pulmonary embolism

Above is a real case report presented to the author and pulmonary endarterectomy done by the author. It just indicate the treatment modality for the symptomatic chronic pulmonary thromboembolism not responding to highest medical therapy. Author does not claim the replication of the same outcome for all patients nor claim the only expert for the surgery mentioned in the above case report.

ACUTE PULMONARY EMBOLISM: Acute (PE). Occurs when there is partial or complete block of the main pulmonary or its branches. Despite the many advances in medical science and bein most preventable disease, the hospital mortality may be more than 10%. 

Symptoms vary from asymptomatic to fatal death.

Diagnosis of the PE is very difficult and high suspicion is required to diagnose the disease as symptoms are nonspecific and mimics other diseases like coronary artery disease, aortic dissection, cardiac tamponade, arrythmia, pneumonia or pneumothorax.

DIAGNOSIS: CT- Pulmonary Arteriography is the method of choice for diagnosis of PE.

Echocardiography is first line examination for suspicion of PE to diagnose the sign of right ventricle dysfunction in PE. But it can not definitely diagnose the PE as RV dysfunction can be due to other conditions of the heart and lung disease.

TREATMENT: 

Conservative Treatment: Oxygen support, vital monitoring, IV fluids and anticoagulants.

Thrombolysis: For high risk selected patients. Useful when initiated with in 48 hours or can be tried with onset of symptoms less than 14 days. can be given in two form- 1. Systemic or 2.Catheter directed.

IVC filter: For those have contraindication for anticoagulants and have recurrent PE despite anticoagulants.

Surgical Thrombectomy: It is reserved for the patient who are high risk patients on maximal support, contraindication or failed thrombolytic therapy. Outcome have improved with surgery over the period with advancement. Operative mortality may be as low as below 10%.