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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on June 20, 2009
Continuing Education in Anaesthesia, Critical Care & Pain 2009 9(4):119-124; doi:10.1093/bjaceaccp/mkp016
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Diagnosis and initial treatment of patients with suspected pulmonary thromboembolism

Edwin J.R. van Beek, MD PhD MEd FRCR
Professor of Radiology
Department of Radiology
Carver College of Medicine
University of Iowa
JPP 3895, 200 Hawkins Drive
Iowa City, IA 52242-1077, USA
Tel: +1 319 356 3371
Fax: +1 319 356 2220
Visiting Professor of Radiology
Unit of Academic Radiology
University of Sheffield, Sheffield, UK

Charlie A. Elliot, MB MD MRCP
Consultant Pulmonary Vascular Physician
Sheffield Pulmonary Vascular Disease Unit
Royal Hallamshire Hospital
Sheffield Teaching Hospitals NHS Trust
Sheffield, UK

David G. Kiely, BSc MD FCCP MRCP
Consultant Pulmonary Vascular Physician
Sheffield Pulmonary Vascular Disease Unit
Royal Hallamshire Hospital
Sheffield Teaching Hospitals NHS Trust
Sheffield, UK
E-mail: edwin-vanbeek@uiowa.edu (for correspondence)

The first 150 words of the full text of this article appear below.


Key points

Pulmonary thromboembolism (PTE) is part of a larger clinico-pathological entity, venous thromboembolism.
Pulmonary embolism must be particularly considered in postoperative patients with risk factors, a family history, or both.
Pulmonary embolism requires an objective diagnosis for accurate management.
Computerized tomographic pulmonary angiography is the radiological investigation of choice in patients with suspected PTE.
In patients with massive PTE, thrombolysis is an effective therapy. Thrombolysis should be considered in patients with submassive PTE, particularly if they are deteriorating on heparin therapy.
Patients with persistent symptoms of breathlessness after a diagnosis of acute PTE require assessment to exclude chronic thromboembolic pulmonary hypertension.

 

Pulmonary thromboembolism (PTE) remains a frequently occurring diagnostic problem, with an incidence of approximately one to two cases per thousand of population per year.1 Only 15–25% of patients undergoing radiological investigation will have the diagnosis confirmed and the remaining patients should not be subjected to the risks of . . . [Full Text of this Article]


   Classification
 

   Treatment and prognosis
 
Low-molecular-weight heparin

Thrombolysis

Chronic thromboembolism

Bleeding complications

Vena cava filters


   Diagnostic tests
 
Ultrasonography

Lung scintigraphy

Computerized tomographic pulmonary angiography

MR angiography

Echocardiography

Pulmonary angiography


   Diagnostic management according to classification1
 
Massive pulmonary embolism

Submassive pulmonary embolism

Non-massive pulmonary embolism


   Conclusion
 

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