PULMONARY EMBOLISM Edited by Ufuk Çobanoğlu Pulmonary Embolism Edited by Ufuk Çobanoğlu Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Anja Filipovic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Pulmonary Embolism, Edited by Ufuk Çobanoğlu p. cm. ISBN 978-953-51-0233-5 Contents Preface IX Chapter 1 Risk Factor for Pulmonary Embolism 1 Ufuk Çobanoğlu Chapter 2 Risk Stratification of Patients with Acute Pulmonary Embolism 19 Calvin Woon-Loong Chin Chapter 3 Pulmonary Embolism in the Elderly – Significance and Particularities 37 Pavel Weber, Dana Weberová, Hana Kubešová and Hana Meluzínová Chapter 4 Venous Thromboembolism in Bariatric Surgery 67 Eleni Zachari, Eleni Sioka, George Tzovaras and Dimitris Zacharoulis Chapter 5 Non-Thrombotic Pulmonary Embolism 75 Vijay Balasubramanian, Malaygiri Aparnath and Jagrati Mathur Chapter 6 Pathophysiology, Diagnosis and Treatment of Pulmonary Embolism Focusing on Thrombolysis – New approaches 119 Diana Mühl, Gábor Woth, Tamás Kiss, Subhamay Ghosh and Jose E. Tanus-Santos Chapter 7 Ventilation Perfusion Single Photon Emission Tomography (V/Q SPECT) in the Diagnosis of Pulmonary Embolism 143 Michel Leblanc Chapter 8 Risk Stratification of Submassive Pulmonary Embolism: The Role of Chest Computed Tomography as an Alternative to Echocardiography 169 Won Young Kim, Shin Ahn and Choong Wook Lee VI Contents Chapter 9 Quantitative Ventilation/Perfusion Tomography: The Foremost Technique for Pulmonary Embolism Diagnosis 185 Marika Bajc and Jonas Jögi Chapter 10 Dual Source, Dual Energy Computed Tomography in Pulmonary Embolism 205 Yan’E Zhao, Long Jiang Zhang, Guang Ming Lu, Kevin P. Gibbs and U. Joseph Schoepf Chapter 11 Numerical Analysis of the Mechanical Properties of a Vena Cava Filter 219 Kazuto Takashima, Koji Mori, Kiyoshi Yoshinaka and Toshiharu Mukai Preface Pulmonary embolism is a serious, potentially life-threatening cardiopulmonary disease that occurs due to partial or total obstruction of the pulmonary arterial bed. Pulmonary embolism constitutes 5-25% of in-hospital deaths, and mortality is decreased from 30% to 8% with early treatment. Therefore, risk factors should be identified and treatment should be planned to decrease the risk of mortality. Clinical findings, routine laboratory data, electrocardiogram, chest X-ray, and arterial blood gases are not sufficient to diagnose or rule out pulmonary embolus. The presence of some nonspecific findings such as dyspnea, pleuritic chest pain, tachypnea, and tachycardia, and one or more risk factors for venous thromboembolism raise suspicion for pulmonary embolus. However, it is not possible to diagnose pulmonary embolus with these factors. Recently, new improvement occurred in the diagnosis and treatment of the disease. The aim of this disease is to re-review pulmonary embolism in the light of new developments. In this book, in addition to risk factors causing pulmonary embolus, a guide for systematic approaches to lead the risk stratification for decision making is also presented. In order to provide a maximum length of active life and continuation of functional abilities as the aim of new interventional gerontology, the risk factors causing pulmonary embolus in elderly individuals are evaluated, and the approach to prevention and treatment is defined. The risk of the development of deep vein thrombosis and pulmonary embolism, combined with obesity due to immobility, the disease of this era, irregular and excessive eating, and treatment management are highlighted. Non-thrombotic pulmonary emboli are also covered and an attempt is made to constitute an awareness of this picture that can change the treatment and prognosis of the disease to a considerable extent. In addition to the pathophysiological definition of pulmonary embolus, the priority goal of quick and definitive diagnosis is emphasized, and diagnostic strategies are discussed in the book. A numerical analysis of the vena cava filters, which is a current approach to prevent pulmonary emboli recurrences, is presented in the last chapter. I would like to thank the authors of all chapters for their intense labor and efforts in the preparation of this book. It is our belief that the new opinions and approaches presented will be beneficial to the readers. Dr. Ufuk Çobanoğlu Yüzüncü Yıl University, School of Medicine Chief of Department of Thoracic Surgery Turkey [...]... for Pulmonary Embolism Ufuk Çobanoğlu The University of Yuzuncu Yil Turkey 1 Introduction Pulmonary embolism (PE) is a common disease with high morbidity and mortality, yet it is a disorder that is difficult to diagnose (Stein & Matta, 2010) 90% of the clinical PE originates from the proximal deep veins of the lower extremities An ultrasonographic study involving patients diagnosed with pulmonary embolism. .. Pregnancy/puerperality The use of Oral contraceptives and hormone replacement Previous pulmonary emboli and deep vein thrombosis Antiphospholipid syndrome Chronic obstructive pulmonary disease (COPD) Medical Conditions requiring hospitalization Table 2 Risk factor for pulmonary embolism Risk Factor for Pulmonary Embolism 3 2.1 Antithrombin III deficiency Antithrombin III (AT III) deficiency is among... (1999) Incidence of acute pulmonary embolism in a general hospital: relation to age, sex, and race Chest, Vol.116, No.4, (Oct), pp.( 909-913), ISSN: (Print) 0012-3692, (Electronic) 1931-3543 Stein, PD., & Matta, F (2010) Acute pulmonary embolism Curr Probl Cardiol, Vol.35, No.7, (Jul), pp.(317-376), ISSN: (Print) 0146-2806, (Electronic)1535-6280 Subbarao, J., & Smith J Pulmonary embolism during stroke... will be discussed 2 Hemodynamic consequences of acute pulmonary embolism Anatomically massive PE has been defined as having more than 50% obstruction of the pulmonary vasculature or the occlusion of two or more lobar arteries (Urokinase Pulmonary Embolism Study Group, 1970) In a unique situation, a large embolus may lodge at the bifurcation of the main pulmonary artery, i.e saddle embolus Although it was... studies showing that it affects the endothelial Risk Factor for Pulmonary Embolism 5 cells by causing the formation of reactive oxygen forms, such as superoxide, hydrogen peroxide and hydroxyl radicals, it causes proliferative response by affecting the smooth muscle cells and increasing collagen production, it affects the clotting system by increasing tissue factor production in the monocytes, creating... Prevention and management of venous thromboembolism in pregnancy Clin Chest Med, Vol 24, No.1, (Mar), pp.(123-137),ISSN: (Print) 0272-5231, (Electronic) 1557-8216 14 Pulmonary Embolism Goldhaber, SZ., Grodstein, F., Stampfer, MJ., Manson, JE., Colditz, GA., Speizer, FE., Willett, WC., & Hennekens, CH (1997) A prospective study of risk factors for pulmonary embolism in women JAMA, Vol.277, No.8 (Feb),... especially in patients with co-existing heart failure or pulmonary disease Cardiogenic shock occurs in less than 5% of acute PE, and these patients have a high risk of death Conversely, patients with non-massive PE present with stable blood pressure and have a lower risk of death In the International Cooperative Pulmonary Embolism Registry, 22 Pulmonary Embolism the death rate was about 58% in hemodynamically... Concomitant deep venous thrombosis at diagnosis 1 History of venous thromboembolism 1 Congestive heart failure 1 Hypoxia (arterial PaO2 < 60mmHg) 1 Geneva Risk Categories Low risk: 2 or fewer points; High risk: 3 or more points Table 1 Geneva Pulmonary Embolism Prognostic Index 23 Risk Stratification of Patients with Acute Pulmonary Embolism Variable Points Age 1 point/year Male gender 10 Cancer 30 Congestive... 1996, respectively (Makris et al., 1997) In patients with genetic thrombophilia, the predisposition to thrombotic and recurrent venous thromboembolism (VTE) in the early stages of life is increased 2 Pulmonary Embolism Table 1 Virchow’s triad/ venous thromboembolism risk factors Genetic risk factors Antithrombin III deficiency Protein C deficiency Protein S deficiency Activated Protein C resistance... sites (lower limbs and pulmonary embolism) (Mariani et al., 2005) 2.11 Factor XII deficiency Severe FXII deficiency (FXII activity . PULMONARY EMBOLISM Edited by Ufuk Çobanoğlu Pulmonary Embolism Edited by Ufuk Çobanoğlu Published by InTech Janeza. Pulmonary Embolism, Edited by Ufuk Çobanoğlu p. cm. ISBN 978-953-51-0233-5 Contents Preface IX Chapter 1 Risk Factor for Pulmonary