The clinical significance of pulmonary embolism: uncertainties and implications for treatment – a debate

Egermayer, Paul; Town, G. Ian

doi:10.1046/j.1365-2796.1997.74880000.x

Cited by 41 publications

(19 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As technology improves, detection of increasingly smaller emboli is becoming possible. But instead of clarifying the need for treatment, their detection raises further questions: previously undetected emboli may have remained stable or self-resolved [79][80][81][82], so should they be treated with anticoagulant therapy, which carries a risk of bleeding [83] and increases economic cost? In this study, we have assessed the potential impact of subsegmental emboli on perfusion.…”

Section: (C) Subsegmental Embolismmentioning

confidence: 99%

“…The long-term contribution to human health is, therefore, to pinpoint the characteristics of PE that are most worrisome, hence defining a patient that should be monitored more carefully, and conversely identifying the groups of patients for whom the risks associated with anticoagulant therapy are likely to outweigh the benefits [81,88]. This study will provide an important new approach to understand lung perfusion that will be equally applicable to studying alterations to perfusion and gas exchange in other respiratory diseases, particularly those for which PH is a component.…”

Section: (E) the Contribution Of Modelling Studies To Understanding Dmentioning

confidence: 99%

See 1 more Smart Citation

Pulmonary embolism: predicting disease severity

Burrowes

Clark

Marcinkowski

et al. 2011

Phil. Trans. R. Soc. A.

View full text Add to dashboard Cite

Pulmonary embolism (PE) is the most common cause of acute pulmonary hypertension, yet it is commonly undiagnosed, with risk of death if not recognized promptly and managed accordingly. Patients typically present with hypoxemia and hypocapnia, although the presentation varies greatly, being confounded by co-mordidities such as preexisting cardio-respiratory disease. Previous studies have demonstrated variable patient outcomes in spite of similar extent and distribution of pulmonary vascular occlusion, but the pathophysiological determinants of outcome remain unclear. Computational models enable exact control over many of the compounding factors leading to functional outcomes and therefore provide a useful tool to understand and assess these mechanisms. We review the current state of pulmonary blood flow models. We present a pilot study within 10 patients presenting with acute PE, where patient-derived vascular occlusions are imposed onto an existing model of the pulmonary circulation enabling predictions of resultant haemodynamics after embolus occlusion. Results show that mechanical obstruction alone is not sufficient to cause pulmonary arterial hypertension, even when up to 65 per cent of lung tissue is occluded. Blood flow is found to preferentially redistribute to the gravitationally non-dependent regions. The presence of an additional downstream occlusion is found to significantly increase pressures.

show abstract

Section: (C) Subsegmental Embolismmentioning

confidence: 99%

Section: (E) the Contribution Of Modelling Studies To Understanding Dmentioning

confidence: 99%

Pulmonary embolism: predicting disease severity

Burrowes

Clark

Marcinkowski

et al. 2011

Phil. Trans. R. Soc. A.

View full text Add to dashboard Cite

show abstract

“…However, the clinical relevance of these small PEs is a matter of controversy, with some authors arguing that anticoagulation may be safely withheld in this setting [19,21]. Actually, in a large population of in-patients in whom PE had been excluded by CT pulmonary angiography (involving single-and multidetector row CT scans) without further work-up, KRUIP et al [20] have recently observed a 3-month risk of VTE of 4%.…”

Section: In-patient Diagnosis Of Pementioning

confidence: 99%

Diagnosis of pulmonary embolism in hospitalised patients: retrospective survey of an institutional standard

Jouveshomme¹,

Böhn²,

Cazaban³

2007

Eur Respir J

View full text Add to dashboard Cite

The aim of the present study was to assess the safety and implementation of a diagnostic strategy in hospitalised patients with suspected acute pulmonary embolism (PE).A diagnostic strategy was established and implemented in a general hospital. A retrospective cohort study, including 400 consecutive in-patients, was performed in order to assess the appropriateness of the diagnostic management and the incidence of symptomatic venous thromboembolic events (VTE) during follow-up.PE was confirmed in 116 (29%) patients. The incremental value of adding compression ultrasonography (CUS) to multidetector-row computed tomography (MDCT) for the diagnosis of PE was 8.6%. PE was appropriately excluded in 169 (42%) patients due to a normal lung scan (n534), a negative MDCT providing an alternative diagnosis (n594), and a negative MDCT and CUS (n541). During follow-up, VTE occurred in 3.5% patients. The almost unique cause of inappropriate management was the absence of further work-up after a MDCT-negative result for PE providing no alternative diagnosis (n5115). Inappropriate management was associated with a nonsignificant increased risk of VTE (7.2%).A frontline diagnostic work-up based on pulmonary multidetector-row computed tomography associated with a compression ultrasonography of the leg veins is effective and more sensitive than pulmonary multidetector-row computed tomography alone in ruling out pulmonary embolism.

show abstract

“…Major occlusion of the pulmonary arteries in association with chronic PH is estimated to occur in between 0.1±0.4% of autopsies [6,7]. By comparison evidence of recent or old pulmonary embolism (PE) may be found in between 60±90% of all autopsy cases [8].…”

mentioning

confidence: 99%

Is pulmonary embolism a common cause of chronic pulmonary hypertension? Limitations of the embolic hypothesis

Egermayer¹,

Peacock²

2000

Eur Respir J

Self Cite

151

View full text Add to dashboard Cite

Is pulmonary embolism a common cause of chronic pulmonary hypertension? Limitations of the embolic hypothesis. P Egermayer, A.J. Peacock. #ERS Journals Ltd 2000. ABSTRACT: The hypothesis that chronic thromboembolic pulmonary hypertension results from unresolved pulmonary embolism has strongly influenced the diagnosis and management of this disease since the 1960s. However, it is nearly impossible to induce chronic pulmonary hypertension in any animal species by means of repeated embolization of thrombotic material. The haemodynamic effects of thrombotic pulmonary embolism of different degrees of magnitude have also been studied in humans and there is little to suggest that chronic pulmonary hypertension is a likely long term outcome. Furthermore many conditions which predispose to venous thromboembolism do not appear to cause thromboembolic pulmonary hypertension. Other arteriopathic and atherosclerotic risk factors, are found in patients with chronic thromboembolic pulmonary hypertension, but not in those with venous thrombosis, suggesting that these may be unrelated conditions.Thrombosis in situ of the pulmonary arteries is common in severe pulmonary hypertension of any cause. Such thrombosis cannot usually be distinguished from pulmonary embolism. It is hypothesized that in situ thrombosis and pulmonary arteriopathy are common causes of vascular occlusion which is usually diagnosed as "chronic thromboembolic pulmonary hypertension" and that venous thromboembolism is unlikely to be a common cause of chronic pulmonary hypertension. It is further hypothesized that pulmonary embolism is seldom the sole cause of "chronic thromboembolic pulmonary hypertension". Eur Respir J 2000; 15: 440±448.

show abstract

The clinical significance of pulmonary embolism: uncertainties and implications for treatment – a debate

Abstract: Abstract. Egermayer P, Town GI (The

Cited by 41 publications

References 21 publications

Pulmonary embolism: predicting disease severity

Pulmonary embolism: predicting disease severity

Diagnosis of pulmonary embolism in hospitalised patients: retrospective survey of an institutional standard

Is pulmonary embolism a common cause of chronic pulmonary hypertension? Limitations of the embolic hypothesis

Contact Info

Product

Resources

About