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|Pathway of Pulmonary Embolism|
|Copyright © Nucleus Medical Media, Inc.|
- Blood clot in a deep vein of a leg or the pelvis
- Increased levels of clotting factors in the blood
- Prolonged bed rest
- Major surgery, especially after pelvic surgery, knee replacement, or heart surgery
- Injury to a vein in a leg or the pelvis
- Fractures of the hip or thigh bone
- Certain blood disorders
- Prolonged sitting, such as during a long trip
- Pregnancy or postpartum period
- Inflammatory bowel disease
- Autoimmune disorder, such as immune thrombocytopenic purpura , polyarteritis nodosa , or polymyositis
- Taking certain medications, such as birth control pills or antipsychotics
- Arterial blood gas study —to check oxygen levels and lung function
- EKG —to assess the electrical activity of the heart
- D-Dimer blood test—to detect the presence of a clot
If you have a family history of blood clots, and had blood clots in the past for no apparent reason, your doctor may do additional blood tests. The tests will look for possible inherited defects in your clotting system, such as:
- Factor V Leiden mutation (seen in up to 40% of cases)
- Increased factor VIII
- Chest x-ray —to look for signs of dead tissue; the pulmonary embolism cannot be seen on the chest x-ray
- Lung perfusion scan—a test that compares breathing and circulation in all areas of the lungs
- CT scan of the chest
- Pulmonary angiogram —to see blood vessels in the lungs
- Magnetic resonance (MR) angiography
- Echocardiography —to examine the size, shape, and motion of the heart
- Eat a healthful diet that is low in saturated fat and rich in whole grains, fruits, and vegetables.
- Begin a safe exercise program with the advice of your doctor.
- Walk or move your legs to break up long periods of sitting.
- If you smoke, talk with your doctor on ways you can quit .
- Unless you are on a fluid-restricted diet, be sure to drink lots of water.
- Take medication if your doctor recommends it. Anticoagulant drugs are most commonly used.
- Wear elastic stockings if suggested by your doctor. They can help improve circulation in your legs.
- Walk or move your legs to break up long periods of sitting. If you are traveling, get up and walk every few hours.
American Lung Association http://www.lung.org
American Society of Hematology http://www.hematology.org
Canadian Lung Association http://www.lung.ca
Health Canada http://www.hc-sc.gc.ca
Gibson NS, Sohne M, etc. Prognostic value of echocardiography and spiral computed tomography in patients with pulmonary embolism. Curr Opin Pulm Med. 2005;11:380.
Guyatt GH, Norris SL, et al; American College of Chest Physicians. Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):53S-70S.
Konstantinides S. Clinical practice. Acute pulmonary embolism. N Engl J Med. 2008;359:2804-2813. Review.
Philbrick JT, Shumate R, et al. Air travel and venous thromboembolism: a systematic review. J Gen Intern Med. 2007;22:107-114.
Pulmonary embolism. JAMA. February 2001.
Pulmonary embolism. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated August 22, 2013. Accessed August 28, 2013.
Pulmonary embolus. Canadian Lung Association website. Available at: http://www.lung.ca/diseases-maladies/a-z/embolus-embolie/index%5Fe.php . Updated September 24, 2012. Accessed August 28, 2013.
Qaseem A, Snow V, et al. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Intern Med. 2007;146:454-458.
Rubini G, Niccoli A, et al. Acute pulmonary embolism: comparison and integration of perfusion lung scintigraphy with multislice spiral CT. Radiol Med. 2007;112:174-184.
10/5/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Parker C, Coupland C, Hippisley-Cox J. Antipsychotic drugs and risk of venous thromboembolism: nested case-control study. BMJ. 2010;341:c4245.
12/17/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010;375(9715):657-663.
1/26/2012 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Zöller B, Li X, Sundquist J, Sundquist K. Risk of pulmonary embolism in patients with autoimmune disorders: a nationwide follow-up study from Sweden. Lancet. 2012;379(9812):244-249.
- Reviewer: Michael Woods, MD
- Review Date: 09/2013
- Update Date: 09/30/2013