Pulmonary Emboli

Risk Factors

  • Risk factors for DVT/PE:
  • Immobility, w/risk increasing based on duration, e.g. long car ride, plane ride, bed bound
  • Active cancer → in particular mucin secreting adenocarcinomas, NHL, AML, others
  • Meds, toxins→ e.g. smoking, estrogen
  • Trauma/vascular injury, surgery
  • Chronic intravascular catheters
  • Pregnancy - w/hypercoag state extending ~6w post-partum
  • Chronic inflammatory conditions→ IBD, lupus, Behcet's dz, etc
  • Prior hx DVT or PE
  • Biochemical predispositions, consider in particular when unexplained DVT: protein S or C deficiency, Anti-thrombin 3 defic, Prothrombin mutation, factor 5 leiden resistance, anti-phospholipid AB (arterial and venous)
  • Acquired predispositions, often linked to clots in unusual places: nephrotic syndrome (renal vein), p vera (hepatic vein), HIT, ET (arterial and venous), PNH, hyperhomocystinemia
  • Mechanical predispositions that compress veins→ stasis→ clot
  • Can have contribution from more than one RF

Symptoms

  • Cough
  • SOB
  • Acute or subactue if recurrent events
  • Chest pain (often pleuritic)
  • Lightheaded, dizzy, syncope/presyncope (based on degree of compromise)

Physical Exam Findings

  • Tachycardia
  • Tachypnea
  • Often clear lungs
  • Less commonly wheezing or findings of effusion
  • Unexplained unilateral edema, prominent superficial veins (DVT)

Tests

Links