Pulmonary embolism classification: Difference between revisions
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**Develop '''slowly''' progressive [[dyspnea]] over a period of years due to [[pulmonary hypertension]]. | **Develop '''slowly''' progressive [[dyspnea]] over a period of years due to [[pulmonary hypertension]]. | ||
*Based on characteristic of the embolus: | *Based on characteristic of the embolus<ref name="pmid19168835">{{cite journal| author=Castañer E, Gallardo X, Ballesteros E, Andreu M, Pallardó Y, Mata JM et al.| title=CT diagnosis of chronic pulmonary thromboembolism. | journal=Radiographics | year= 2009 | volume= 29 | issue= 1 | pages= 31-50; discussion 50-3 | pmid=19168835 | doi=10.1148/rg.291085061 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19168835 }} </ref>: | ||
**Embolus is eccentric and Contiguous with the vessel wall | **Embolus is eccentric and Contiguous with the vessel wall | ||
**Embolus reducing the arterial diameter by ≥50% | **Embolus reducing the arterial diameter by ≥50% | ||
Revision as of 16:05, 7 November 2011
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Pulmonary Embolism Microchapters |
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Pulmonary Embolism Assessment of Probability of Subsequent VTE and Risk Scores |
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Pulmonary embolism classification On the Web |
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Risk calculators and risk factors for Pulmonary embolism classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [2]
Synonyms and keywords: PE
Overview
Pulmonary embolism is classified in two different ways based upon:
- Time of appearance of symptoms & Size of embolus : Acute vs Chronic
- Severity of the disease : Massive vs Submassive vs Low-risk
Acute PE
Pulmonary embolism is called acute, if the embolism is
- Based on time of appearance of Symptoms:
- Develop symptoms and signs immediately after obstruction of pulmonary vessels.
- Based on characteristic of the embolus:
- Situated centrally within the vascular lumen
- Occludes a vessel.
It also causes distention of the involved vessel.
Chronic PE
Chronic pulmonary embolism is a consequence of incomplete resolution of pulmonary embolism.
It has the following characteristic:
- Based on time of appearance of Symptoms:
- Develop slowly progressive dyspnea over a period of years due to pulmonary hypertension.
- Based on characteristic of the embolus[1]:
- Embolus is eccentric and Contiguous with the vessel wall
- Embolus reducing the arterial diameter by ≥50%
- Evidence of recanalization within the thrombus
- Presence of an arterial web
Massive PE
In the past, "massive pulmonary embolism" has been defined on the basis of angiographic burden of emboli by using the Miller Index[2]. This is a retrospective diagnosis based upon the pulmonary angiogram that does not inform prospective decisions.
Recently American heart association[3] has proposed the following definition for Massive PE: Acute pulmonary embolism with sustained hypotension (systolic blood pressure <90 mm Hg for at least 15 minutes or requiring inotropic support, not due to a cause other than PE, such as arrhythmia, hypovolemia, sepsis, or left ventricular [LV] dysfunction), pulselessness, or persistent profound bradycardia (heart rate <40 bpm with signs or symptoms of shock).
Submassive PE
American heart association[3] has proposed the following definition for Submassive PE: "Acute PE without systemic hypotension (systolic blood pressure ≥90 mm Hg) but with either RV dysfunction or myocardial necrosis."
Low-risk PE
American heart association[3] has proposed the following definition for Low-risk PE: "Acute PE and the absence of the clinical markers of adverse prognosis that define massive or submassive PE."
References
- ↑ Castañer E, Gallardo X, Ballesteros E, Andreu M, Pallardó Y, Mata JM; et al. (2009). "CT diagnosis of chronic pulmonary thromboembolism". Radiographics. 29 (1): 31–50, discussion 50-3. doi:10.1148/rg.291085061. PMID 19168835.
- ↑ Miller GA, Sutton GC, Kerr IH, Gibson RV, Honey M (1971). "Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism". Br Heart J. 33 (4): 616. PMID 5557502.
- ↑ 3.0 3.1 3.2 Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ; et al. (2011). "Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association". Circulation. 123 (16): 1788–830. doi:10.1161/CIR.0b013e318214914f. PMID 21422387.