Pulmonary Thromboembolism – PTE

Question 1

pathophysiology

Answer 1

Obstruction of the pulmonary artery and its branches by thrombi
A major cause of morbidity and mortality in canine IMHA
Blood stasis, hypercoagulability and endothelial damage predispose to PTE

Question 2

Additional diseases associated with PTE

Answer 2

Hyperadrenocorticism
Protein-losing nephropathy/enteropathy
Cardiac disease (cardiomyopathy in cats)
Sepsis 
Neoplasia 
Pancreatitis, inflammatory diseases, S. lupi ?

Question 3

Clinical signs

Answer 3

are often acute and dramatic

Respiratory distress, tachypnea, dyspnea, orthopnea, cyanosis

Question 4

Diagnosis

Answer 4

Chest x-rays lack sensitivity and specificity
CT (or MRI) pulmonary angiography is fairly sensitive and specific
Ddimer
Echocardiography: Pulmonary hypertension

Arterial blood gas analysis- severe hypoxemia in acute cases

Question 5

Ddimer

Answer 5

D-dimer is a sensitive marker (80% sensitivity in one study, almost 100% sensitivity in acute cases)
Most useful immediately following development of PTE
D-dimer is not specific, useful for ruling-out PTE in acute cases

– די-דימר יורד בצורה משמעותית לאחר 24שעות. כלומר, אם נוצר
זה עתה קריש – די דימר יכול להיות גבוה מאוד, אך לאחר 24-48שעות רמותיו יכולות לרדת
משמעותית –

Question 6

treatment

Answer 6

Oxygen
Anticoagulant treatment: Prevents further expansion of thrombus
The thrombus undergoes natural fibrinolysis
Clopidogrel
Aspirin
Heparin and low-molecular weight heparin

Thrombolytics:
Streptokinase
Tissue plasminogen activator
Urokinase
Limited information in veterinary medicine

Treating underlying disease