Pulmonary Embolism

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An Overview of Causes, Diagnosis, Treatment & Prevention
Pulmonary embolism (PE) is a fatal and a life threatening disease that involves the blockage of the main artery of the lung or any of its branches through a substance that may have reached the lungs through the bloodstream. A common reason for this type of blockage is a clot in the blood. A blood clot may be large or small in size, and there may be multiple clots.
PE belongs to a group of problems that are together known as venous thromboembolism (VTE). Venous signifies relation to veins, thrombosis means blockage of a blood vessel through a blood clot or thrombus and embolism takes place when a thrombus is detached from the site of its formation and travels with the blood flow to get struck in a narrow blood vessel at any place in the body. The thrombus is then known as an embolus.
Causes of Pulmonary Embolism
In majority of the cases, deep vein thrombosis (DVT) is the most common cause of embolism. In DVT, a blood clot or thrombus that has originated in a deep vein and travels in the blood circulation to get stuck in one of the blood vessels of the lung. The detached thrombus is known as an embolus and can lead to embolism. Most of the DVTs originate from veins in the legs or the pelvis. In rare cases, a PE may originate from a blood clot in the arm veins or from a thrombus originating in the heart.

Signs and Symptoms of Pulmonary Embolism
The symptoms are usually sudden in onset and may depend on the size of the clot. The present health status of an individual that is affected may also play some role in addition to how well the individual’s lungs can manage the clot.
Small Pulmonary Embolism may result in:
a) No symptoms at all which is common
b) Breathlessness that may vary from very mild to a high level
c) Chest pain which may be pleuritic and may result from the irritation caused by blood clot on the pleura around the lungs
d) Hemoptysis or coughing up blood
e) Mild fever
f) Tachycardia
A massive or multiple PE may result in:
a) Severe breathlessness
b) Chest pain that may be felt in the center of the chest behind the breastbone
c) Collapse or feeling unwell or fainting as a large clot may have interface with the heart and the blood circulation that may lead to a great reduction in the blood pressure.
d) Cardiac arrest in extreme cases where the heart may stop pumping blood due to the clot.
e) Indications of a DVT such as pain at back of leg calf, tenderness in calf muscles or swelling of leg or foot may be present. Calf may turn warm and red.
Diagnostic Tests for Pulmonary Embolism
Multiple tests may be conducted in order to confirm the diagnosis that may include:
a) A Blood test for D-dimer
This detects the fragments of breakdown products of a blood clot. The higher the fragment level, the more chances of blood clot in the vein. But, this test may be positive in many other cases such as a recent surgery or pregnancy and therefore this test does not necessarily diagnose a DVT or PE, but may indicate the likely probability of having a blood clot. It can help in deciding if future tests are needed.
b) CT Pulmonary Angiography and Ventilation/perfusion scan (V/Q or lung scintigraphy)
These are specialized scans that monitor the circulation in the lung and are useful as they can accurately indicate whether PE is present or not. V/Q is used in some cases where a CTPA may not be available or it is recommended to clients allergic to dyes or have CKD.
c) Ultrasound (Duplex Doppler)
This test indicates the blood flow in the leg veins and any blockage to the blood flow. In case a DVT is found, then a PE may be assumed as the cause of the symptoms.

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