Pulmonary embolism

Question 1

What is pulmonary embolism?

Answer 1

Obstruction of pulmonary arteries by solid, liquid, or gaseous masses

Question 2

What are the causes of pulmonary embolism?

Answer 2

(Deep vein thrombosis) obesity, hypomobility or immobility, malignancy, pregnancy, dehydration , hypercoagulability, use of contraceptives, previous DVT
(Fat embolism) major surgical interventions (e.g., endoprosthesis replacement, osteosynthesis, closed long bone fractures)

Question 3

What are the clinical features of pulmonary embolism?

Answer 3

chest pain: typically pleuritic
dyspnoea
haemoptysis
tachycardia
tachypnoea

Question 4

How is pulmonary embolism diagnosed?

Answer 4

If suspected, use Well’s score
(If PE likely, >4) immediate computed tomography pulmonary angiogram (CTPA)
(If PE unlikely, 4 or less) D-dimer test. If test positive arrange CTPA. If negative consider differential diagnosis
(Others) V/Q scan, X-ray, pulmonary angiography

Question 5

What is the treatment of PE?

Answer 5

Direct oral anticoagulants (DOACs)e.g.apixaban or rivaroxaban, first choice anticoagulant for at least 3 months, then determine if VTE is provoked or unprovoked
(If provoked, stop treatment. If unprovoked, additional 3 months)

(PE with haemodynamic instability) Thromoblysis