Pulmonary Embolism

Contents
1 Pathway for the Diagnosis and Management of Pulmonary Embolism
	1 Introduction
	2 Description of the Pathway
	References
2 Epidemiology, Pathophysiology and Predisposing Factors of Pulmonary Embolism and Deep Vein Thrombosis
	1 Introduction
	2 Epidemiology
	3 Pathophysiology
	4 Predisposing Factors
	5 Summary
	References
3 Non-imaging Diagnosis of Pulmonary Embolism
	1 Introduction
	2 Clinical Presentation
	3 Symptoms and Signs
	4 Thromboembolic Risk
	5 Pretest probability Scores for the Diagnosis of PE
	6 Biomarkers
		6.1 D-dimer
		6.2 D-dimer Usage
		6.3 Troponin
		6.4 Natriuretic Peptides
	7 Electrocardiogram
	8 Chest X-ray
	9 Arterial Blood Gases
	References
4 Imaging Modalities in Pulmonary Embolism: Echocardiography
	1 Introduction
	References
5 Imaging Modalities in Venous-Thromboembolism: Ultrasound for Lower Extremity Deep Venous Thrombosis
	1 Introduction
	2 Exam Protocol
		2.1 Anatomy
		2.2 Image Acquisition and Techniques
	3 Exam Protocol
	4 Pitfalls and Mimickers
	References
6 Imaging Modalities in Acute Pulmonary Embolism: Computerized Tomography
	1 Introduction
	2 CTPA Protocol and Technical Considerations
	3 Normal Appearance and Anatomy of Pulmonary arteries on CTPA
	4 CTPA Findings in Acute PE
	5 Predictors of PE Severity and Clinical Outcome
	6 Multienergy CT in PE Imaging
	7 Computer Assisted Detection
	8 CTPA in pregnancy
	9 CTPA Radiation dose
	References
.7 Ventilation/Perfusion Scintigraphy for the Diagnosis of Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension
	1 Introduction
	2 DIAGNOSIS of PE
	3 IMAGING of PE
	4 Radionuclide V/Q Scintigraphy
	5 Chronic Thromboembolic Pulmonary Hypertension (CTEPH)
	6 In Summary
	References
8 Imaging Modalities in Pulmonary Embolism—Pulmonary Angiography
	1 Background
	2 Anatomy and Angiography
	3 Indications for Catheter Pulmonary Angiography
	4 Contraindications (Relative) to Catheter Pulmonary Angiography
	5 Patient Preparation and Technique
		5.1 Flow Chart
	6 Complications and Anticipated Outcome of Catheter Pulmonary Angiography
	References
9 Integrating Clinical, Laboratory and Imaging Tests in the Diagnosis of Pulmonary Embolism
	1 Clinical Presentation
	2 Evaluation of Clinical Probability
	3 D-Dimer Testing
	4 Computerised Tomography Pulmonary Angiography (CTPA) and Ventilation-Perfusion Scintigraphy
	5 Further Investigations
		5.1 Lower Limb Ultrasonography
		5.2 Magnetic Resonance Imaging
		5.3 Echocardiography
	6 Integration (Fig. 1)
	References
10 Management of the High-Risk Pulmonary Embolism in the Acute Phase—Respiratory, Hemodynamic and Mechanical Support
	1 Introduction
	2 Respiratory Support
	3 Hemodynamic Support
		3.1 Fluid Management
		3.2 Pharmacological Support—Vasopressor and Inotrope support
			3.2.1 Vasopressors
			3.2.2 Inotropes
			3.2.3 Pulmonary Vasodilators
	4 Extracorporeal Membrane Oxygenation (ECMO) and Mechanical Circulatory Support (MCS)
		4.1 ECMO
		4.2 MCS
	5 Cardiac Arrest Management
	References
11 Pharmacologic Treatment of Pulmonary Embolism
	1 Introduction
	2 Initial Treatment for Pulmonary Embolism:
		2.1 Systemic thrombolysis for Acute Pulmonary Embolism
		2.2 Local Thrombolysis
	3 Anticoagulation in Treatment of Pulmonary Embolism
		3.1 The Heparins
		3.2 Vitamin K Antagonist (VKA)
		3.3 Direct Oral Anticoagulants (DOACs)
	4 Chronic Long-Term Anticoagulation
		4.1 Extended Duration Treatment
	References
12 Catheter Directed Thrombolytic Therapy in Pulmonary Embolism
	1 Introduction
	2 The Rationale for CDT and Its Indications
	3 Contraindications
		3.1 The Procedure
		3.2 Post Procedure Follow-Up
		3.3 Potential Complications of CTD
	4 The Evidence to Support the Use of CDT
	5 Conclusions
	References
13 Surgical Treatment of Acute Pulmonary Embolism
	1 Introduction
	2 Preoperative Evaluation
	3 Operative Procedure
		3.1 Preparation
		3.2 Surgical Technique
		3.3 Retrograde Pulmonary Embolectomy
		3.4 IVC Filter
	4 ECMO
		4.1 Postoperative Care and Follow-Up
	5 Outcomes
	6 Conclusion
	References
14 Pulmonary Embolism Response Team: A Multidisciplinary Approach to Improve Pulmonary Embolism Management
	1 Introduction
	2 Pulmonary Embolism Response Team (PERT) Structure and Organization
	3 PERT Outcomes
	4 PERT Quality Improvement and Continuing Education
	5 Conclusion
	References
15 Pulmonary Embolism in Pregnancy and the Postpartum Period
	1 Background
	2 Pathophysiology of Thromboembolism in Pregnancy
	3 Risk Assessment
	4 VTE Prevention in Pregnancy
	5 Diagnosis
	6 Treatment
	7 Delivery
	8 Conclusion
	References
16 Pulmonary Embolism in Cancer Patients
	1 Introduction
	2 Specific Groups and Clinical Considerations in Oncology Patients with PE
		2.1 Asymptomatic (Incidental) Pulmonary Embolism
		2.2 Subsegmental Pulmonary Embolism
		2.3 Catheter-Related PE in Cancer Patients
			2.3.1 Totally Implantable Venous Access Ports (TIVAPs) for Chemotherapy
			2.3.2 Catheter Tip Placement: Right Atrium (RA) Versus Superior Vena Cava (SVC)
			2.3.3 Treatment
	3 Thrombolytic Therapy in Cancer Patients
	4 Treatment of Pulmonary Embolism in Thrombocytopenic Patients
	5 Preventive Treatment in Cancer Patients
	6 Direct Oral Anticoagulants for Treatment of VTE in Cancer Patients
	7 Duration of Treatment
	References
17 Chronic Thromboembolic Pulmonary Hypertension (CTEPH)
	1 Introduction
	2 Pathogenesis
	3 Epidemiology and Risk Factors
	4 Screening for CTEPH
	5 Diagnosis
	6 Treatment of CTEPH
		6.1 Anticoagulants
		6.2 Pulmonary Endarterectomy (PEA)
		6.3 Pulmonary Balloon Angioplasty (BPA)
		6.4 Medical Therapy
		6.5 Pulmonary Rehabilitation
		6.6 Pulmonary Artery Denervation
		6.7 Open Questions Relating to Treatment in CTEPH
	7 Evaluating Risk and Prognosis
	References
18 Pulmonary Thromboembolism in COVID-19
	1 Introduction
		1.1 Epidemiology
	2 Hypercoagulable State
	3 Endothelial Injury
	4 Microthrombosis
	5 Diagnosis
	6 Treatment
	7 Conclusion
	References
19 Travel Related Venous Thromboembolism
	1 Introduction
	2 Incidence
	3 Pathogenesis
	4 Risk Factors
	5 Guidelines
	6 VTE Prevention in COVID 19 Era
	References
20 Illustrative Cases of Multimodality Imaging in the Diagnosis and Management of Pulmonary Embolism
	1 Introduction
	2 Illustrative Case of Low-Risk Pulmonary Embolism
	3 Illustrative Case of Intermediate Low Risk Pulmonary Embolism
	4 Illustrative Case of Intermediate-High Risk Pulmonary Embolism
	5 Illustrative Case of High Risk Pulmonary Embolism
	Reference
21 Pulmonary Embolism: Information for the Patient and Family
	1 Pulmonary Embolism: Information for the Patient and Family
		1.1 Overview
		1.2 Causes
		1.3 Symptoms
		1.4 Diagnosis
		1.5 Treatment
	2 Summary
Index