardial infarct History of prior DVT Oral contraceptives, Estrogen replacement Fractures, Surgery Malignancy Obesity Prolong bed rest Pregnancy Systemic lupus erythematosus (SLE) Trauma Varicose veins, venous stasis, venography
  6. 6. The Most Common Risk Factors for DVT and PE Venous stasis a condition of stoppage or reduced blood flow through the veins. Prolonged immobilization - this situation occurs when one is put in a cast to heal a fracture, or suffers paralysis of a limb, or is bedridden due to illness or being elderly. Trauma and surgery - these conditions carry an increased risk of developing VTE and PE. When there are major multisystem injuries, such as a high impact motor vehicle accident, the incidence rate for DVT is approximately 58%. Oral Contraception - has been known for many years to be a contributor to PE. Oral contraceptive use combined with cigarette smoking is well documented as a cause of sudden death in healthy women. Pregnancy - In some women venous stasis can be a complication of pregnancy. The cause is contributed to a decrease in fibrinolytic function. Congenital - In a small fraction of the general population there are those who suffer chronic hypercoagulable blood condition. Often this is a congenitally caused hypercoagulation because of mutated Factor V. Mutated Factor V is the most common cause of congenital hypercoagulation and is seen in some form in about 5% of the population. Acquired deficiencies are seen in protein C, protein S and Antithrombin III. Acquired deficiencies occur in nearly 10% of young people who are diagnosed with PE.
  7. 7. Evaluation Scheme Based on Clinical Probability.
  8. 8. CT Anatomy
  9. 9. Types of pulmonary embolism. Thrombotic pulmonary embolism. Acute pulmonary embolism. Chronic pulmonary embolism Non-thrombotic pulmonary embolism.
  10. 10. High Sensitivity D-Dimer. High negative predictive value for PE (based on pulmonary angiography) For D-dimer 500ng/mL, sens=93%, spec=25%, and positive predictive value (PPV) = 30% PPV and NPV are affected by prevalence. Test is also useful for DVT rule out (