State of the art paper Clinical update on pulmonary embolism

Abstract

Pulmonary embolism (PE) is a major cause of cardiovascular mortality and financial burden that affects the community. The diagnosis of PE can be difficult because of the nonspecific symptoms, which include cough, dyspnea, hemoptysis and pleuritic chest pain. Hereditary and acquired risk factors are associated with PE. Incidence of PE is increasing, associated with the development in the diagnostic methods. Evidence-based algorithms can help clinicians diagnose PE. Serum D-dimer level, computed tomography pulmonary angiogram (CTPA), ventilation-perfusion scintigraphy or echocardiography help to establish clinical probability and the severity of PE. Anticoagulation is the standard treatment for PE. However, thrombolytic treatment is a significant alternative in high risk of PE as it provides rapid clot resolution. This article reviews the risk factors, diagnostic algorithms, and methods of treatment in PE in the light of current information.

27 Patients with pulmonary thromboembolism

“…Dispne ve takipneyle birlikte plöretik ağrı olguların yarıdan fazlasında bulunur. Hemoptizi olguların %10'undan daha azında görülür (5,6,14).…”

“…Klinik bulgular semptomsuz bir tablodan hipotansiyon, şok ve ani ölüme kadar uzanan geniş bir yelpaze içermektedir.Yaşlı hastalarda kalp oskultasyonunda pozitif fizik muayene bulgusu bulunabilir. Bazı olgularda (>38.5˚C) ateş, siyanoz, gallop ritmi, DVT ye bağlı olarak alt ekstremite şişliği ve Homan's belirtisi bulunabilir (5,6,14). Bizim olgularımızda Fizik muayenede, Takipne (%66.7) en sık bulguydu.…”

“…Pulmoner Emboli çogunlukla alt ekstremite derin venlerinden kaynaklanır (5,6). Doppler USG altın standart olmamakla birlikte, çogunlukla yaygın olarak kullanılmaktadır.…”

“…Bir Alman patolog olan Rudolph Virchow tarafın-dan 1856 yılında ilk defa venöz tromboembolizm ve onun triadı olan vasküler endotelyel hasar, hiperkoagülobite ve venöz stazın tanımlanmasından sonra pulmoner embolinin teşhisinde ve tedavisinde belirgin ilerlemeler kaydedilmiştir (4,5).…”

The prevalence of combined pro-thrombotic polymorphisms in patients with recurrent deep vein thrombosis – does genetic testing provide any benefit?

“…Besides the cases that are sometimes misdiagnosed, DVT may also display a subclinical course, with pulmonary embolism, a serious life threatening complication, as the only clinical manifestation of the disease [1]. In that form, even if properly treated, thromboembolism is still associated with a high mortality rate of up to 15% [2].…”