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Pulmonary Embolism

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Chest 2002;122;1440-1456

Introduction

• Pulmonary embolism (PE) occurs when venous

thrombosis, usually from the deep veins of the

proximal legs, travels to the lungs causing a

potential spectrum of consequences, includingdyspnea, chest pain, hypoxemia, and

sometimes death

• !eep venous thrombosis (!"#) and PE

represent a continuum of the disease entity

$nown as venous thromboembolism ("#E)

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Chest 2002;122;1440-1456

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P%#&'P&I'*'+

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E-+. /0#0 or new 12223 #horax 4 ray . nonspesifi$ 5estermar$ sign (focal oligemia)

only 6 7 (tein et al)

0 *aboratory. D-Dimer  has a &igh 8egative Predictive "alue

Troponin positif mar$er of &igher mortality

9 2lood +as  %nalysis usually abnormaly in PE massive and

normaly in PE submassive

: ;ltrasound . sensitivity <:37 and specificity <=67

6 *ung scan . sensitivity <:67 and specificity <>7 

? @-# . ensitivitas <67 dan spesifisitas <37 = elective %ngiografi is +old standard of PE

Chest 2002;122;1440-1456

Modalities Diagnostic o PE

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!on "peciic #linical "ymptoms o PE 

•   -hest pain

•   #achycardi

•   &emoptysis•   !yspnoe

•   yncope

•   -yanosis

"$ould be combined %it$ &Prediction rules”

To 'ncreased"peciicities

( )ell*s score or +ene,e score

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 %cute Pulmonary Embolism. Imaging in the Emergency !epartment

1adiol -lin 8 %m 99 (3>>6) 3:<A3?

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"uspected PE

#$est . /ay and E#+

ssess clinicallieli$ood and

consider setting

utpatient %it$

lo% or intermediate

clinical suspicion

'npatient or $ig$

clinical suspicion

D-dimer 

!ormal 3ig$

!o PE

#$est #T

!ormal Positi,e

Treat or PE!o PEDiagnosis

3>>

thromboembolism in

1P% and *P%

 and its branches

4 1ay. hamtom sign (B)

E-+. /0#inverted "B9

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E- +uidelines

PE treatment

• &aemodynamic and respiratory support

• #hrombolytic treatment

• urgical embolectomy

• &eparin anticoagulation

• 'ral anticoagulation

• "enous filter 

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 %cute Pulmonary Embolism. Imaging in the Emergency !epartment

1adiol -lin 8 %m 99 (3>>6) 3:<A3?

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