Pulmonary embolism

Shaikah Al-Otibi

Embolism
Occlusion of the arterial circulation by embolus Embolus is a detached intravscular solid,liquid,or gaseous mass that is carried by blood to a site distant from its point of origin. Forms: -Dislodged thrombus thromboembolism(99%) -Droplets of fat -bubbles of air or nitrogen -atherosclerotic debris -tumor fragments -bits of bone marrow -foreign bodies

Pulmonary embolism
Pulmonary embolism has an incidence of 20 to 25 per 100,000 hospitalized patient . PE cause 200,000 deaths per year in US.

In more than 95% of instance venous emboli originate from deep leg vein thrombi above the level of the knee Carried through larger channels and usually pass through RSH into p.vasculature

Depending on the size of embolus: *Occlude the main pulmonary artery. *Impact across the bifurcation.(saddle embolus) *Pass out into the smaller branching arterioles.

pathology
1-massive embolism:
Obstructs the right ventricular outflow tract and therefore suddenly increase pulmonary vascular resistance causing acute right heart failure

2-Small embolism:
impacts in terminal ,peripheral pulmonary vessels and may be clinical silent unless it causes pulmonaru infarction.

Clinical features:
*Outcome of pulmonary emboli depends on size of emboli. *Most pulmonary emboli (60-80) are clinically silent because they are small

1-Small\medium pulmonary emboli: symptoms: Dyspnea

Pleuritic chest pain haemoptysis

Signs:

Tachycardia Pleural rub Raised diaphragm Crackle ,low grade fever

Massive pulmonary embolism: Severe dyspnea Symptoms: Sweaty ,pale

Sudden syncope or fainting Sever Central chest pain

Signs:

hypotension ,Raised JVP, wide split of S2 Severe cyanosis Low urine output

Multiple recurrent pulmonarry embolism:

Symptoms:
Syncope of Pulmonary hypertension Dyspnea on effort

Signs:

RV heave Loud pulmonary Second sound PI, Heptomegaly ,ankle odema

Investigation:
ChestX-ray,ECG,and blood gases: May all be normal with small\medium pulmonary emboli . any abnormalities with massive emboli are not spesific . X-ray:Decreased vascular markings and raised hemidiaphragm. Pulmonary infa: wedge shaped opacity adjacent to the pleural edge ,pleural effeusion. Blood gases: hypoxemia and hypocapnia

2-radionuclide lung scan (V\Q) scan Demonestrate areas of ventilated lung with Perfusion defects

3-ultrasound Detect clots in the pelvic or iliofemoral veins.

Spiral CT
images the pulmonary vessels directly and has approximately 90% sensitivity and specifity for medium large pulmonary emboli

MRI: Similar results and is used if CT is contraindicated