Saddle Pulmonary Embolism
A comprehensive overview of pulmonary embolism covering subjects as: treatment, symptoms, diagnostics, research, causes, pictures and images
Saddle pulmonary embolism
A "horse" pulmonary embolism on a bifurcation is rare and it may occur to all levels of the pulmonary arterial tree and saddle pulmonary embolism can be interlobar, inter-segmental or inter-sub-segmental. It can also be a "horse" on the bifurcation of the pulmonary artery trunk. Symptoms are also misleading in the other pulmonary emboli but are more often signs of a suffering with a right dilatation of the atrium and of the right ventricle.
Saddle pulmonary embolisms, on "horse" on the bifurcation of the trunk of the pulmonary artery were significantly larger on the right than on the left: the length of these emboli can be very large, up to several tens of centimeters, indicating their source from a thrombosis from a large profound vein. Paradoxically, this is the kind of situation that a lower limb Doppler ultrasound may be negative, because the long thrombus may migrate into the pulmonary circulation.
Evolution, complications, prognosis
The natural history of saddle pulmonary embolism is determined by many factors: size and number of clots, the absence or presence of underlying cardiopulmonary disease, the appellant thromboembolism, precocity of diagnosis and correct treatment.
The saddle pulmonary embolism evolution is favorable, spontaneous regression or after an anticoagulant treatment. Pulmonary heart regresses and disappears after 7-14 days, as post-embolic pleurisy. On cardiac's, the average congestive heart failure may worsen or trigger refractory tachyarrhythmias, both factors contributing to death.
Massive pulmonary embolism is a serious trend in the short term, but a relatively good long-term trend. Sudden death, instantaneous in 30-60 minutes after the accident embolism, accounts for two thirds of embolic death. Patients who survive the initial incident may evolve with cardiogenic shock, low cardiac output syndrome or right heart failure, for the next 1-3 days. Regression of these pathological conditions is relatively rapid, with appropriate treatment (anticoagulants).
Whatever the form of saddle pulmonary embolism small, medium or large, the recurrence is possible, usually within days after the initial episode, rarely a few weeks or months. Rates of recurrence were 20% -25% on the persons treated with anticoagulants, the risk is substantially reduced if adequate anticoagulant treatment, but greatly increased in people who are not in correct formation and expansion factors of venous thrombosis.
Clinical picture of saddle pulmonary embolism
Clinical Manifestations of saddle pulmonary embolism are extremely varied and, in part, nonspecific, they reflect the diversity of anatomical and physic-pathological consequences of the disease.
The factors influencing the clinical picture is mainly pulmonary vascular obstruction size - hence the severity of embolic obstruction and vasoconstriction, mechanical, and obvious obstruction during cardiopulmonary status before the embolic episode.
From the practical point of view, the best individual clinical pictures are: 1. massive pulmonary embolism, 2. pulmonary infarction, 3. chronic thromboembolic. But there are many atypical clinical aspects and environmental aspects, between the saddle pulmonary embolism, massive or recurrent.
Diagnosis of saddle pulmonary embolism
Saddle pulmonary embolism positive diagnosis can be easily (for example DVT + pulmonary heart pictures of acute DVT + typical clinical picture of pulmonary infarction) or extremely difficult or impossible by conventional methods. Given the severity of illness and emergency treatment must be suspected and formulated on clinical grounds. Using methods of exploration, non-invasive and potentially invasive, will be gradually obtained the results going to be confronted with basic clinical data.
Formulation of a diagnostic algorithm is difficult
Differential diagnosis of saddle pulmonary embolism is, in most cases, extremely difficult, illustrated by high proportion of accidents unrecognized by conventional methods of exploration (approximately 70%). The condition may be confused with many diseases or clinical syndromes of acute severe illness such as: acute pleura-pulmonary, acute right heart failure, cardiogenic shock, myocardial infarction, acute pulmonary edema, sudden coronary death, acute respiratory failure.