Last reviewed: June 2018
Last updated: July  2018

Summary

Definition

History and exam

Key diagnostic factors

  • chest pain
  • dyspnea
  • tachypnea
  • presyncope or syncope
  • hypotension (systolic BP <90 mmHg)

Other diagnostic factors

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

Risk factors

  • increasing age
  • diagnosis of deep vein thrombosis (DVT)
  • obesity (BMI ≥29 kg/m²)
  • surgery within the last 2 months
  • bed rest >5 days
  • previous venous thromboembolic event
  • family history of venous thromboembolism (VTE)
  • active malignancy
  • cigarette smoking
  • chronic obstructive pulmonary disease (COPD)
  • recent trauma or fracture
  • congestive heart failure (CHF)
  • central venous catheterization
  • pregnancy/postpartum period
  • varicose veins
  • recent air travel
  • history of spontaneous abortion
  • recent acute myocardial infarction
  • sepsis
  • recent blood transfusion
  • combined hormonal contraception
  • oral hormone replacement therapy (HRT)
  • paralysis of the lower extremities
  • inflammatory bowel disease
  • nephrotic syndrome
  • Behcet disease
  • homocysteinemia
  • Philadelphia-negative myeloproliferative neoplasms
  • factor V Leiden mutation
  • prothrombin G20210A mutation
  • antithrombin deficiency
  • protein C deficiency
  • protein S deficiency
  • antiphospholipid antibody syndrome

Diagnostic investigations

1st investigations to order

  • Wells criteria/Geneva score
  • multiple-detector computed tomographic pulmonary angiography (CTPA)
  • ventilation-perfusion (V/Q) scan
  • coagulation studies
  • BUN and creatinine
  • CBC
  • Pulmonary Embolism Rule-Out Criteria (PERC)
  • D-dimer test
Full details

Investigations to consider

  • chest x-ray (CXR)
  • magnetic resonance (MR) angiography
  • pulmonary angiography
  • electrocardiography (ECG)
  • arterial blood gases (ABG)
  • thrombophilia screen
  • ultrasonography
Full details

Emerging tests

  • brain natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP), heart-type fatty acid-binding protein (H-FABP)
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

Professor of Medicine

Department of Internal Medicine

University of Utah

Director

Thrombosis Clinic

Intermountain Medical Center

Salt Lake City

UT

Disclosures

SMS is an investigator for two investigator-initiated clinical trials for which his institution receives funds from Bristol-Myers Squibb to enrol patients.

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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