Emergency Radiology

, Volume 13, Issue 4, pp 161–169

Massive pulmonary embolus with hemodynamic compromise: therapeutic options

  • Derek G. Lohan
  • Carmel G. Cronin
  • Conor P. Meehan
  • Stephen T. Kee
  • Michael D. Dake
  • Ian R. Davidson
  • Gerard J. O’Sullivan
Review Article

Abstract

Recent advances in pharmacotherapeutics and interventional techniques have resulted in resurgence in interest regarding the optimal means of management of hemodynamically significant pulmonary embolic disease. However, these various techniques have many associated disadvantages, and it is of paramount importance that the responsible physician has a detailed understanding of each of these so that the appropriate intervention be requested and performed. By way of background discussion and relevant cases in point, we consider each of these management options in turn, with particular reference to the advantages, disadvantages, and application of each.

Keywords

Pulmonary embolus Hemodynamic compromise Treatment options 

References

  1. 1.
    Lee LC, Shah K (2001) Clinical manifestation of pulmonary embolism. Emerg Med Clin N Am 19:925–942CrossRefGoogle Scholar
  2. 2.
    Goldhaber SZ, Visani L, DeRosa M (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353:1386–1389PubMedCrossRefGoogle Scholar
  3. 3.
    Kucher N, Goldhaber SZ (2005) Management of massive pulmonary embolism. Circulation 112:28–32CrossRefGoogle Scholar
  4. 4.
    Ferrari E, Imbert A, Chevalier T, Mihoubi A, Morand P, Baudouy M (1997) The ECG in pulmonary embolism. Predictive value of negative T waves in precordial leads—80 case reports. Chest 111(3):537–543 (Mar)PubMedGoogle Scholar
  5. 5.
    Báez AA, Goyal D (2006) Acute cor pulmonale from massive bilateral pulmonary emboli. Internet J Emerg Med 3(1)Google Scholar
  6. 6.
    Kline JA, Israel EG, Michelson EA, O’Neil BJ, Plewa MC, Portelli DC (2001) Diagnostic accuracy of a bedside d-dimer assay and alveolar dead-space measurement for rapid exclusion of pulmonary embolism: a multicenter study. JAMA 285:761–768PubMedCrossRefGoogle Scholar
  7. 7.
    Farrell S, Hayes T, Shaw M (2000) A negative SimpliRED d-dimer assay result does not exclude the diagnosis of deep vein thrombosis or pulmonary embolus in emergency department patients. Ann Emerg Med 35:121–125PubMedCrossRefGoogle Scholar
  8. 8.
    Kucher N, Goldhaber SZ (2003) Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism. Circulation 108:2191–2194PubMedCrossRefGoogle Scholar
  9. 9.
    Pruszczyk P, Bochowicz A, Torbicki A, Szulc M, Kurzyna M, Fijalkowska A (2003) Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism. Chest 123:1947–1952PubMedCrossRefGoogle Scholar
  10. 10.
    Patel S, Kazerooni EA, Cascade PN (2003) Pulmonary embolism: optimization of small pulmonary artery visualization at multi-detector row CT. Radiology 227:455–460PubMedCrossRefGoogle Scholar
  11. 11.
    Quiroz R, Kucher N, Zou KH, Kipfmueller F, Costello P, Goldhaber SZ, Schoepf UJ (2005) Clinical validity of a negative computed tomography scan in patients with suspected pulmonary embolism: a systematic review. JAMA 293:2012–2017PubMedCrossRefGoogle Scholar
  12. 12.
    Stein PD, Fowler SE, Goodman LR, Gottschalk A, Hales CA, Hull RD et al (206) Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 354(22):2383–2385 (Jun)CrossRefGoogle Scholar
  13. 13.
    Schoepf UJ, Kucher N, Kipfmueller F, Quiroz R, Costello P, Goldhaber SZ (2004) Right ventricular enlargement on chest computed tomography: a predictor of early death in acute PE. Circulation 110:2376–2380CrossRefGoogle Scholar
  14. 14.
    Turkstra F, Koopman MM, Buller HR (1997) The treatment of deep vein thrombosis and pulmonary embolism. Thromb Haemost 78(1):489–496 (Jul)PubMedGoogle Scholar
  15. 15.
    Zidane M, Schram MT, Planken EW, Molendijk WH, Rosendaal FR, van der Meer FJ, Huisman MV (2000) Frequency of major hemorrhage in patients treated with unfractionated intravenous heparin for deep vein thrombosis or pulmonary embolism. Arch Intern Med 160:2369–2373PubMedCrossRefGoogle Scholar
  16. 16.
    Buller HR, Agnelli G, Hull RD, Hyers TM, Prins MH, Raskob GF (2004) Antithromotic therapy for venous thromboembolic disease; the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126:401S–428SPubMedCrossRefGoogle Scholar
  17. 17.
    Goldhaber SZ (2002) Modern treatment of pulmonary embolism. Eur Respir J 19(Suppl 35):22s–27sCrossRefGoogle Scholar
  18. 18.
    Wicki J, Perrier A, Perneger TV, Bounameaux H, Junod AF (2000) Predicting adverse outcome in patients with acute pulmonary embolism: a risk score. Thromb Haemost 84:548–552PubMedGoogle Scholar
  19. 19.
    Wan S, Quinlan DJ, Agnelli G, Eikelboom JW (2004) Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation 110:744–749PubMedCrossRefGoogle Scholar
  20. 20.
    Uflacker R, Stange C, Vujic I (1996) Massive pulmonary embolism: preliminary results of treatment with the Amplatz Thrombectomy Device. J Vasc Interv Radiol 7:519–528PubMedCrossRefGoogle Scholar
  21. 21.
    Ullmann M, Hemmer W, Hannekum A (1999) The urgent pulmonary embolectomy: mechanical resuscitation in the operating theatre determines the outcome. Thorac Cardiovasc Surg 47:5–8PubMedCrossRefGoogle Scholar
  22. 22.
    Gulba DC, Schmid C, Borst HG, Lichtlen P, Dietz R, Luft FC (1994) Medical compared with surgical treatment for massive pulmonary embolism. Lancet 343:576–577PubMedCrossRefGoogle Scholar
  23. 23.
    Tajima H, Surata S, Kumazaki T, Nakazawa K, Abe Y, Komada Y et al (2004) Hybrid treatment of acute massive pulmonary thromboembolism: mechanical fragmentation with a modified rotating pigtail catheter, local fibrinolytic therapy, and clot aspiration followed by systemic fibrinolytic therapy. AJR 183:589–595PubMedGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2006

Authors and Affiliations

  • Derek G. Lohan
    • 1
  • Carmel G. Cronin
    • 1
  • Conor P. Meehan
    • 1
  • Stephen T. Kee
    • 2
  • Michael D. Dake
    • 3
  • Ian R. Davidson
    • 1
  • Gerard J. O’Sullivan
    • 1
  1. 1.Department of RadiologyUniversity College HospitalGalwayIreland
  2. 2.Department of Interventional RadiologyUCLA Medical CenterLos AngelesUSA
  3. 3.Department of RadiologyUniversity of Virginia Health SystemCharlottesvilleUSA

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