Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Overview of acute pulmonary embolism

INTRODUCTION

Acute pulmonary embolism (PE) is a common and often fatal disease. Mortality can be reduced by prompt diagnosis and therapy. Unfortunately, the clinical presentation of PE is variable and nonspecific, making accurate diagnosis difficult.

The epidemiology, prognosis, pathophysiology, risk factors, symptoms, and signs of acute PE are reviewed here. The diagnosis and treatment of acute PE are discussed in detail elsewhere. (See "Diagnosis of acute pulmonary embolism" and "Treatment of acute pulmonary embolism".)

DEFINITIONS

PE refers to obstruction of the pulmonary artery or one of its branches by material (eg, thrombus, tumor, air, or fat ) that originated elsewhere in the body. This topic review focuses on PE due to thrombus. Air emboli and fat emboli are discussed elsewhere. (See "Air embolism" and "Fat embolism syndrome".)

PE can be classified as acute or chronic. Patients with acute PE typically develop symptoms and signs immediately after obstruction of pulmonary vessels. In contrast, patients with chronic PE tend to develop slowly progressive dyspnea over a period of years due to pulmonary hypertension. (See "Clinical manifestations and diagnosis of chronic thromboembolic pulmonary hypertension" and "Treatment of chronic thromboembolic pulmonary hypertension".)

Acute PE can be further classified as massive or submassive:
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2009 UpToDate, Inc.
References Top
  1. Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on Pulmonary Embolism, European Society of Cardiology. Eur Heart J 2000; 21:1301.
  2. Kucher, N, Goldhaber, SZ. Management of massive pulmonary embolism. Circulation 2005; 112:e28.
  3. Coon, WW, Willis, PW. Deep venous thrombosis and pulmonary embolism: Prediction, prevention and treatment. Am J Cardiol 1959; 4:611.
  4. Soloff, LA, Rodman, T. Acute pulmonary embolism. II. Clinical. Am Heart J 1967; 74:829.
  5. Bergqvist, D, Lindblad, B. A 30-year survey of pulmonary embolism verified at autopsy: An analysis of 1274 surgical patients. Br J Surg 1985; 72:105.
  6. Goldhaber, SZ, Hennekens, CH, Evans, DA, et al. Factors associated with the correct antemortem diagnosis of major pulmonary embolism. Am J Med 1982; 73:822.
  7. Ryu, JH, Pellikka, PA, Froehling, DA, et al. Saddle pulmonary embolism diagnosed by CT angiography: frequency, clinical features and outcome. Respir Med 2007; 101:1537.
  8. Horlander, KT, Mannino, DM, Leeper, KV. Pulmonary embolism mortality in the United States, 1979-1998: an analysis using multiple-cause mortality data. Arch Intern Med 2003; 163:1711.
  9. Carson, JL, Kelley, MA, Duff, A, et al. The clinical course of pulmonary embolism: One year follow-up of PIOPED patients. N Engl J Med 1992; 326:1240.
  10. Goldhaber, SZ, Visani, L, De Rosa, M. Acute pulmonary embolism: Clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353:1386.
  11. Nijkeuter, M, Sohne, M, Tick, LW, et al. The natural course of hemodynamically stable pulmonary embolism: Clinical outcome and risk factors in a large prospective cohort study. Chest 2007; 131:517.
  12. ten Wolde, M, Sohne, M, Quak, E, et al. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med 2004; 164:1685.
  13. Sanchez, O, Trinquart, L, Colombet, I, et al. Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review. Eur Heart J 2008; 29:1569.
  14. Grifoni, S, Vanni, S, Magazzini, S, et al. Association of persistent right ventricular dysfunction at hospital discharge after acute pulmonary embolism with recurrent thromboembolic events. Arch Intern Med 2006; 166:2151.
  15. Pieralli, F, Olivotto, I, Vanni, S, et al. Usefulness of bedside testing for brain natriuretic Peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism. Am J Cardiol 2006; 97:1386.
  16. Cavallazzi, R, Nair, A, Vasu, T, Marik, PE. Natriuretic peptides in acute pulmonary embolism: a systematic review. Intensive Care Med 2008; :.
  17. Klok, FA, Mos, IC, Huisman, MV. Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism: a systematic review and meta-analysis. Am J Respir Crit Care Med 2008; 178:425.
  18. Kucher, N, Printzen, G, Goldhaber, SZ. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation 2003; 107:2545.
  19. Torbicki, A, Galie, N, Covezzoli, A, et al. Right heart thrombi in pulmonary embolism: results from the International Cooperative Pulmonary Embolism Registry. J Am Coll Cardiol 2003; 41:2245.
  20. Becattini, C, Vedovati, MC, Agnelli, G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 2007; 116:427.
  21. Kostrubiec, M, Pruszczyk, P, Bochowicz, A, et al. Biomarker-based risk assessment model in acute pulmonary embolism. Eur Heart J 2005; 26:2166.
  22. Kistner, RL, Ball, JJ, Nordyke, RA, Freeman, GC. Incidence of pulmonary embolism in the course of thrombophlebitis of the lower extremities. Am J Surg 1972; 124:169.
  23. Moser, KM, LeMoine, JR. Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med 1981; 94:439.
  24. Weinmann, EE, Salzman, EW. Deep-vein thrombosis. N Engl J Med 1994; 331:1630.
  25. Moser, KM. Venous thromboembolism. Am Rev Respir Dis 1990; 141:235.
  26. Nakos, G, Kitsiouli, EI, Lekka, ME. Bronchoalveolar lavage alterations in pulmonary embolism. Am J Respir Crit Care Med 1998; 158:1504.
  27. Benotti, JR, Dalen, JE. The natural history of pulmonary embolism. Clin Chest Med 1984; 5:403.
  28. Girard, P, Decousus, M, Laporte, S, Buchmuller, A. Diagnosis of pulmonary embolism in patients with proximal deep vein thrombosis: specificity of symptoms and perfusion defects at baseline and during anticoagulant therapy. Am J Respir Crit Care Med 2001; 164:1033.
  29. Stein, PD, Beemath, A, Matta, F, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120:871.
  30. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators. JAMA 1990; 263:2753.
  31. Darze, ES, Latado, AL, Guimaraes, AG, et al. Incidence and clinical predictors of pulmonary embolism in severe heart failure patients admitted to a coronary care unit. Chest 2005; 128:2576.
  32. Heit, JA, O'Fallon, WM, Petterson, TM, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med 2002; 162:1245.
  33. Pulido, T, Aranda, A, Zevallos, MA, et al. Pulmonary embolism as a cause of death in patients with heart disease: an autopsy study. Chest 2006; 129:1282.
  34. Goldhaber, SZ, Grodstein, F, Stampfer, MJ, et al. A prospective study of risk factors for pulmonary embolism in women. JAMA 1997; 277:642.
  35. Stein, PD, Fowler, SE, Goodman, LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006; 354:2317.
  36. Stein, PD, Terrin, ML, Hales, CA, et al. Clinical, laboratory, roentgenographic and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 1991; 100:598.
  37. Stein, PD, Saltzman, HA, Weg, JG. Clinical characteristics of patients with acute pulmonary embolism. Am J Cardiol 1991; 68:1723.
  38. Le Gal, G, Testuz, A, Righini, M, et al. Reproduction of chest pain by palpation: diagnostic accuracy in suspected pulmonary embolism. BMJ 2005; 330:452.
white circle LOG IN
white circle DEMO