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For further information, see CMDT Part 9-25: Pulmonary Venous Thromboembolism

Key Features

Essentials of Diagnosis

  • May present with one or more of the following:

    • Dyspnea

    • Pleuritic chest pain

    • Hemoptysis

    • Syncope

  • Tachypnea, tachycardia, hypoxia (alone or in combination)

  • Risk stratification with clinical scores, cardiac biomarkers, and right ventricular imaging is key for management

General Considerations

  • Venous thromboembolism (VTE) is often clinically silent until it presents with significant morbidity or mortality

  • Patients at highest risk include those with

    • Critical illness

    • Cancer

    • Stroke

    • Myocardial infarction

    • Age > 75 years

    • Prolonged immobility

    • Obesity

    • Kidney disease

    • Previous VTE

    • Hypercoagulable states

  • Pulmonary thromboemboli most often originate in deep veins of the lower extremities

  • Pulmonary thromboembolism (PE) develops in 50–60% of patients with proximal lower extremity deep venous thrombosis (DVT); 50% of these events are asymptomatic

  • Hypoxemia results from vascular obstruction leading to dead space ventilation, right-to-left shunting, and decreased cardiac output

  • Other types of pulmonary emboli

    • Fat embolism

    • Air embolism

    • Amniotic fluid embolism

    • Septic embolism (eg, endocarditis)

    • Tumor embolism (eg, renal cell carcinoma)

    • Foreign body embolism (eg, talc in injection drug use)

    • Parasite egg embolism (schistosomiasis)

Demographics

  • Third most common cause of death in hospitalized patients

  • Most cases are not recognized antemortem

  • < 10% with fatal emboli receive specific treatment

Clinical Findings

Symptoms and Signs

  • See Table 9–18

  • Clinical symptoms depend on the size of the embolus and the patient's preexisting cardiopulmonary status

  • Dyspnea occurs in 75–85% and chest pain in 65–75% of patients

Table 9–18.Frequency of specific symptoms and signs in patients at risk for pulmonary thromboembolism.

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