Acute Pulmonary Embolism (Diagnosis and Management of)

Preamble
Introduction

• Epidemiology
• Predisposing factors
• Natural history
• Pathophysiology
• Clinical classification of pulmonary embolism severity

Diagnosis

• Clinical presentation
• Assessment of clinical probability
• D-dimer testing
• Computed tomographic pulmonary angiography
• Lung scintigraphy
• Pulmonary angiography
• Magnetic resonance angiography
• Echocardiography
• Compression venous ultrasonography
• Diagnostic strategies
  • Suspected pulmonary embolism with shock or hypotension
  • Suspected pulmonary embolism without shock or hypotension        

Prognostic assessment

• Clinical parameters
• Imaging of the right ventricle by echocardiography or computed tomographic angiography
• Laboratory biomarkers
  
  • Markers of right ventricular dysfunction 
  • Markers of myocardial injury   
  • Other laboratory biomarkers        
• Combined modalities and scores
• Prognostic assessment strategy

Treatment in the acute phase

• Haemodynamic and respiratory support
• Anticoagulation        
  
  • Parenteral anticoagulation
  • Vitamin K antagonists
  • New oral anticoagulants
• Thrombolytic treatment         
• Surgical embolectomy
• Percutaneous catheter-directed treatment
• Venous filters
• Early discharge and outpatient treatment
• Therapeutic strategies
  • Pulmonary embolism with shock or hypotension (high-risk pulmonary embolism)
  • Pulmonary embolism without shock or hypotension (intermediate- or low-risk pulmonary embolism)

Duration of anticoagulation

• New oral anticoagulants for extended treatment

Chronic thromboembolic pulmonary hypertension

• Epidemiology
• Pathophysiology
• Clinical presentation and diagnosis
• Treatment and prognosis

Specific problems

• Pregnancy
  • Diagnosis of pulmonary embolism in pregnancy
  • Treatment of pulmonary embolism in pregnancy

• Pulmonary embolism and cancer
  • Diagnosis of pulmonary embolism in patients with cancer
  • Prognosis of pulmonary embolism in patients with cancer
  • Management of pulmonary embolism in patients with cancer
  • Occult cancer presenting as unprovoked pulmonary embolism
• Non-thrombotic pulmonary embolism
  • Septic embolism
  • Foreign-material pulmonary embolism
  • Fat embolism
  • Air embolism
  • Amniotic fluid embolism
  • Tumour embolism

References