Pulmonary embolism causes

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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] Ogheneochuko Ajari, MB.BS, MS [3]

Overview

Pulmonary embolism (PE) is the acute obstruction of the pulmonary artery or one of its branches by a thrombus, air, tumor, or fat. Most often, PE is due to a venous thrombus which has been dislodged from its site of formation in the deep veins of the lower extremities, a process referred to as venous thromboembolism.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Pulmonary embolism is a life-threatening condition and must be treated as such irrespective of the underlying cause.

Common Causes

• The most common cause of PE is a venous thrombus which has been dislodged from its site of formation in the deep veins of the lower extremities.
  • Deep vein thrombosis

• Non-thrombotic causes of PE are:
  • Cancer
  • Fat
  • Infection
  • Amniotic fluid

Causes by Organ System

Cardiovascular	Antithrombin III deficiency, deep vein thrombosis, dyslipidemia, embolism, fat, heart failure, hypercholesterolemia, hypertension, May-Thurner syndrome, Meadows syndrome, Paget-Schroetter disease, pelvic vein thrombosis, plasminogen deficiency, thromboembolism, thrombosis
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	Behcet's disease
Drug Side Effect	Bevacizumab, Clomifene, Crizotinib, Ethynodiol diacetate and ethinyl estradiol, glucocorticoids, Goserelin, hormone replacement therapy, Interferon gamma, lenalidomide, Letrozole, Medroxyprogesterone, Meropenem, Pramipexole, Progesterone, oral contraceptives, tamoxifen, testosterone, thalidomide, transdermal contraceptive
Ear Nose Throat	No underlying causes
Endocrine	Polycystic ovary syndrome
Environmental	No underlying causes
Gastroenterologic	Colorectal cancer, inflammatory bowel disease, liver disease, Paget-Schroetter disease
Genetic	Paroxysmal nocturnal hemoglobinuria, protein C deficiency, protein S deficiency
Hematologic	Antiphospholipid syndrome, antithrombin III deficiency, deep vein thrombosis, embolism, essential thrombocythemia, essential thrombocytosis, factor V Leiden mutation, factor XII deficiency, familial dysfibrinogenemia, heparin cofactor II deficiency, heparin-induced thrombocytopenia, hyperviscosity, paroxysmal nocturnal hemoglobinuria, pelvic vein thrombosis, plasminogen deficiency, polycythemia vera, protein C deficiency, protein S deficiency, thromboembolism, thrombosis
Iatrogenic	Cancer surgery, neurosurgery, orthopedic surgery, presence of central venous catheter, vascular surgery
Infectious Disease	Infection, tuberculosis
Musculoskeletal/Orthopedic	Bone fractures
Neurologic	Corticobasal degeneration
Nutritional/Metabolic	Dyslipidemia, hypercholesterolemia, hyperhomocysteinemia
Obstetric/Gynecologic	Amniotic fluid, antiphospholipid syndrome, hormone replacement therapy, Meadows syndrome, oral contraceptives, ovarian hyperstimulation syndrome, polycystic ovary syndrome, pregnancy, transdermal contraceptive
Oncologic	Cancer, colorectal cancer, lung cancer, malignancy, pancreatic cancer, polycythemia vera, prostate cancer, renal cell carcinoma
Ophthalmologic	No underlying causes
Overdose/Toxicity	heparin-induced thrombocytopenia, neuroleptic malignant syndrome
Psychiatric	Corticobasal degeneration, neuroleptic malignant syndrome
Pulmonary	Asthma, lung cancer, thrombosis
Renal/Electrolyte	Chronic renal disease, nephrotic syndrome, renal cell carcinoma
Rheumatology/Immunology/Allergy	Antiphospholipid syndrome, Behcet's disease, Hughes-Stovin syndrome, prothrombin gene mutation G20210A, rheumatoid arthritis
Sexual	No underlying causes
Trauma	Injury, intravenous drug use, surgery, trauma
Urologic	Prostate cancer
Miscellaneous	Cancer surgery, immobilization, neurosurgery, orthopedic surgery, renal transplantation, vascular surgery

Causes in Alphabetical Order

• Amniotic fluid
• Antiphospholipid syndrome
• Antithrombin III deficiency
• Asthma
• Behcet's disease
• Bevacizumab
• Bone fractures
• Cancer
• Cancer surgery
• Chronic renal disease
• Colorectal cancer
• Corticobasal degeneration
• Deep vein thrombosis
• Dyslipidemia
• Ethynodiol diacetate and ethinyl estradiol
• Embolism
• Essential thrombocythemia
• Essential thrombocytosis
• Factor V Leiden mutation
• Factor XII deficiency
• Familial dysfibrinogenemia
• Fat
• Glucocorticoids
• Heart failure
• Heparin cofactor II deficiency
• Heparin-induced thrombocytopenia

• Hormone replacement therapy
• Hughes-Stovin syndrome
• Hypercholesterolemia
• Hyperhomocysteinemia
• Hypertension
• Hyperviscosity
• Immobilization
• Infection
• Inflammatory bowel disease
• Injury
• Interferon gamma
• Intravenous drug use
• Lenalidomide
• Liver disease
• Lung cancer
• Malignancy
• May-Thurner syndrome
• Meadows syndrome
• Medroxyprogesterone
• Nephrotic syndrome
• Neuroleptic malignant syndrome
• Neurosurgery
• Oral contraceptives
• Orthopedic surgery
• Ovarian hyperstimulation syndrome
• Paget-Schroetter disease

• Pancreatic cancer
• Paroxysmal nocturnal hemoglobinuria
• Pelvic vein thrombosis
• Plasminogen deficiency
• Polycystic ovary syndrome
• Polycythemia vera
• Pregnancy
• Presence of central venous catheter
• Prostate cancer
• Protein C deficiency
• Protein S deficiency
• Prothrombin gene mutation G20210A
• Renal cell carcinoma
• Renal transplantation
• Rheumatoid arthritis
• Surgery
• Tamoxifen
• Testosterone
• Thalidomide
• Thromboembolism
• Thrombosis
• Transdermal contraceptive
• Trauma
• Tuberculosis
• Vascular surgery