Pulmonary embolism

24 Pulmonary embolism



image

Fig. 24.1A This radiograph demonstrates a very subtle area of oligaemia in the right upper zone, with a decreased vessel count. The subsequent CT pulmonary angiogram demonstrated a right-sided pulmonary embolus.



Background


Pulmonary embolism (PE) is a serious condition and a leading cause of mortality. It is important for all on-call doctors to be familiar with this condition, as it can occur in any inpatient. It is a common postoperative complication and a common reason for admission to hospital.


Algorithms for clinical assessment of PE and the role of simple tests and imaging are often poorly understood.



Clinical features


Clinical signs and symptoms are non-specific and a high index of suspicion for this condition is necessary.


Remember to seek risk factors: malignancy, immobility, coagulopathies, recent surgery (this list is not exhaustive).



Symptoms


Symptoms include dyspnoea, pleuritic chest pain and haemoptysis; their onset is usually sudden.



Signs


Chest wall tenderness may occur. The patient may also have tachypnoea, tachycardia and hypoxia. Massive PE may be associated with hypotension and raised JVP.



Differential diagnosis


The following conditions should be excluded – some can be diagnosed using simple tests before asking for a CT pulmonary angiogram:


• myocardial infarction/acute coronary syndrome – consider ECG and troponins

• pneumothorax – CXR to rule out (see Chapter 18).

• pneumonia – history may be different (productive cough and high fever), and CXR (although consolidation may look like infarction) (see Chapter 8)

• aortic dissection – widened mediastinum on CXR, different history (see Chapter 23)

• pericarditis – central pain of insidious onset, saddle-shaped ST segments on ECG

Related posts:

Permanent pacemakers Gastric outlet obstruction Caecal volvulus Large bowel obstruction Brodie’s abscess Slipped upper femoral epiphysis

Stay updated, free articles. Join our Telegram channel
Tags:
Aug 20, 2016 | Posted by in ULTRASONOGRAPHY | Comments Off on Pulmonary embolism

Full access? Get Clinical Tree
Get Clinical Tree app for offline access