Overview
Pulmonary embolism occurs when thrombotic material, usually from a deep venous thrombosis, travels to the pulmonary arterial circulation.
Severity ranges from small emboli to massive obstruction causing right ventricular failure and shock.
Clinical Features
Common symptoms include sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia.
Severe PE may cause syncope, hypotension, or cardiac arrest.
Unexplained acute dyspnea with tachycardia should prompt PE consideration when thromboembolic risk is present.
Investigation
Diagnosis is guided by clinical probability, D-dimer testing when appropriate, and definitive imaging such as CT pulmonary angiography when indicated.
Management
Anticoagulation is the mainstay of treatment. Hemodynamically unstable patients may require thrombolysis or catheter/surgical intervention in selected circumstances.
Clinical Pearls
PE severity is determined by more than clot size: right ventricular strain and hemodynamic effect matter greatly.
END OF REVIEW
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