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PULMONARY EMBOLISM

PULMONARY EMBOLISM. Dr. Mohammad ABD-EL-SABOUR Professor of Pulmonary Medicine Ain Shams University. Pulmonary Embolism, Infarction. Embolism : Impaction of a thrombus or foreign matter in the pulmonary vascular bed.

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PULMONARY EMBOLISM

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  1. PULMONARY EMBOLISM Dr. Mohammad ABD-EL-SABOUR Professor of Pulmonary Medicine Ain Shams University

  2. Pulmonary Embolism, Infarction • Embolism : Impaction of a thrombus or foreign matter in the pulmonary vascular bed. • Infarction : The pathological changes which develop in the lung as a result of pulmonary embolism.

  3. Pulmonary Thrombo-embolism • Thrombosis of peripheral veins , embolization of pulmonary arteries , and pulmonary infarction. • Primary thrombosis in pulmonary arteries and veins

  4. Pulmonary Embolism, Prevalence • PE : The cause of, or a major contributory factor to, death in 7-9% of necropsy cases • PM Pul. Angiographic technique : 14-18% • Considering smaller thrombi : 60% • PE is a major contributory factor to death in 50 000-200 000 patients per year in USA

  5. EMBOLUS • Thrombotic • Non-thrombotic : Fat, Air, Tumour , Amniotic fluid, IV Drug abusers.

  6. Pathogenesis of Vascular Thrombosis • Decrease in blood flow below a certain critical level. • Increase in coagulability of blood. • Damage of the vessel wall.

  7. Bed rest Post-operative After severe blood loss and trauma CCP CHF Varicose veins Advancing age Obesity Post-partum Malignancy DM Pneumonia Debilitating diseases 1ry polycythemia Race, Diet RISK FACTORS

  8. PE, Clinical Features • Size of the embolus and blood vessel occluded. • State of the lung. • Associated disease(s).

  9. PE , Clinical Features • Massive Pulmonary Embolism ( MPE ) • Pulmonary Infarction ( PI ) • Obliterative Pulmonary Hypertension

  10. Massive Pulmonary Embolism MPE • CLINICAL SETTING • ELDERLY,POSSIBLY OBESE • AROUND THE 10th DAY POST-OP. • CALLING FOR BED-PAN • EXPIRING SUDDENLY OR WHILE IN THE ACT OF DEFECATION • IMMEDIATELY FATAL,2/3 DIE IN THE FIRST TWO HOURS

  11. SHOCK DYSPNEA APPREHENSION TACHYCARDIA SWEATING CHEST PAIN FAINTNESS CYANOSIS AF COLLAPSE Massive Pulmonary Embolism MPE

  12. MPE, Differential Diagnosis • Myocardial Infarction. • Dissecting Aortic Aneurysm. • Peumothorax. • Major Pulmonary Collapse. • Shock. • Perforating Peptic Ulcer. • Acute Pancreatitis.

  13. CARDIOGENIC PULMONARY EDEMA • SUDDEN ONSET OF DYSPNEA • SOMETIMES SEVERE CHEST PAIN • PINK FROTHY SPUTUM • EXTREME ANXIETY AND ORTHOPNEA • DIAPHORESIS AND CYANOSIS • TACHYPNEA AND AIR HUNGER • WHEEZING • DIFFUSE MOIST RALES,GALLOP

  14. ACUTE PULMONARY EDEMA IN COPD • HISTORY OF PREVIOUS HEART DIS. • SUDDEN,NOT ACUTE OR INSIDIOUS, ONSET OF DYSPNEA • PINK FROTHY SPUTUM • DIFFUSE MOIST RALES,PULSUS ALTERNANS,GALLOP,MURMURS • CXR,ECG,ABG

  15. PNEUMOTHORAX • SHARP UNILATERAL CHEST PAIN • DYSPNEA;EXTREME IN TENSION PNX • PRIMARY, SECONDARY, TRAUMATIC, BAROTRAUMA • TACHYPNOEIC • RAPID LOW VOLUME PULSE • HYPOTENSION • SURGICAL EMPHYSEMA

  16. PNEUMOTHORAX • UNILATERAL BULGE • TRACHEAL SHIFT • HYPER-RESONANCE • DIMINISHED INTENSITY OR ABSENT BREATH SOUNDS • CXR • INTERCOSTAL TUBE DRAINAGE

  17. MASSIVE PULMONARY COLLAPSE • CLINICAL SETTING • TRACHEAL SHIFT • UNILATERAL DULLNESS • DIMINISHED OR ABSENT BREATH SOUNDS • CXR • BRONCHOSCOPY

  18. COMPREHENSIVEASSESSMENT • HISTORY : PT., PT.’S RELATIVES, WITNESS • PHYSICAL EXAMINATION: GENERAL RESPIRATORY CARDIOVASCULAR

  19. COMPREHENSIVE ASSESSMENT • INVESTIGATIVE STUDIES • ECG • ABG • CXR • ELECTROLYTES • ENZYMES

  20. Pulmonary Infarction, Pathology • Blood Vessels: Engorgement, Hemorrhage from distended necrotic capillaries, Granulation tissue repair , Fibrous scar • Bronchioles: usually survive, may turn bronchiactatic

  21. Pulmonary Infarction, Pathology • Bacterial Infection : Abscess Source : embolus, blood-borne, bronchi . • Pleural Complications : Pleurisy, Pleural effusion, Empyema.

  22. Pulmonary Infarction, Clinical Picture • Pleuritic chest pain, Pleural rub, Pleural effusion • Hemoptysis: in only 50% of cases • Finding the source of embolization: in only 60% of cases • Tachcardia( more than 100/ min ) Tachypnoea • Jaundice, Cyanosis

  23. Pulmonary Infarction, Clinical Picture • Locally: No Physical Findings, Consolidation, Diminished Intensity of Breath Sounds, Crepitus, Wheezing Chest • Pleural Rub • Signs of Pleural Effusion

  24. Pulmonary Infarction, Clinical Picture • With Infection: Worsening of the Clinical Status: Abscess or Empyema • Persistent Fever, Malaise, Sweating • Increasing Pulse Rate • Leucocytosis more than 20 000 • Chest X-Ray

  25. Clinical Features of PTE

  26. Clinical Features of PTE

  27. Clinical Features of PTE

  28. Value of Diagnostic Tests in PTE

  29. Value of Diagnostic Tests in PTE

  30. Value of Diagnostic Tests in PTE

  31. Value of Diagnostic Tests in PTE

  32. Value of Diagnostic Tests in PTE

  33. Value of Diagnostic Tests in PTE

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