pulmonary disorders
Pulmonary Embolism (PE)
Introduction
Pulmonary embolism (PE) is the occlusion of pulmonary arteries by thrombi that originate elsewhere, typically in the large veins of the legs or pelvis. Risk factors for pulmonary embolism are conditions that impair venous return, conditions that cause endothelial injury or dysfunction, and underlying hypercoagulable states. Symptoms of pulmonary embolism are nonspecific and include dyspnea, pleuritic chest pain, and, in more severe cases, light-headedness, presyncope, syncope, or cardiorespiratory arrest. Signs are also nonspecific and may include tachypnea, tachycardia, and in more severe cases, hypotension. Diagnosis of pulmonary embolism is most commonly accomplished with CT angiography, although ventilation perfusion scanning is sometimes required. Pulmonary embolism treatment is with anticoagulants and, sometimes, clot dissolution with systemic or catheter-directed thrombolysis or by removal of the clot via catheter suction thrombectomy or surgical resection. When anticoagulation is contraindicated, an inferior vena caval (IVC) filter can be considered until anticoagulation is resumed. Preventive measures include early mobilization, anticoagulants, and, in patients who are hospitalized, sometimes mechanical compression devices that are applied to the legs. (See alsoEuropean Society of Cardiology 2019 Guidelines on Diagnosis and Management of Pulmonary EmbolismandAmerican Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism.) The estimated annual incidence of pulmonary embolism world wide is approximately 1 per 1000 people ( General references ). Up to 20% of people diagnosed with acute PE die in the next 90 days ( 