Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • chest pain
  • dyspnoea
  • presyncope or syncope
  • tachypnoea
  • hypotension (systolic BP <90 mmHg)

Other diagnostic factors

  • feeling of apprehension
  • cough
  • tachycardia
  • fever
  • haemoptysis
  • elevated jugular venous pressure
  • sternal heave
  • accentuated pulmonary component of S2
  • unilateral swelling/tenderness of calf

Risk factors

  • increasing age
  • diagnosis of DVT
  • obesity (BMI ≥29 kg/m^2)
  • surgery within the last 2 months
  • bed rest >5 days
  • previous venous thromboembolic event
  • family history of venous thromboembolism
  • active malignancy
  • cigarette smoking
  • COPD
  • recent trauma or fracture
  • CHF
  • central venous catheterisation
  • pregnancy/postnatal period
  • varicose veins
  • recent air travel
  • history of spontaneous abortion
  • recent acute MI
  • sepsis
  • recent blood transfusion
  • oral contraceptive pill
  • paralysis of the lower extremities
  • inflammatory bowel disease
  • nephrotic syndrome
  • Behcet's disease
  • homocysteinaemia
  • polycythaemia vera
  • factor V Leiden mutation
  • prothrombin gene mutation
  • antithrombin III deficiency
  • protein C deficiency
  • protein S deficiency
  • antiphospholipid antibody syndrome
  • chest CT

Diagnostic investigations

1st investigations to order

  • ECG
  • CXR
  • ABG
  • Wells' score
  • Geneva score
  • Pulmonary Embolism Rule-Out Criteria (PERC)
  • D-dimer
  • multiple-detector computed tomographic pulmonary angiography (CTPA) of chest
  • ventilation-perfusion scan (V/Q scan)
  • lung scintigraphy
Full details

Investigations to consider

  • digital subtraction angiography (DSA)
  • transthoracic echocardiography (TTE)
  • MR angiography
  • trans-oesophageal echocardiography
  • coagulation studies
  • thrombophilia screen
  • brain natriuretic peptide (BNP)
  • troponin I
  • troponin T
  • pulmonary angiography
  • prognostic stratification
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Medicine and Surgery

Section of Vascular Medicine, Department of Surgery

Co-Director

Jefferson Vascular Center

Sidney Kimmel Medical College at Thomas Jefferson University

Thomas Jefferson University Hospitals

Philadelphia

PA

Disclosures

GM has received grants or research support from BMS, J&J, Sanofi-Aventis, Portola, and Janssen; he has served as a Scientific Consultant for BMS, J&J, and Sanofi-Aventis.

Assistant Professor of Medicine and Surgery

Section of Vascular Medicine, Department of Surgery

Sidney Kimmel Medical College at Thomas Jefferson University

Thomas Jefferson University Hospitals

Philadelphia

PA

Disclosures

LHE declares that he has no competing interests.

Assistant Professor of Medicine and Surgery

Section of Vascular Medicine, Department of Surgery

Sidney Kimmel Medical College at Thomas Jefferson University

Thomas Jefferson University Hospitals

Philadelphia

PA

Disclosures

TG declares that he has no competing interests.

Assistant Professor of Medicine and Surgery

Section of Vascular Medicine, Department of Surgery

Sidney Kimmel Medical College at Thomas Jefferson University

Thomas Jefferson University Hospitals

Philadelphia

PA

Disclosures

GO declares that he has no competing interests.

Dr Geno Merli, Dr Luis H. Eraso, Dr Taki Galanis, and Dr Geoffrey Ouma would like to gratefully acknowledge Dr Miguel Angel de Gregorio, Dr Alicia Laborda, and Dr Seth W. Clemens, previous contributors to this monograph. MAG, AL, and SWC declare that they have no competing interests.

Peer reviewers VIEW ALL

Associate Professor of Medicine

University of Alabama at Birmingham

Birmingham

AL

Disclosures

KW declares that he has no competing interests.

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

C.S. Mott Children's Hospital

Ann Arbor

MI

Disclosures

JRC declares that he has no competing interests.

Advanced Clinical Fellow

Cleveland Clinic Foundation

Cleveland

OH

Disclosures

SW declares that he has no competing interests.

Respiratory Physician and Associate Professor

Ramón y Cajal Hospital and Alcalá de Henares University

Respiratory Department and Medicine Department

Madrid

Spain

Disclosures

DJ has received consulting fees from Boehringer Ingelheim, Bayer, Leo-Pharm, and Rovi, and lecture fees from Sanofi Aventis.

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