Pulmonary Embolism

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Pulmonary Embolism (PE) is a medical condition where one or more emboli (blood clot) lodged in the pulmonary artery.

• Breaking of a blood clot in the deep veins of lower limbs, known as deep vein thrombosis (DVT).

1. Usually formed in the deep veins of the lower extremities, one or more emboli travel to the pulmonary arteries, causing obstruction. 

2. The affected area is no longer perfused. 

3. An increase in pulmonary artery pressure and a decrease in cardiac output. 

4. Ischemia affecting the tissue.

• DVT.

• Previous PE or DVT.

• Cancer.

• Trauma particularly of lower limbs.

• Immobility e.g. long distance travel or hospitalisation.

• Medications such as oral contraceptives or hormone replacement therapy (HRT).

• Older age (over 60 years old).

• Blood disorder e.g. thrombophilia.  

• Pregnancy. 

• Cancer.

• Obesity.

• Varicose veins. 

• Pleuritic chest pain

• Shortness of breath

• Leg pain + swelling (unilateral usually but can also be bilateral) + redness around calf area. 

• Abdominal pain (lower abdo).

• Cough and/or haemoptysis. 

• Fever

• O/E: Tachycardia, hypoxia, raised,  jugular venous pressure (JVP), murmur might be heard, hypotension.

• Good history + examination + Wells score (see table 1). 

• Chest X-ray.

• ECG. 

• D-dimer blood test. 

• Computed tomographic pulmonary angiography (CTPA).

• Arterial blood gases (ABG).

• Duplex Ultrasound.

• If PE is likely (well score > 4) hospital admission for immediate CTPA + other investigations. 

• If PE is unlikely ( well score < 4), D-dimer within 4 hrs; consider starting an anticoagulant e.g. apixaban or rivaroxaban (follow local guideline or NICE). 

Well's score for PE