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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) may be present

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

General Considerations

  • Venous thromboembolism (VTE), often referred to as pulmonary embolism (PE), is often clinically silent until it presents with significant morbidity or mortality

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

  • Risk factors for PE include the Virchow triad, which comprises

    • Venous stasis (eg, due to immobility, hyperviscosity, increased central venous pressures)

    • Injury to the vessel wall (eg, due to prior episodes of thrombosis, orthopedic surgery, trauma)

    • Hypercoagulability (eg, due to medications, disease, inherited gene defects or acquired thrombophilias)

  • 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)


  • Third most common cause of death in hospitalized patients

  • Most cases are not recognized antemortem

Clinical Findings

Symptoms and Signs

  • See Table 9–18

  • Clinical symptoms and signs are similar to those of other cardiopulmonary conditions

  • Dyspnea and chest pain on inspiration are common

Table 9–18.Clinical prediction rule for PE.

Differential Diagnosis

  • Myocardial infarction

  • Pneumonia

  • Pericarditis

  • Heart failure

  • Pleuritis (pleurisy)

  • Pneumothorax

  • Pericardial tamponade


  • Diagnosis primarily relies on clinical prediction scores ...

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