Overview
Which imaging studies aid in the diagnosis of pulmonary embolism (PE)?
Where does pulmonary embolism (PE) originate?
How is pulmonary thromboembolism characterized?
What are the possible presentations of pulmonary embolism (PE)?
When are clinical scoring systems used to determine the probability of pulmonary embolism (PE)?
What are the signs and symptoms of pulmonary embolism (PE)?
Which tests are performed in the diagnosis of pulmonary embolism (PE)?
When is anticoagulation therapy initiated for pulmonary embolism (PE)?
When is thrombolytic therapy indicated for pulmonary embolism (PE)?
What is the role of long-term anticoagulation therapy for pulmonary embolism (PE)?
Which anticoagulation medications are used in the treatment of pulmonary embolism (PE)?
Which thrombolytic agents are used in the treatment of pulmonary embolism (PE)?
What are the surgical options in the treatment of pulmonary embolism (PE)?
What are the risks of undiagnosed pulmonary embolism (PE)?
What is the difference between acute and chronic pulmonary embolism (PE)?
What is the difference between central, peripheral, and massive pulmonary embolism (PE)?
What are challenges in the correct diagnosis of pulmonary embolism (PE)?
Is pulmonary embolism (PE) a disease or a complication of DVT?
How is the diagnosis of pulmonary embolism (PE) confirmed?
When should anticoagulation begin following signs of DVT or pulmonary embolism (PE)?
What is the effect of long-term anticoagulation in treating pulmonary embolism (PE)?
What are the consequences of pulmonary embolism (PE)?
What are respiratory consequences of pulmonary embolism (PE)?
What are hemodynamic consequences of pulmonary embolism (PE)?
Which hereditary factors are increase the risk of pulmonary embolism (PE)?
What is the Virchow triad and how does it influence thrombus formation?
Where does thrombosis originate?
Where does pulmonary embolism (PE) originate and where does it travel?
What are the causes of pulmonary embolism (PE)?
How does HIV infection affect the risk of developing pulmonary embolism (PE)?
How does venous stasis cause pulmonary embolism (PE)?
What causes hypercoagulable states?
Why does immobilization increase the risk of pulmonary embolism (PE)?
How can trauma increase the risk of pulmonary embolism (PE)?
What is the incidence of thromboembolic disease in pregnancy?
How much does contraceptives or HRT increase the risk of venous thromboembolism in women?
What is the relationship between pulmonary embolism (PE) and cancer?
Which acute disorders increase the risk of pulmonary embolism (PE)?
What are common risk factors for pulmonary embolism (PE)?
What causes pulmonary embolism (PE) in children?
What is the incidence of pulmonary embolism (PE) in the US?
What is the mortality rate of pulmonary embolism (PE) in the US?
What percentage of hospitalized patients have pulmonary embolism (PE)?
What is the incidence of venous thromboembolism in the US?
What role does autopsy have in the understanding of pulmonary embolism (PE)?
What is the global prevalence of pulmonary embolism (PE)?
Is pulmonary embolism (PE) more common in men or women?
Does pulmonary embolism (PE) have a racial predilection?
How does the prevalence of pulmonary embolism (PE) vary among different age groups?
How common is pulmonary embolism (PE) in children?
What is the risk of thromboembolic disease during pregnancy?
What is the incidence of postoperative death due to pulmonary embolism (PE)?
What factors affect the prognosis of pulmonary embolism (PE)?
What is the effect of anticoagulant treatment on mortality rates of pulmonary embolism (PE)?
What increases the risk of recurrent pulmonary embolism (PE)?
How is massive pulmonary embolism (PE) defined and what is the associated mortality rate?
How is nonmassive pulmonary embolism (PE) defined and what is the associated mortality rate?
What education should patients with pulmonary embolism (PE) be given?
Presentation
Why does pulmonary embolism (PE) often go untreated?
Pulmonary embolism (PE) should be considered in patients with which risk factors?
How are physical exam findings for pulmonary embolism (PE) categorized?
What is the typical presentation of pulmonary embolism (PE)?
What atypical symptoms may be caused by pulmonary embolism (PE)?
When should a diagnosis of pulmonary embolism (PE) be actively considered?
What are acute respiratory consequences of pulmonary embolism (PE)?
What is the incidence of physical signs in pulmonary embolism (PE)?
What is the incidence of symptoms of pulmonary embolism (PE)?
What are the signs and symptoms of massive pulmonary embolism (PE)?
What is the presentation of acute pulmonary infarction?
What is the presentation of acute embolism without infarction?
What is the presentation of multiple pulmonary emboli (PE) or thrombi?
What are the signs of pulmonary embolism (PE) in children?
What are complications of pulmonary embolism (PE)?
DDX
How often does pulmonary embolism (PE) go undiagnosed and why?
What differential diagnoses should be considered in suspected pulmonary embolism (PE)?
What are the differential diagnoses for Pulmonary Embolism (PE)?
Workup
What is the role of lab testing in the diagnosis of pulmonary embolism (PE)?
What should be considered in the workup of patients with suspected pulmonary embolism (PE)?
How is the clinical probability of pulmonary embolism (PE) determined?
What does D-dimer testing measure in patients with suspected pulmonary embolism (PE)?
When can pulmonary embolism (PE) be reliably excluded?
When is D-dimer testing most reliable in the diagnosis of pulmonary embolism (PE)?
How are D-dimer results used to diagnose pulmonary embolism (PE)?
What is the alternative to D-dimer testing?
What is the expected white blood cell count range in patients with pulmonary embolism (PE)?
How can ABG determinations assist in the diagnosis of pulmonary embolism (PE)?
Is the PO2 level on ABG analysis useful in diagnosing pulmonary embolism (PE)?
How effective is PaO2 level on ABG analysis in predicting pulmonary embolism (PE)?
How are troponin assessments used in the diagnosis pulmonary embolism (PE)?
What is the significance of elevated serum troponin in patients with pulmonary embolism (PE)?
What is the role of leptin testing in the evaluation of pulmonary embolism (PE)?
What does a finding of elevated BNP levels indicate in the evaluation of pulmonary embolism (PE)?
What is the role of BNP testing in the evaluation of acute pulmonary embolism (PE)?
How does the presence of hyponatremia affect the prognosis of acute pulmonary embolism (PE)?
What is the role of venography in the diagnosis of pulmonary embolism (PE)?
How is pulmonary angiography performed to diagnose pulmonary embolism (PE)?
What is the mortality rate of angiography?
What is the role of angiography in the diagnosis of pulmonary embolism?
How effective is pulmonary angiography in the detection of pulmonary embolism (PE)?
How effective is pulmonary angiography in detecting multiple recurrences of pulmonary embolism (PE)?
How has CT pulmonary angiography affected the rate of diagnosis of pulmonary embolism (PE)?
What is the role of CT scanning in the diagnosis of pulmonary embolism (PE)?
What is the role of CTA in the detection of pulmonary embolism (PE)?
What are the benefits of CT scanning in the diagnosis of pulmonary embolism (PE)?
How effective is MDCTA in detecting pulmonary embolism (PE)?
What chest radiography findings suggest the presence of pulmonary embolism (PE)?
How is V/Q scanning used for the diagnosis of pulmonary embolism (PE)?
What are the high-probability criteria for V/Q scanning diagnosis of pulmonary embolism (PE)?
What are the low-probability criteria for V/Q scanning diagnosis of pulmonary embolism (PE)?
How is ECG used in the workup for pulmonary embolism (PE)?
What is the role of MRI in the diagnosis of pulmonary embolism (PE)?
What are the possible adverse effects of magnetic resonance angiography?
How effective is MRI in diagnosing pulmonary embolism (PE)?
What is the role of MRI in the evaluation of pulmonary embolism (PE) in children?
What is the role of MRI in the evaluation of pulmonary embolism (PE)?
What is the role of echocardiography in the evaluation of pulmonary embolism (PE)?
Which echocardiography views are useful in the evaluation of pulmonary embolism (PE)?
How is duplex ultrasonography used to diagnose pulmonary embolism (PE)?
What does a negative ultrasonography result suggest in the evaluation of DVT?
What do ultrasonographic images of thrombus look like?
Treatment
Which patients are at risk for pulmonary embolism (PE) despite therapeutic anticoagulation?
What is the treatment of choice in children with pulmonary embolism (PE)?
When is thrombolytic therapy indicated in pulmonary embolism (PE)?
When is thrombolytic therapy most beneficial in pulmonary embolism (PE)?
How does thrombolytic therapy affect risk of major bleeding in pulmonary embolism (PE)?
What is the efficacy of heparin therapy for pulmonary embolism (PE)?
What is the critical therapeutic level of heparin in patients with pulmonary embolism (PE)?
How is IV unfractionated heparin (UFH) administered for treatment of pulmonary embolism (PE)?
What are the treatment guidelines for the use of LMWH in acute pulmonary embolism (PE)?
What are the advantages of LMWH therapy for pulmonary embolism (PE)?
What are the ACCP guidelines for outpatient LMWH therapy for pulmonary embolism (PE)?
What are alternatives to warfarin for prophylaxis and treatment of pulmonary embolism (PE)?
How effective is rivaroxaban (Xarelto) in the treatment of pulmonary embolism (PE)?
How effective is apixaban in the treatment of pulmonary embolism (PE)?
How effective is dabigatran (Pradaxa) in the treatment of pulmonary embolism (PE)?
How effective is edoxaban (Savaysa) in the treatment of pulmonary embolism (PE)?
How effective is betrixaban in the treatment of pulmonary embolism (PE)?
What are the indications for fondaparinux therapy in acute pulmonary embolism (PE)?
How is warfarin therapy used in the treatment of acute pulmonary embolism (PE)?
What are the ACCP guidelines for duration of anticoagulation therapy for pulmonary embolism (PE)?
What are the ACCP guidelines for long-term anticoagulation for pulmonary embolism (PE)?
What is heparin-induced thrombocytopenia (HIT)?
What is the frequency and prevalence of heparin-induced thrombocytopenia (HIT)?
What is the clinical manifestation of heparin-induced thrombocytopenia (HIT)?
How is heparin-induced thrombocytopenia (HIT) treated?
How is pulmonary embolism (PE) treated in patients resistant to heparin?
When is embolectomy indicated in the treatment of pulmonary embolism (PE)?
When are vena cava filters indicated in the treatment of pulmonary embolism (PE)?
When are compression stockings used as adjunctive treatment for pulmonary embolism (PE)?
Which type of compression stocking is the most effective in the prophylaxis of thromboembolism?
How effective is the use of gradient compression stockings in reducing the risk of DVT?
Are gradient compression pantyhose recommended for pregnant women?
When is physical activity recommended for pulmonary embolism (PE)?
When are cardiovascular medications indicated in the treatment of pulmonary embolism (PE)?
What is the treatment for children with sickle cell disease and pulmonary symptoms?
What is the treatment for hypotension with pulmonary embolism (PE)?
What is the role of drotrecogin in the treatment of pulmonary embolism (PE)?
What is the duration of treatment for pulmonary embolism (PE)?
What is the duration of long-term anticoagulation for pulmonary embolism (PE)?
What is the treatment for pulmonary embolism (PE) after hospital discharge?
How does pregnancy affect the risk of DVT and pulmonary embolism (PE)?
How is pulmonary embolism (PE) diagnosed during pregnancy?
What are the treatment options for pulmonary embolism (PE) during pregnancy?
When is fibrinolytic therapy initiated in patients with pulmonary embolism (PE)?
When should consultation with a pulmonologist be considered for suspected pulmonary embolism (PE)?
When is consultation with a cardiac surgeon necessary for pulmonary embolism (PE)?
When is consultation with a hematologist indicated for pulmonary embolism (PE)?
When should interventional radiology consultation be considered for pulmonary embolism (PE)?
How is pulmonary embolism (PE) prevented?
What is the QThrombosis algorithm?
What are medicolegal concerns regarding pulmonary embolism (PE)?
Which areas of pulmonary embolism (PE) treatment require further research and clinical trials?
Guidelines
What are the ACP guidelines for the evaluation of suspected acute pulmonary embolism (PE)?
What are the ACEP guidelines for the diagnosis of pulmonary embolism (PE)?
What are the ACR guidelines for detection of pulmonary embolism (PE)?
What are the key recommendations of the ACCP guidelines for antithrombotic thrombolytic therapy?
What are the AHA guidelines for the management of acute pulmonary embolism (PE)?
What are the AHA guidelines for catheter-based interventions in pulmonary embolism (PE)?
What are the AHA guidelines for use of vena cava filters in pulmonary embolism (PE)?
What are the ACOG guidelines on the diagnosis and management of thromboembolism during pregnancy?
Medications
What medications should be considered in the initial management of pulmonary embolism (PE)?
-
A large pulmonary artery thrombus in a hospitalized patient who died suddenly.
-
Pulmonary embolism was identified as the cause of death in a patient who developed shortness of breath while hospitalized for hip joint surgery. This is a close-up view.
-
Lung infarction secondary to pulmonary embolism occurs rarely.
-
Posteroanterior and lateral chest radiograph findings are normal, which is the usual finding in patients with pulmonary embolism.
-
High-probability perfusion lung scan shows segmental perfusion defects in the right upper lobe and subsegmental perfusion defects in right lower lobe, left upper lobe, and left lower lobe.
-
A normal ventilation scan will make the noted defects in the previous image a mismatch and, hence, a high-probability ventilation-perfusion scan.
-
Anterior views of perfusion and ventilation scans are shown here. A perfusion defect is present in the left lower lobe, but perfusion to this lobe is intact, making this a high-probability scan.
-
A segmental ventilation perfusion mismatch is evident in a left anterior oblique projection.
-
A pulmonary angiogram shows the abrupt termination of the ascending branch of the right upper-lobe artery, confirming the diagnosis of pulmonary embolism.
-
A chest radiograph with normal findings in a 64-year-old woman who presented with worsening breathlessness.
-
This perfusion scan shows bilateral perfusion defects. The ventilation scan findings were normal; therefore, these are mismatches, and this is a high-probability scan.
-
This ultrasonogram shows a thrombus in the distal superficial saphenous vein, which is under the artery.
-
A posteroanterior chest radiograph showing a peripheral wedge-shaped infiltrate caused by pulmonary infarction secondary to pulmonary embolism. Hampton hump is a rare and nonspecific finding. Courtesy of Justin Wong, MD.
-
Computed tomography angiogram in a 53-year-old man with acute pulmonary embolism. This image shows an intraluminal filling defect that occludes the anterior basal segmental artery of the right lower lobe. Also present is an infarction of the corresponding lung, which is indicated by a triangular, pleura-based consolidation (Hampton hump).
-
Computed tomography angiography in a young man who experienced acute chest pain and shortness of breath after a transcontinental flight. This image demonstrates a clot in the anterior segmental artery in the left upper lung (LA2) and a clot in the anterior segmental artery in the right upper lung (RA2).
-
Computed tomography angiogram in a 55-year-old man with possible pulmonary embolism. This image was obtained at the level of the lower lobes and shows perivascular segmental enlarged lymph nodes as well as prominent extraluminal soft tissue interposed between the artery and the bronchus.
-
Computed tomography venograms in a 65-year-old man with possible pulmonary embolism. This image shows acute deep venous thrombosis with intraluminal filling defects in the bilateral superficial femoral veins.
-
The pathophysiology of pulmonary embolism. Although pulmonary embolism can arise from anywhere in the body, most commonly it arises from the calf veins. The venous thrombi predominately originate in venous valve pockets (inset) and at other sites of presumed venous stasis. To reach the lungs, thromboemboli travel through the right side of the heart. RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle.
-
A spiral CT scan shows thrombus in bilateral main pulmonary arteries.
-
CT scan of the same chest depicted in Image 18. Courtesy of Justin Wong, MD.
-
Longitudinal ultrasound image of partially recanalized thrombus in the femoral vein at mid thigh.
-
Sequential images demonstrate treatment of iliofemoral deep venous thrombosis due to May-Thurner (Cockett) syndrome. Far left, view of the entire pelvis demonstrates iliac occlusion. Middle left, after 12 hours of catheter-directed thrombolysis, an obstruction at the left common iliac vein is evident. Middle right, after 24 hours of thrombolysis, a bandlike obstruction is seen; this is the impression made by the overlying right common iliac artery. Far left, after stent placement, image shows wide patency and rapid flow through the previously obstructed region. Note that the patient is in the prone position in all views. (Right and left are reversed.)
-
Lower-extremity venogram shows outlining of an acute deep venous thrombosis in the popliteal vein with contrast enhancement.
-
Lower-extremity venogram shows a nonocclusive chronic thrombus. The superficial femoral vein (lateral vein) has the appearance of 2 parallel veins, when in fact, it is 1 lumen containing a chronic linear thrombus. Although the chronic clot is not obstructive after it recanalizes, it effectively causes the venous valves to adhere in an open position, predisposing the patient to reflux in the involved segment.
-
Pulmonary embolus.
Tables
What would you like to print?
- Overview
- Presentation
- DDx
- Workup
- Approach Considerations
- Clinical Scoring Systems
- D-Dimer Follow-Up on Low-to-Moderate Pretest Probability
- Ischemia-Modified Albumin levels
- White Blood Cell Count
- Arterial Blood Gases
- Troponin levels
- Brain Natriuretic Peptide
- Venography
- Angiography
- Computed Tomography Scanning
- Chest Radiography
- Ventilation-Perfusion Scanning
- Electrocardiography
- Magnetic Resonance Imaging
- Echocardiography
- Duplex Ultrasonography
- Show All
- Treatment
- Guidelines
- Medication
- Questions & Answers
- Media Gallery
- References