Jul 19, 2023
A pulmonary embolism is a blood clot that prevents blood flow to a lung artery. Most frequently, a blood clot begins in a deep leg vein and moves to the lung. Rarely does the clot develop in a vein in a different area of the body. Deep vein thrombosis (DVT) is the medical term for when a blood clot develops in one or more of the body's deep veins.
Pneumoembolism poses a serious risk to life because one or more clots prevent blood from reaching the lungs. But the chance of dying is significantly decreased with quick medical attention. You can lessen your risk of pulmonary embolism by taking steps to avoid blood clots in your legs.
Blood clotting occurs naturally to stop bleeding. Blood clots are formed by the body, which then dissolves them. In some cases, the body may not be able to dissolve a clot. A significant health issue could come from this.
It is possible for blood to clot in a vein as a result of decreased blood flow, a defect in clot formation, or damage to the blood vessel wall.
In arteries and veins, blood clots can develop. Leg veins can either be deep veins, which are encircled by muscle and bone, or superficial veins, which are close to the skin's surface.
Deep leg veins are where venous clots most frequently form. Deep vein thrombosis (DVT) is the medical term for this condition. Once a blood clot has developed in the deep veins of the leg, there is a chance that some of it could separate and move through the circulation to another part of the body, frequently the lung. A pulmonary embolism is most frequently caused by DVT.
Deep vein thrombosis: “Virchow Triad”. Prolonged Immobilization for more than 72 hours can cause thrombosis in mainly soleal veins and popliteal veins so a piece of the clot has broken and passes through the right side of the heart resulting in a ventilation-perfusion mismatch.
A fat embolus (typically related to the shattering of a big bone), an embolus of amniotic fluid, air bubbles, and an upper body deep vein thrombosis are some less common causes of pulmonary embolism. Additionally, clots may develop on the end of an intravenous (IV) catheter that is inserted continuously, separate, and go to the lungs.
The signs of a pulmonary embolism can be very different depending on how much of your lung is damaged, the size of the clots, and whether or not you have a heart or lung condition.
These are typical symptoms:
Pulmonary embolism risk factors include:
On examining the patient with pulmonary embolism we can find the following findings:
The Wells criteria for pulmonary embolism is a risk stratification score and clinical decision rule used to calculate the likelihood of acute pulmonary embolism (PE) in individuals whose medical histories and physical examinations suggest that acute PE may be present. It includes the following:
B – Blood in sputum
D – Deep vein thrombosis sign and symptoms present is Homan Sign (Pain on the calf while dorsiflexion of the ankle)
C – Cancers
H – A heart rate of more than 100 /min on the 3rd or 4th day is suggestive of atelectasis or PTE.
I – Immobilization of more than 3 days or surgery less than 4 weeks
P– Prior pulmonary embolism Or Prior DVT (If Score > 4 = High probability)
Multiple small pulmonary emboli enter into the Right heart leading to blockage of small arteries of the Pulmonary artery that result in mild distension of the right ventricle without affecting the left ventricle. Seen in around 60 % of cases. In this condition, the Blood pressure tends to remain normal in the patient.
Diagnosis of pulmonary embolism can be made with the help of following methods:
There is a block by dislodged emboli on the pulmonary artery which presents dilated to the proximal emboli called Palla sign - commonly seen in the Right descending pulmonary artery and wedge-shaped infarction to the distal emboli called Hampton hump.
Wester Mark Sign – Due to focal oligemia seen in only one lung where emboli lodged into the Right descending pulmonary artery.
Pulmonary embolism (PE) treatment options include:
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