Pulmonary Embolism

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, including
dyspnea, chest pain, hypoxemia, and sometimes
death.
• Deep venous thrombosis (DVT) and PE
represent a continuum of the disease entity
known as venous thromboembolism (VTE).

Chest 2002;122;1440-1456
Chest 2002;122;1440-1456
PATHOPHYSIOLOGY
 Modalities Diagnostic of PE

1. ECG: S1Q3T3 or new RBBB

2. Thorax X ray : nonspesifik. Westermark sign (focal oligemia)
only 6 % (Stein et al)
3. Laboratory: D-Dimer has a High Negative Predictive Value
Troponin positif marker of Higher mortality
4. Blood Gas Analysis usually abnormaly in PE massive and
normaly in PE submassive
5. Ultrasound : sensitivity 95.2% and specificity 98.6%
6. Lung scan : sensitivity 95.6% and specificity 90%
7. MSCT : Sensitivitas 96% dan spesifisitas 92%
8. Selective Angiografi is Gold standard of PE

Chest 2002;122;1440-1456
 Non Specific Clinical Symptoms of PE

• Chest pain
• Tachycardi
• Hemoptysis To Increased
Specificities
• Dyspnoe
• Syncope
• Cyanosis

Should be combined with “Prediction rules”

( Well’s score or Geneve score )
Acute Pulmonary Embolism: Imaging in the Emergency Department
Radiol Clin N Am 44 (2006) 259–271
 Suspected PE

Chest X Ray and ECG X Ray: hamtom sign (-)

ECG: S1Q3Tinverted V1-4
Assess clinical
likelihood and
consider setting

Outpatient with Inpatient or high

low or intermediate clinical suspicion
clinical suspicion

D-dimer 1200
thromboembolism in
RPA and LPA
Normal High Chest CT
and its branches

No PE Normal Positive

Diagnosis No PE Treat for PE

 ESC Guidelines
PE treatment
• Haemodynamic and respiratory support
• Thrombolytic treatment
• Surgical embolectomy
• Heparin anticoagulation
• Oral anticoagulation
• Venous filter
Acute Pulmonary Embolism: Imaging in the Emergency Department
Radiol Clin N Am 44 (2006) 259–271