acute massive pulmonary embolism

(redirected from acute massive pulmonary thromboembolus)

acute massive pulmonary embolism

A condition defined as “…obstruction or significant filling defect involving two or more lobar pulmonary arteries, or the equivalent amount of emboli in smaller or other arteries”. It is the second most common cause of sudden death, after sudden cardiac death.

Clinical findings
Nonspecific; index of suspicion should be high in patients with dyspnea, tachypnea, or chest pain and risk factors for pulmonary embolism.

Diagnosis
Pulmonary angiography is the gold-standard diagnostic modality, but is rarely performed, as CT angiography is nearly as sensitive and specific.

Management
Immediate full anticoagulation followed by long-term anticoagulation, to prevent deep-vein thrombosis and recurrent pulmonary embolism.

Risk factors, pulmonary embolism
Major factors
Venous stasis
Hypercoagulable states
Immobilisation
Surgery and trauma
Pregnancy
Oral contraceptives and estrogen replacement
Malignancy
Hereditary factors resulting in a hypercoagulable state

Other factors
Acute medical illness
Central venous instrumentation within the past 3 months
Chronic obstructive pulmonary disease
Drug abuse (intravenous drugs)
Drug-induced lupus anticoagulant
Heart failure
Hemolytic anemias
Heparin-associated thrombocytopenia
Homocystinemia
Homocystinuria
Hyperlipidemias
Inflammatory bowel disease
Malignancy, especially lung cancer
Phenothiazines
Prior pulmonary embolism
Smoking
Stroke, paresis, or paralysis
Surgery within the last 3 months
Thrombocytosis
Current or past history of thrombophlebitis
Travel of 4 hours or more in the past month
Trauma to the lower extremities and pelvis during the past 3 months
Varicose veins
Venography
Venous pacemakers
Venous stasis
Warfarin (first few days of therapy)
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