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Overview of acute pulmonary embolism in adults

B Taylor Thompson, MD
Christopher Kabrhel, MD, MPH
Section Editor
Jess Mandel, MD
Deputy Editor
Geraldine Finlay, MD


Acute pulmonary embolism (PE) is a form of venous thromboembolism (VTE) that is common and sometimes fatal. The clinical presentation of PE is variable and often nonspecific making the diagnosis challenging. The evaluation of patients with suspected PE should be efficient so that patients can be diagnosed and therapy administered quickly to reduce the associated morbidity and mortality.

The definition, epidemiology, pathogenesis, and pathophysiology of PE are discussed in detail in this topic. A broad overview of the clinical presentation, evaluation, and diagnosis as well as treatment, prognosis, and follow-up of PE is also provided in this topic; however, a detailed discussion of these issues is provided separately. (See "Clinical presentation, evaluation, and diagnosis of the nonpregnant adult with suspected acute pulmonary embolism" and "Treatment, prognosis, and follow-up of acute pulmonary embolism in adults".)


Definition — Pulmonary embolus (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 upon PE due to thrombus. Tumor, air, and fat emboli are discussed separately. (See "Pulmonary tumor embolism and lymphangitic carcinomatosis in adults: Diagnostic evaluation and management" and "Air embolism" and "Fat embolism syndrome".)

Nomenclature — PE can be classified by the following:

The temporal pattern of presentation (acute, subacute, or chronic) – Patients with PE can present acutely, subacutely, or chronically:

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Literature review current through: Sep 2017. | This topic last updated: Dec 16, 2016.
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  1. COON WW, WILLIS PW. Deep venous thrombosis and pulmonary embolism: prediction, prevention and treatment. Am J Cardiol 1959; 4:611.
  2. Soloff LA, Rodman T. Acute pulmonary embolism. II. Clinical. Am Heart J 1967; 74:829.
  3. 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.
  4. Sardi A, Gluskin J, Guttentag A, et al. Saddle pulmonary embolism: is it as bad as it looks? A community hospital experience. Crit Care Med 2011; 39:2413.
  5. Wiener RS, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med 2011; 171:831.
  6. Kröger K, Küpper-Nybelen J, Moerchel C, et al. Prevalence and economic burden of pulmonary embolism in Germany. Vasc Med 2012; 17:303.
  7. Huang W, Goldberg RJ, Anderson FA, et al. Secular trends in occurrence of acute venous thromboembolism: the Worcester VTE study (1985-2009). Am J Med 2014; 127:829.
  8. Goldacre MJ, Roberts S, Yeates D, Griffith M. Hospital admission and mortality rates for venous thromboembolism in Oxford region, UK, 1975-98. Lancet 2000; 355:1968.
  9. Martinez C, Cohen AT, Bamber L, Rietbrock S. Epidemiology of first and recurrent venous thromboembolism: a population-based cohort study in patients without active cancer. Thromb Haemost 2014; 112:255.
  10. Alotaibi GS, Wu C, Senthilselvan A, McMurtry MS. Secular Trends in Incidence and Mortality of Acute Venous Thromboembolism: The AB-VTE Population-Based Study. Am J Med 2016; 129:879.e19.
  11. Konstantinides SV. Trends in incidence versus case fatality rates of pulmonary embolism: Good news or bad news? Thromb Haemost 2016; 115:233.
  12. 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.
  13. Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158:585.
  14. Naess IA, Christiansen SC, Romundstad P, et al. Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 2007; 5:692.
  15. Tagalakis V, Patenaude V, Kahn SR, Suissa S. Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am J Med 2013; 126:832.e13.
  16. Lassila R, Jula A, Pitkäniemi J, Haukka J. The association of statin use with reduced incidence of venous thromboembolism: a population-based cohort study. BMJ Open 2014; 4:e005862.
  17. The Surgeon General's call to action to prevent deep vein thrombosis and pulmonary embolism. United States Department of Health and Human Services, 2008.
  18. Arya R. Venous thromboembolim prevention. London: Department of Health, 2009.
  19. Cohen AT, Agnelli G, Anderson FA, et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98:756.
  20. Smith SB, Geske JB, Kathuria P, et al. Analysis of National Trends in Admissions for Pulmonary Embolism. Chest 2016; 150:35.
  21. Søgaard KK, Schmidt M, Pedersen L, et al. 30-year mortality after venous thromboembolism: a population-based cohort study. Circulation 2014; 130:829.
  22. 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.
  23. PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990; 263:2753.
  24. Darze ES, Latado AL, Guimarães 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.
  25. 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.
  26. 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.
  27. Zöller B, Li X, Sundquist J, Sundquist K. Risk of pulmonary embolism in patients with autoimmune disorders: a nationwide follow-up study from Sweden. Lancet 2012; 379:244.
  28. Goldhaber SZ, Grodstein F, Stampfer MJ, et al. A prospective study of risk factors for pulmonary embolism in women. JAMA 1997; 277:642.
  29. Girard P, Decousus M, Laporte S, et al. 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.
  30. 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.
  31. Moser KM, LeMoine JR. Is embolic risk conditioned by location of deep venous thrombosis? Ann Intern Med 1981; 94:439.
  32. Weinmann EE, Salzman EW. Deep-vein thrombosis. N Engl J Med 1994; 331:1630.
  33. van Langevelde K, Srámek A, Vincken PW, et al. Finding the origin of pulmonary emboli with a total-body magnetic resonance direct thrombus imaging technique. Haematologica 2013; 98:309.
  34. Kearon C. Natural history of venous thromboembolism. Circulation 2003; 107:I22.
  35. Masuda EM, Kistner RL. The case for managing calf vein thrombi with duplex surveillance and selective anticoagulation. Dis Mon 2010; 56:601.
  36. Righini M, Paris S, Le Gal G, et al. Clinical relevance of distal deep vein thrombosis. Review of literature data. Thromb Haemost 2006; 95:56.
  37. Schwarz T, Schmidt B, Beyer J, Schellong SM. Therapy of isolated calf muscle vein thrombosis with low-molecular-weight heparin. Blood Coagul Fibrinolysis 2001; 12:597.
  38. Macdonald PS, Kahn SR, Miller N, Obrand D. Short-term natural history of isolated gastrocnemius and soleal vein thrombosis. J Vasc Surg 2003; 37:523.
  39. Gillet JL, Perrin MR, Allaert FA. Short-term and mid-term outcome of isolated symptomatic muscular calf vein thrombosis. J Vasc Surg 2007; 46:513.
  40. Lautz TB, Abbas F, Walsh SJ, et al. Isolated gastrocnemius and soleal vein thrombosis: should these patients receive therapeutic anticoagulation? Ann Surg 2010; 251:735.
  41. Schwarz T, Buschmann L, Beyer J, et al. Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study. J Vasc Surg 2010; 52:1246.
  42. Sales CM, Haq F, Bustami R, Sun F. Management of isolated soleal and gastrocnemius vein thrombosis. J Vasc Surg 2010; 52:1251.
  43. Palareti G, Cosmi B, Lessiani G, et al. Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: the blind, prospective CALTHRO study. Thromb Haemost 2010; 104:1063.
  44. Moser KM. Venous thromboembolism. Am Rev Respir Dis 1990; 141:235.
  45. 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.
  46. Nakos G, Kitsiouli EI, Lekka ME. Bronchoalveolar lavage alterations in pulmonary embolism. Am J Respir Crit Care Med 1998; 158:1504.
  47. Benotti JR, Dalen JE. The natural history of pulmonary embolism. Clin Chest Med 1984; 5:403.
  48. Flinterman LE, van Hylckama Vlieg A, Cannegieter SC, Rosendaal FR. Long-term survival in a large cohort of patients with venous thrombosis: incidence and predictors. PLoS Med 2012; 9:e1001155.