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PULMONARY EMBOLISM
Edited by Ufuk Çobanoğlu
Pulmonary Embolism
Edited by Ufuk Çobanoğlu
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2012 InTech
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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
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