Pulmonary Embolism Questions & Answers

Updated: Jun 21, 2018
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Questions & Answers

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)?

Why is knowledge of bronchovascular anatomy required to interpret CT scans in the evaluation of 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 do elevated plasma levels of natriuretic peptides or lactate affect mortality in patients with 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)?

Why is massive pulmonary embolism (PE) best defined by hemodynamic findings and evidence of myocardial injury?

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?

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?

Which test should be performed for patients with low-to-moderate probability of pulmonary embolism (PE)?

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)?

Is there a demonstrated relationship between elevated troponin levels and risk of death from 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)?

How much does elevated BNP levels increase the risk of mortality and complications in acute 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)?

If angiography results are negative, what further studies are needed to rule out 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)?

What are the ACR recommendations for the use of chest radiography in suspected 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 intermediate-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)?

What are the very low-probability criteria, or normal findings, 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 echocardiography used for the diagnosis of right ventricular dysfunction in suspected pulmonary embolism (PE)?

How is duplex ultrasonography used to diagnose pulmonary embolism (PE)?

What is the evidence that right ventricular dilatation on bedside echocardiography aids in the diagnosis of 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 patient factors are commonly used to determine if a venous thrombosis may lead to pulmonary embolism (PE)?

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 role of thrombolytic therapy in the management of patients at intermediate risk of embolism (PE)?

When is IV unfractionated heparin (UFH) therapy preferred for anticoagulation for 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 duration of anticoagulation therapy for recurring pulmonary embolism (PE)?

What are the ACCP guidelines for long-term anticoagulation for pulmonary embolism (PE)?

What are the ACCP treatment guidelines for pulmonary embolism (PE) in association with an active neoplasm?

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 white anti-embolic stockings (Ted hose) effective in the treatment of DVT and pulmonary embolism (PE)?

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

Which organizations have issued guidelines for the diagnosis and management of pulmonary embolism (PE)?

What are the AAFP and ACP recommendations for the use of clinical prediction rules in pulmonary embolism (PE)?

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 new or revised recommendations in the updated ACCP guidelines on antithrombotic therapy and prevention of thrombosis?

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)?

Which medications in the drug class Anticoagulants are used in the treatment of Pulmonary Embolism?

Which medications in the drug class Thrombolytics are used in the treatment of Pulmonary Embolism?

Which medications in the drug class Direct Thrombin Inhibitors and Factor Xa Inhibitors are used in the treatment of Pulmonary Embolism?