Pulmonary thromboembolism

Abstract

Objective -To review the pathophysiology, clinical signs, diagnosis, and treatment of pulmonary thromboembolism (PTE) in small animals. Data Sources -Human and veterinary clinical studies, reviews, texts, and recent research in canine and feline PTE diagnosis and thromboembolic therapeutics. Human Data Synthesis -In humans, clinical probability assessment and point-of-care D-dimer-based algorithms are widely used. Computed tomography pulmonary angiography is the gold standard for PTE diagnosis in humans. Echocardiography is increasingly used for bedside assessment of affected patients. In low-risk human patients anticoagulants alone are recommended while patients with cardiogenic shock are treated with thrombolytics followed by anticoagulation. Veterinary Data Synthesis -PTE is associated with numerous predisposing conditions causing hypercoagulability, blood flow stasis, or endothelial injury. Identifying at-risk patients is key to diagnosis in small animals. Thromboelastography provides a method for identifying hypercoagulable patients. Computed tomography pulmonary angiography may replace selective pulmonary angiography as the imaging technique of choice for PTE diagnosis. PTE therapy consists of supportive treatment combined with appropriate, individualized thromboembolic pharmacotherapy for acute treatment and chronic management. Thrombolytic therapy for PTE remains controversial but may be indicated in hemodynamically unstable acute PTE. Thromboprophylaxis in specific conditions is rational although evidence of efficacy is limited. Prognosis depends upon degree of cardiopulmonary compromise and patient response to therapy. Mortality rates in small animals are unknown. Conclusions -New diagnostic techniques and advances in therapy offer significant potential for improvements in the identification and treatment of PTE in small animals. Further study must be directed to validating new diagnostic modalities and evaluating therapeutic regimes.

Computed tomography angiography of bilateral peripheral pulmonary arterial stenoses in a dog

“…This modality offers many diagnostic advantages for evaluating and characterizing vascular disease. 4,6,7,15,16 For this case of bilateral peripheral pulmonary arterial stenosis, it confirmed the diagnosis of right pulmonary arterial stenotic lesion seen on an echocardiogram, as well as delineated the second lesion associated with the left pulmonary artery. It provided the clinician a three-dimensional view of the soft tissue structures so that tortuosity, length, and diameter could all be integrated into a therapeutic plan.…”

Perioperative Blood Pressure Control and Management

“…21,22 The air or clot will interfere with venous return to the left side of the circulation and CO suddenly drops. As perfusion drops, there will be sudden poor-quality sound from a Doppler probe, and a pulse oximeter will either fail to register a signal or display a low oxygen saturation reading.…”

Complex clinical presentations of tick-borne diseases in dogs in Sri Lanka

“…The reduction in left ventricular filling as a of PTE in dogs is underestimated in necropsies, since consequence of RV dilatation will decrease cardiac output thrombi in dogs lyse more rapidly than in humans (within leading to signs of forward failure (hypotension, 3 hours of death) due to greater plasminogen activator cardiogenic shock). If the patient survives an acute crisis activity, greater platelet lytic activity, and secretion of the residual pulmonary hypertension will lead to a long plasminogen activator by the pulmonary endothelium term backward failure resulting in hepatomegaly, ascites, (Goggs et al, 2009). and pleural effusion.…”