Pulmonary embolism classification
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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 on
- 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
- situated centrally within the vascular lumen
- Occludes a vessel.
It also commonly 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
- Embolism is
- eccentric
- contiguous with the vessel wall.
- Embolism 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[1]. This is a retrospective diagnosis based upon the pulmonary angiogram that does not inform prospective decisions.
Recently American heart association[2] 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[2] 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[2] 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
- ↑ 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.
- ↑ 2.0 2.1 2.2 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.