Pulmonary embolism: Difference between revisions

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{{Infobox_Disease |
__NOTOC__
  Name          = Pulmonary embolism |
{| class="infobox" style="float:right;"
  Image          = Pe on pulmonary angiography.jpg|
|-
  Caption        = |
| [[File:Siren.gif|30px|link=Pulmonary embolism resident survival guide]]|| <br> || <br>
  DiseasesDB    = 10956 |
| [[Pulmonary embolism resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
  ICD10          = {{ICD10|I|26||i|26}} |
|}
  ICD9          = {{ICD9|415.1}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 000132 |
}}
{{Pulmonary embolism}}
{{Pulmonary embolism}}
{{CMG}}


'''Associate Editor-In-Chief:''' {{CZ}}, [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]
'''For patient information, click [[{{PAGENAME}} (patient information)|here]]'''


==[[Pulmonary embolism overview|Overview]]==
'''For economy class syndrome, click [[economy class syndrome|here]]'''


==[[Pulmonary embolism epidemiology and demographics|Epidemiology and Demographics]]==
{{CMG}} {{ATI}}; {{AE}} {{CZ}}; {{Rim}}


==[[Pulmonary embolism risk factors|Risk factors]]==
{{SK}} PE; lung blood clot; blood clot-lung; embolism-pulmonary


==[[Pulmonary embolism pathophysiology|Pathophysiology]]==
==[[Pulmonary embolism overview|Overview]]==


==[[Pulmonary embolism natural history|Natural History, Complications & Prognosis]]==
==[[Pulmonary embolism historical perspective|Historical Perspective]]==


==[[Pulmonary embolism diagnosis|Diagnosis]]==
==[[Pulmonary embolism classification|Classification]]==


==[[Pulmonary embolism differential diagnosis|Differential Diagnosis]]==
==[[Pulmonary embolism pathophysiology|Pathophysiology]]==


==[[Pulmonary embolism history & symptoms|History & Symptoms]]==
==[[Pulmonary embolism causes|Causes]]==


==[[Pulmonary embolism physical examination|Physical Examination]]==
==[[Pulmonary embolism differential diagnosis|Differentiating Pulmonary Embolism from other Diseases]]==


==[[Pulmonary embolism laboratory tests|Laboratory Tests]]==
==[[Pulmonary embolism epidemiology and demographics|Epidemiology and Demographics]]==


==[[Pulmonary embolism electrocardiogram|Electrocardiogram]]==
==[[Pulmonary embolism risk factors|Risk Factors]]==


==[[Pulmonary embolism pulmonary angiography|Pulmonary Angiography]]==
==[[Pulmonary embolism triggers|Triggers]]==


==[[Pulmonary embolism CT|CT]]==
==[[Pulmonary embolism natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


==[[Pulmonary embolism ventilation/perfusion scan|Ventilation/Perfusion scan]]==
==Diagnosis==
[[Pulmonary embolism diagnostic approach|Diagnostic Approach]] | [[Pulmonary embolism assessment of clinical probability and risk scores|Assessment of Clinical Probability and Risk Scores]] | [[Pulmonary embolism assessment of probability of subsequent VTE and risk scores|Assessment of Probability of Subsequent VTE and Risk Scores]] | [[Pulmonary embolism history & symptoms|History and Symptoms]] | [[Pulmonary embolism physical examination|Physical Examination]] | [[Pulmonary embolism laboratory findings|Laboratory Findings]] | [[Pulmonary embolism arterial blood gas analysis|Arterial Blood Gas Analysis]] | [[Pulmonary embolism D-dimer|D-dimer]] | [[Pulmonary embolism biomarkers|Biomarkers]] | [[Pulmonary embolism electrocardiogram|Electrocardiogram]] | [[Pulmonary embolism chest x ray|Chest X Ray]] | [[Pulmonary embolism ventilation/perfusion scan|Ventilation/Perfusion Scan]] | [[Pulmonary embolism echocardiography|Echocardiography]] | [[Pulmonary embolism compression ultrasonography|Compression Ultrasonography]] | [[Pulmonary embolism CT|CT]] | [[Pulmonary embolism MRI|MRI]]


==[[Pulmonary embolism echocardiography or ultrasound|Echocardiography or Ultrasound]]==
==Treatment==
[[Pulmonary embolism treatment approach|Treatment Approach]] | [[Pulmonary embolism medical therapy|Medical Therapy]] | [[Pulmonary embolism IVC filter|IVC Filter]] | [[Pulmonary thrombectomy|Pulmonary Thrombectomy]] | [[Pulmonary thromboendarterectomy|Pulmonary Thromboendarterectomy]] | [[Pulmonary embolism discharge care and long term treatment|Discharge Care and Long Term Treatment]] | [[Pulmonary embolism prevention|Prevention]] | [[Pulmonary embolism cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pulmonary embolism future or investigational therapies|Future or Investigational Therapies]]


==[[Pulmonary embolism chest xray|Chest xray]]==
=== Follow-Up ===
[[Pulmonary embolism support group|Support group]]


==[[Pulmonary embolism MRI|MRI]]==
=== Special Scenarios ===
[[Pulmonary embolism special scenario pregnancy|Pregnancy]] | [[Pulmonary embolism special scenario cancer|Cancer]]


==[[Pulmonary embolism low probability diagnostic tests|Low Probability Diagnostic Tests]]==
== Trials ==
[[Pulmonary embolism landmark trials|Landmark Trials]]


===Combining tests into algorithms===
== Case Studies ==
Recent recommendations for a diagnostic algorithm have been published by the PIOPED investigators; however, these recommendations do not reflect research using 64 slice MDCT.<ref name="pmid17185658"/> These investigators recommended:
[[Pulmonary embolism case studies|Case #1]]
* Low clinical probability. If negative D-dimer, PE is excluded. If positive D-dimer, obtain MDCT and based treatment on results.
* Moderate clinical probability. If negative D-dimer, PE is excluded. ''However'', the authors were not concerned that a negative MDCT with negative D-dimer in this setting has an 5% probability of being false. Presumably, the 5% error rate will fall as 64 slice MDCT is more commonly used. If positive D-dimer, obtain MDCT and based treatment on results.
* High clinical probability. Proceed to MDCT. If positive, treat, if negative, addition tests are needed to exclude PE.


==[[Pulmonary embolism medical therapy|Medical Therapy]]==
==Related Chapters==
 
*[[Venous thromboembolism]]
==[[Pulmonary embolism surgery|Surgery]]==
*[[Deep venous thrombosis]]
 
{{WH}}
===Predicting mortality===
{{WS}}
 
The PESI and Geneva prediction rules can estimate mortality and so may guide selection of patients who can be considered for outpatient therapy.<ref name="pmid17625081">{{cite journal |author=Jiménez D, Yusen RD, Otero R, ''et al'' |title=Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient therapy |journal=Chest |volume=132 |issue=1 |pages=24-30 |year=2007 |pmid=17625081 |doi=10.1378/chest.06-2921}}</ref>
 
Right ventricular dysfunction on echocardiography and higher than normal concentrations of troponin identify high risk patients who might need escalation of therapy with thrombolysis or embolectomy even if the blood pressure is normal on presentation.
 
==[[Pulmonary embolism follow-up/recurrence|Follow-Up/Recurrence]]==
 
==References==
{{Reflist|2}}
 
==Sources==
#Bertucci, V., Asch, M.R., Balter, M., Prognosis in a patient with an initial normal pulmonary angiogram, Chest 1994; 105: 1257-1258.
#Cvitanic, O, Marino, P.L., Improved use of arterial blood gas analysis in suspected pulmonary embolism, Chest 1989; 95: 48-51.
#Drucker, E.A., et.al., Acute pulmonary embolism: assessment of helical CT for diagnosis, Radiology 1998; 209: 235-241.
#Ferrari, E., et.al., The ECG in pulmonary embolism: predictive value of negative T waves in precordial leads – 80 case reports, Chest 1997; 111: 537-543.
#Goldhaber, S.Z., et.al., Quantitative plasma D-dimer levels among patients undergoing pulmonary angiography for suspected pulmonary embolism, JAMA 1993; 270: 2819-2822.
#Goldhaber, S.Z., Pulmonary embolism, NEJM 1998; 339: 93-104.
#Mayo, J.R., et.al., Pulmonary embolism: prospective comparison of spiral CT with ventilation-perfusion scintigraphy, Radiology 1997; 205: 447-452.
#Meaney, J.F.M., et.al., Diagnosis of pulmonary embolism with magnetic resonance angiography, NEJM 1997; 336: 1422-1427.
#The PIOPED investigators, Value of the ventilation / perfusion scan in acute pulmonary embolism: results of the prospective investigation of pulmonary embolism diagnosis (PIOPED), JAMA 1990; 263: 2753-2759.
#Remy-Jardin, M., et.al., Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy, Radiology 1996; 200: 6999-706.
#Stein, P.D., et.al., Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease, Chest 1991; 100: 598-603.
#Stein, P.D., et.al., Arterial blood gas analysis in the assessment of suspected pulmonary embolism, Chest 1996; 109: 78-81.
#Thompson, B.T., Hales, C.A., Diagnostic strategies for acute pulmonary embolism, in UpToDate, September 10, 1998.
#Van Erkel, A.R., et.al., Spiral CT angiography for suspected pulmonary embolism: a cost-effective analysis, Radiology 1996; 201: 29-36.
 
== Acknowledgements ==
The content on this page was first contributed by: {{CMG}} and David Feller-Kopman, M.D.
 
List of contributors:
 
== For Patients ==
 
[http://www.nhlbi.nih.gov/new/press/06-05-31.htm NIH information page]
 
<youtube v=gGrDAGN5pC0/>
 
==External links==
* [http://www.vdf.org/ Vascular Disease Foundation]
* [http://www.venousdiseasefoundation.org/ Venous Disease Coalition]
* [http://goldminer.arrs.org/search.php?query=pulmonary%20embolism Goldminer, Pulmonary embolism]
* [http://rad.usuhs.edu/medpix/medpix.html?mode=image_finder&action=search&srchstr=pulmonary%20embolism&srch_type=all#top Images of Pulmonary Embolism]
* [http://www.natfonline.org/ North American Thrombosis Forum]


[[Category:Hematology]]
[[Category:Hematology]]
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[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
 
[[Category:Mature chapter]]
[[es:Tromboembolismo pulmonar]]
[[eo:Pulma embolio]]
[[fr:Embolie pulmonaire]]
[[ko:폐색전증]]
[[nl:Longembolie]]
[[no:Lungeemboli]]
[[pl:Zatorowość płucna]]
[[pt:Embolia pulmonar]]
[[sr:Плућна емболија]]
[[tr:Pulmoner emboli]]
 
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{{WikiDoc Sources}}

Latest revision as of 23:53, 29 July 2020



Resident
Survival
Guide

Pulmonary Embolism Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pulmonary Embolism from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria

Assessment of Clinical Probability and Risk Scores

Pulmonary Embolism Assessment of Probability of Subsequent VTE and Risk Scores

History and Symptoms

Physical Examination

Laboratory Findings

Arterial Blood Gas Analysis

D-dimer

Biomarkers

Electrocardiogram

Chest X Ray

Ventilation/Perfusion Scan

Echocardiography

Compression Ultrasonography

CT

MRI

Treatment

Treatment approach

Medical Therapy

IVC Filter

Pulmonary Embolectomy

Pulmonary Thromboendarterectomy

Discharge Care and Long Term Treatment

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Follow-Up

Support group

Special Scenario

Pregnancy

Cancer

Trials

Landmark Trials

Case Studies

Case #1

Pulmonary embolism On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pulmonary embolism

CDC on Pulmonary embolism

Pulmonary embolism in the news

Blogs on Pulmonary embolism

Directions to Hospitals Treating Pulmonary embolism

Risk calculators and risk factors for Pulmonary embolism

For patient information, click here

For economy class syndrome, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] The APEX Trial Investigators; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Rim Halaby, M.D. [3]

Synonyms and keywords: PE; lung blood clot; blood clot-lung; embolism-pulmonary

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pulmonary Embolism from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach | Assessment of Clinical Probability and Risk Scores | Assessment of Probability of Subsequent VTE and Risk Scores | History and Symptoms | Physical Examination | Laboratory Findings | Arterial Blood Gas Analysis | D-dimer | Biomarkers | Electrocardiogram | Chest X Ray | Ventilation/Perfusion Scan | Echocardiography | Compression Ultrasonography | CT | MRI

Treatment

Treatment Approach | Medical Therapy | IVC Filter | Pulmonary Thrombectomy | Pulmonary Thromboendarterectomy | Discharge Care and Long Term Treatment | Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Follow-Up

Support group

Special Scenarios

Pregnancy | Cancer

Trials

Landmark Trials

Case Studies

Case #1

Related Chapters

Template:WH Template:WS