Pulmonary embolism physical examination

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Editor(s)-In-Chief: C. Michael Gibson, M.S., M.D. [1], The APEX Trial Investigators; Associate Editor(s)-in-Chief:

Overview

Pulmonary emboli are associated with the presence of tachycardia and tachypnea. Signs of right ventricular failure include jugular venous distension, a right sided S3, and a parasternal lift. These signs are often present in cases of massive pulmonary emboli.[1]

Physical Examination

Appearance of the Patient

The patient may appear anxious due to difficulty breathing. More severe cases may be associated with cyanosis.

Vital Signs

Temperature

Pulse

Rate
Rhythm
  • The pulse is regular.
Strength
  • The pulse may be weak if the patient is in shock.
Symmetry
  • The pulses are symmetric.

Respiratory Rate

Blood Pressure

Skin

Neck

Heart

Inspection

Auscultation

Lungs

Extremities

Signs of deep vein thrombosis (listed below) may be present in majority of patients with PE.[1]

  • Unilateral calf or thigh tenderness
  • Unilateral calf or thigh pitting edema
  • Unilateral calf or thigh swelling
  • Difference in calf diameters > 3 cm (the calf circumference is measured 10 cm below the tibial tuberosity)
  • Difference in thigh diameters (the thigh circumference is measured 10-15 cm above the patella)
  • Unilateral calf or thigh warmth
  • Unilateral calf or thigh erythema
  • Palpable cord (a thickened palpable vein suggestive of thrombosed vein)
  • Dilatation of unilateral collateral superficial veins
  • Localized tenderness upon palpation of the deep veins
    • Posterior calf
    • Popliteal fossa
    • Inner anterior thigh

Supportive Trial Data

The Prospective Investigation Of Pulmonary Embolism Diagnosis II (PIOPED II) study identified the following signs to be present in the majority of patients with a confirmed pulmonary embolism diagnosed by angiography.[1]

References

  1. 1.0 1.1 1.2 1.3 1.4 Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK (2007). "Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II". The American Journal of Medicine. 120 (10): 871–9. doi:10.1016/j.amjmed.2007.03.024. PMC 2071924. PMID 17904458. Retrieved 2012-04-29. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P; et al. (2008). "Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)". Eur Heart J. 29 (18): 2276–315. doi:10.1093/eurheartj/ehn310. PMID 18757870.
  3. Kürkciyan I, Meron G, Sterz F, Janata K, Domanovits H, Holzer M; et al. (2000). "Pulmonary embolism as a cause of cardiac arrest: presentation and outcome". Arch Intern Med. 160 (10): 1529–35. PMID 10826469.

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