pulmonary embolism - Pulmonary embolism is a blockage of an...

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Pulmonary embolismis a blockage of an artery in the lungs by a blood clot, fat, air or clumped tumor cells. By far the most common form of pulmonary embolism is a thromboembolism, which occurs when a blood clot, generally a venousthrombus, becomes dislodged from its site of formation and embolizesto the arterialblood supply of one of the lungs. Symptoms may include difficulty breathing, painduring breathing, andmore rarely circulatory instability and death. Treatment is with anticoagulantmedication, such as warfarin. Other rarer forms of pulmonary embolism occur when material other than a blood clot is responsible. Such materials can include fat or bone (usually in association with significant trauma), air (often when diving), and amniotic fluid (affecting mothers during child-birth).[edit] Signs, symptoms and risk factors[edit] Clinical presentationSignsof PE are sudden-onset dyspnea(shortness of breath, 73%), tachypnea(rapid breathing, 70%), chest painof "pleuritic" nature (worsened by breathing, 66%), cough(37%), hemoptysis(coughing up blood, 13%), and in severe cases, cyanosis, tachycardia(rapid heart rate), hypotension, shock, loss of consciousness, and death. Although most cases have no clinical evidence of deep venous thrombosis(DVT) in the legs, findings that indicate DVT may aid in the diagnosis.[edit] Risk factorsThe most common sources of embolism are proximal leg deep venous thrombosis(DVTs) or pelvic vein thromboses. Any risk factor for DVT also increases the risk that the venous clot will dislodge and migrate to the lung circulation, which happens in up to 15% of all DVTs.Risk factors for DVT and PE (together "venous thromboembolism" or VTE) can be divided into genetic, acquiredand circumstantialcauses. In many occasions, more than one risk factor is present:GeneticoFactor V Leiden(3% of the population are heterozygousfor FVL). oProthrombinmutation (G20210A). oProtein C deficiency. oProtein S deficiency. oAntithrombin IIIdeficiency. oHigh homocysteinelevels due to MTHFRmutation. oPlasminogenand fibrinolysisdisorders. AcquiredoAntiphospholipid antibodiesAnticardiolipin antibodiesand/or lupus anticoagulantsoRenal disease(renal loss of antithrombin) oParoxysmal nocturnal hemoglobinuriaCircumstantialoImmobilisation, e.g., after surgeryor traumaoUse of estrogen-containing hormonal contraceptionoObesity
oPregnancyoCancer( as in Trousseau's syndrome) [edit] DiagnosisThe diagnosis of PE is based primarily on medical imagingbecause the typical clinical presentation (shortness of breath, chest pain) cannot be definitively differentiated from other causes of chest pain and shortness of breath.[edit] Clinical criteriaThe decision to do medical imaging is based on clinical grounds, i.e. the medical historyof the individual and the details of their symptoms.

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