Current diagnosis and treatment in pulmonary thromboembolism

Abstract

Pulmonary thromboembolism (PTE), is usually a complication of deep vein thrombosis (DVT). Pulmonary thromboembolism develops as a result of obstruction of pulmonary artery and / or branches with pieces that ruptured from the deep vein thrombosis of the leg. Pulmonary thromboembolism and DVT is also referred as venous thromboembolism (VTE) because of two events often remain together. The true incidence is uncertain because of more than half of the patients can be lost before the diagnosis. Despite the many new developments in the last decade on the diagnosis and treatment, PTE is still one of the difficult to diagnose and fatal diseases of lungs. Classical and contemporary approaches to the diagnosis and treatment of PTE were evaluated together in this review. J Clin Exp Invest 2013; 4 (3): 443-446

Keywords

• Pulmonary, thromboembolism, diagnosis, treatment

Pulmoner tromboembolide güncel tanı ve tedavi

Öz

Pulmoner tromboembolizm (PTE), genellikle derin ven trombozunun (DVT) bir komplikasyonudur. Bacak derin venlerinde meydana gelen trombüslerden kopan parçaların pulmoner arter ve/veya dallarını tıkaması sonucu gelişir. PTE ve DVT\'nin genellikle birlikte seyretmesi sebebiyle, iki olay birlikte venöz tromboembolizm (VTE) olarak da ifade edilir. Hastaların yarısından fazlası tanı konulmadan kaybedildiğinden gerçek insidans belirsizdir. Son dekatta tanı ve tedaviyle ilgili birçok yeni gelişmeye rağmen PTE halen akciğerin, tanısı zor ve ölümle sonuçlanabilen hastalıklardan biridir. Bu derlemede PTE tanı ve tedavisinde klasik ve güncel yaklaşımlar birlikte değerlendirildi.

Anahtar Kelimeler

• Pulmoner, tromboembolizm, tanı, tedavi

Kaynakça

1. Sandler DA, Martin JF. Autopsy proven pulmonary embo- lism in hospital patients: Are we detecting enough deep vein thrombosis? J R Soc Med 1989; 82: 203-205.
2. Wittram C, Maher MM, Yoo AJ, et al. CT angiography of pulmonary embolism: Diagnostic criteria and causes of misdiagnosis. Radiographics 2004; 24: 1219-1238.
3. Goldhaber SZ. Pulmonary embolism. Lancet 2004; 363: 1295-1305.
4. Tsai AW, Cushman M, Rosamond WD, et al. Cardiovascu- lar risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiol- ogy. Arch Intern Med 2002; 162: 1182-1189.
5. Heit JA, Cohen AT, Anderson FA, VTE Impact Assessment Group. Estimated annual number of incident and recur- rent, non-fatal and fatal venous thromboembolism (VTE) events in the U. S. Blood 2005;106:267-272.
6. Wiener RS, Schwartz LM, Woloshin S. Time trends in pul- monary embolism in the United States: evidence of over diagnosis. Arch Intern Med 2011;171:831-835.
7. Li XY, Fan J, Cheng YQ, et al. Incidence and prevention of venous thromboembolism in acutely ill hospitalized el- derly Chinese. Chin Med J 2011; 124: 335-340.
8. Stein PD, Kayalı F, Olson RE. Estimated case fatality rate of pulmonary embolism 1979 to 1998. Am J Cardiology 2004; 93:1197-1199.

9. Carson JL, Kelley MA, Duff A, et al. The clinical course of pulmonary embolism. N Engl J Med 1992; 326: 1240- 1245.
10. Mitchell RN, Cotran RS: Hemodynamic disorders, throm- bosis and shock. In: Cotran RS, ed. Robbins Pathologic basis of disease. 6th ed. Philadelphia: WB Saunders, 1999:13-130.
11. Torbicki A, Van Beek EJR, Charbonnier B, et al. Guide- lines on diagnosis and management of acute pulmonary embolism Eur Heart J 2000;21:1301-1336.
12. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Man- agement of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) [practice guideline]. Eur Heart J 2008; 29:2276-2315.
13. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003; 58: 470-484.
14. Yung G L, Fedullo P F, Pulmonary Thromboembolic Dis- ease, Fishman A P, Elias J A, Fishman JA, Grippi MA, Senior RM, Pack AI, Fishman’s Pulmonary Diseases and Disorders, Fouth Edition, Philadelphia, Pennsylvania, Mc Graw Hill Medical, 2008; 1423-1447.
15. Luca Masotti, MD, Roberto Cappelli, MD. Risk manage- ment in acute pulmonary embolism. www.intechopen. com
16. Miniati M, Prediletto R, Formichi B, et al. Accuracy of clin- ical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 1999; 159: 864-871.
17. Stein PD, Fowler SE, Goodman LR, et al. Multi- detector computed tomography for acute pulmonary embolism. N Engl J Med 2006; 354: 2317-2327.
18. Cogo A, Lensing AWA, Kopman MMW, et al. Compres- sion ultrasonograpy for diagnostic management of pa- tients with clinically suspected deep vein thrombosis: prospective cohort study. Br Med J 1998; 316: 17-20.
19. Stein PD, Chenevert TL, Fowler SE, et al: Gadolinium- enhanced magnetic resonance angiography for pulmo- nary embolism: A multicenter prospective study (PIOPED III. Ann Intern Med 2010; 152: 434-443.
20. The PIOPED Investigators. Value of the ventilation/perfu- sion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagno- sis (PIOPED). JAMA 1990; 263: 2753-2759.
21. Richman PB. Simplifying the evaluation of pulmonary embolism. Chest 2006; 129: 1400-1402.
22. Wells PS, Rodger M. Diagnosis of pulmonary embolism: when is imaging needed? Clin Chest Med 2003; 24:13-28.
23. Stein PD, Sostman HD, Bounameaux H, et al. Challeng- es in the diagnosis of acute pulmonary embolism. Am J Med 2008; 121: 565-571.
24. Binder L, Pieske B, Olschewski M, et al. N-terminal pro- brain natriuretic peptide or troponin testing followed by echo- cardiography for risk stratification of acute pulmo- nary embolism. Circulation 2005; 112: 1573-1579.
25. Puls M, Dellas C, Lankeit M, et al. Heart-type fatty acid binding protein permits early risk stratification of pulmo- nary embolism. Eur Heart J 2007; 28: 224-229.
26. Kearon C, Kahn SR, Agnelli K, et al. Antithrombotic ther- apy for venous thromboembolic disease. ACCP evidence based clinical practice guidelines (8th Edition). Chest 2008; 133: 454-545.