Pulmonary Embolism

Question 1

What are some of the symptoms of PE?

Answer 1

Variable dyspnoea
Haemoptysis
Cough
Syncope
Pleuritic pain (indicates infarction)

Question 2

What are some possible pathophysiological abnormalities arising from PE?

Answer 2

Hypoxaemia
Local PA obtruction and widespread vasoconstriction leading to RV dysfunction
Constriction of airways distal to bronchi
Decreased pulmonary compliance due to haemorrhage, loss of surfactant

Question 3

What are the different outcomes of PE as influenced by the size/number of emboli?

Answer 3

Large/numerous: sudden collapse and death, acute cor pulmonale
Medium: acute cor pulmonale, pulmonary infarction (usually with pre-existing disease)
Small: can be clinically silent, may cause infarction, multiple small emboli over time can lead to chronic PAH and chronic cor pulmonale

Question 4

What is a saddle PE?

Answer 4

PE across pulmonary trunk and bifurcation of arteries

Question 5

What kind of necrosis occurs in pulmonary infarct?

Answer 5

Coagulative

Question 6

What kind of infarct is a pulmonary infarct? Why?

Answer 6

Haemorrhagic, due to dual blood supply (pulmonary and bronchial arteries)
Wedge-shaped