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Pulmonary embolism occurs when there is an acute obstruction of the pulmonary artery or one of its branches. It is commonly caused by a venous thrombus that has dislodged from its site of formation and embolized to the arterial blood supply of one of the lungs. The process of clot formation and embolization is termed [[thromboembolism]].
Pulmonary embolism occurs when there is an acute obstruction of the pulmonary artery or one of its branches. It is commonly caused by a venous thrombus that has dislodged from its site of formation and embolized to the arterial blood supply of one of the lungs. The process of clot formation and embolization is termed [[thromboembolism]].


==Pathophysiology==
==Clot Formation==
==Clot Formation==
* Most pulmonary emboli commonly originate in the [[iliofemoral vein]], deep within the vasculature of the lower extremity.
* Most pulmonary emboli commonly originate in the [[iliofemoral vein]], deep within the vasculature of the lower extremity.

Revision as of 01:51, 30 October 2012

Pulmonary Embolism Microchapters

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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Pulmonary embolism occurs when there is an acute obstruction of the pulmonary artery or one of its branches. It is commonly caused by a venous thrombus that has dislodged from its site of formation and embolized to the arterial blood supply of one of the lungs. The process of clot formation and embolization is termed thromboembolism.

Clot Formation

  • Most pulmonary emboli commonly originate in the iliofemoral vein, deep within the vasculature of the lower extremity.
  • Less commonly, a pulmonary embolism may also arise in the upper extremity veins, renal veins, or pelvic veins.
  • The nature of the clinical manifestation of a pulmonary embolism depends on a number of factors:[1]
    • The presence of any preexisting cardiopulmonary conditions.
    • The role of chemical vasoconstriction as it is insinuated by platelets releasing serotonin and thromboxane which adhere to the embolus.
    • The presence of pulmonary artery dilatation and subsequent reflex vasoconstriction.
    • The size of the embolus and the degree to which it occludes the vascular tree and its subsequent branches.

Embolization

  • After formation, a thrombus will travel from the site of origin and circulate through the inferior vena cava into the right ventricle and on into the pulmonary vasculature where it will lodge.[2]
  • Depending upon the patient, there can be one or many pulmonary emboli present. The size of the clot(s) and their physiologic impact will depend largely on the individual patient and subsequent anatomy of the vasculature. [2]

Hemodynamic Consequences

Mechanism

Current research suggests that a pulmonary embolism arises through the following progression of events.[4]

References

  1. Kostadima, E., & Zakynthinos, E. (2007). Pulmonary Embolism: Pathophysiology, Diagnosis, Treatment. Hellenic Journal of Cardiology, 94-107.
  2. 2.0 2.1 2.2 2.3 2.4 McGill University. (2004, June 24). Pulmonary Embolism. Retrieved May 7, 2012, from McGill Virtual Stethoscope Pathophysiology.
  3. Benotti JR, Dalen JE (1984). "The natural history of pulmonary embolism". Clin Chest Med. 5 (3): 403–10. PMID 6488744.
  4. Fengler BT, Brady WJ (2009). "Fibrinolytic therapy in pulmonary embolism: an evidence-based treatment algorithm". Am J Emerg Med. 27 (1): 84–95. doi:10.1016/j.ajem.2007.10.021. PMID 19041539. Retrieved 2011-12-21. Unknown parameter |month= ignored (help)

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