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Pulmonary embolism
Pulmonary embolism (PE) is form of embolism and thromboembolism in which a blockage of the pulmonary artery (or one of its branches), usually when a deep vein thrombosis (blood clot from a vein), becomes dislodged from its site of formation and embolizes to the arterial blood supply of one of the lungs.[1] This process is termed thromboembolism.
Pathophysiology
The development of thrombosis is classically due to a group of causes named Virchow's triad (alterations in blood flow, factors in the vessel wall and factors affecting the properties of the blood). Often, more than one risk factor is present.
- Alterations in blood flow: immobilization (after surgery, injury or long-distance air travel), pregnancy (also procoagulant), obesity (also procoagulant)
- Factors in the vessel wall: of limited direct relevance in VTE
- Factors affecting the properties of the blood (procoagulant state):
- Estrogen-containing hormonal contraception
- Genetic thrombophilia (factor V Leiden, protein C deficiency, protein S deficiency, antithrombin deficiency, hyperhomocysteinemia and plasminogen/fibrinolysis disorders). The role of prothrombin mutation G20210A, is unclear.[2]
- Acquired thrombophilia (malignancy, antiphospholipid syndrome, nephrotic syndrome, paroxysmal nocturnal hemoglobinuria)
Diagnosis
The diagnosis of PE is based primarily on validated clinical criteria combined with selective testing because the typical clinical presentation (shortness of breath, chest pain) cannot be definitively differentiated from other causes of chest pain and shortness of breath.[3] Patients can present with atypical syndromes such as unexplained exacerbations of chronic obstructive pulmonary disease.[4] .... (read more)
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