Pulmonary embolism (PE) is a serious and potentially life-threatening condition caused by a blockage in one or more arteries in the lungs, typically due to a blood clot (thrombus) that has traveled from another part of the body, most often the legs (deep vein thrombosis, or DVT).<br /><br />Causes<br /><br />Deep vein thrombosis (DVT): The most common cause; blood clots in the legs or pelvis that travel to the lungs.<br /><br />Other causes:<br /><br />Fat embolism (from fractures or surgery)<br /><br />Air embolism (from medical procedures or trauma)<br /><br />Amniotic fluid embolism (rare, during childbirth)<br /><br /><br /><br />Risk Factors<br /><br />Immobility (e.g., prolonged bed rest, long flights)<br /><br />Recent surgery, especially orthopedic or abdominal<br /><br />Cancer and chemotherapy<br /><br />Hormonal therapies (e.g., birth control pills, hormone replacement therapy)<br /><br />Pregnancy and postpartum period<br /><br />Obesity<br /><br />Smoking<br /><br />Inherited clotting disorders (e.g., Factor V Leiden)<br /><br />History of previous DVT or PE<br /><br /><br />Symptoms<br /><br />Sudden shortness of breath<br /><br />Chest pain, often sharp and worse with deep breaths (pleuritic chest pain)<br /><br />Rapid or irregular heartbeat<br /><br />Cough, possibly with blood-streaked sputum<br /><br />Anxiety or a sense of impending doom<br /><br />Lightheadedness or fainting<br /><br />Leg swelling or pain (if associated with DVT)<br /><br /><br />Diagnosis<br /><br />Clinical assessment: History and physical exam<br /><br />Imaging studies:<br /><br />CT pulmonary angiography (gold standard)<br /><br />Ventilation-perfusion (V/Q) scan<br /><br />Doppler ultrasound (for DVT)<br /><br /><br />Lab tests:<br /><br />D-dimer test (elevated levels indicate clotting but are nonspecific)<br /><br />Arterial blood gas (may show hypoxia)<br /><br /><br /><br />Treatment<br /><br />1. Anticoagulation therapy:<br /><br />Heparin (low molecular weight or unfractionated) followed by oral anticoagulants like warfarin, apixaban, or rivaroxaban.<br /><br /><br /><br />2. Thrombolytic therapy: For severe cases, clot-dissolving medications like alteplase may be used.<br /><br /><br />3. Surgical or catheter-based interventions:<br /><br />Embolectomy or catheter-directed thrombolysis for large or life-threatening emboli.<br /><br /><br /><br />4. Supportive care:<br /><br />Oxygen therapy, IV fluids, and pain management.<br /><br /><br /><br />5. Inferior vena cava (IVC) filter: For patients who cannot tolerate anticoagulation.<br /><br /><br /><br />Prevention<br /><br />Early mobilization after surgery or during hospitalization<br /><br />Compression stockings or pneumatic compression devices<br /><br />Anticoagulant prophylaxis in high-risk patients<br /><br />Lifestyle modifications (e.g., weight loss, smoking cessation)<br /><br /><br />Complications<br /><br />Pulmonary hypertension<br /><br />Right heart failure<br /><br />Recurrent embolism<br /><br />Death if untreated or severe<br /><br /><br />PE is a medical emergency. Prompt diagnosis and treatment significantly improve outcomes.<br />Dr Alaa Baqir Rahim<br />