The Clinical Profile of Unresolved Pulmonary Embolism

doi:10.1378/chest.84.6.669

Chest

Volume 84, Issue 6, December 1983, Pages 669-678

https://doi.org/10.1378/chest.84.6.669 Get rights and content

Nearly all patients with pulmonary embolism (PE) have complete clinical and hemodynamic and at least near complete roentgenographic and angiographic resolution within four to six weeks of the acute event. To classify the syndrome of unresolved pulmonary embolism we reviewed our experience and that of the English literature to extract 30 well-described cases. The mean age at presentation was 45 years, and most patients were less than 60 years old. Almost all complained of dyspnea, and the majority had at least one clinical event suggestive of PE. Most had clinical evidence of pulmonary hypertension. Roentgenographic, arterial blood gas and electrocardiographic findings were nonspecific, though the perfusion lung scan was always abnormal. Most patients exhibited mild-to-moderate pulmonary hypertension. The severity of pulmonary artery obstruction was quite variable and did not correlate with the magnitude of arterial hypoxemia or pulmonary hypertension. Most patients did not improve with long-term anticoagulation therapy and underwent pulmonary embolectomy with acceptable mortality. Postoperative improvement correlated with improved arterial blood gas levels, abatement of pulmonary hypertension, and more satisfactory pulmonary perfusion.

Section snippets

CASE 1

A 60-year-old man complained of exertional dyspnea of 18 months’ duration. A chest x-ray film performed four months prior to admission was normal, but a ventilation/perfusion lung scan demonstrated bilateral segmental and lobar perfusion defects which ventilated normally. Pulmonary angiography demonstrated multiple proximal pulmonary emboli. He was treated with heparin for two weeks followed by a four-month course of anticoagulation therapy with warfarin. Despite rigorously maintained

METHODS

In order to supplement our experience with UPE, we reviewed the English literature and selected all cases of unresolved pulmonary embolism fulfilling the following criteria:

1.
Symptoms compatible with pulmonary embolism occurring at least two months prior to evaluation and definitive diagnosis.
2.
The presence of pulmonary embolism verified by angiography and/or pulmonary embolectomy.
3.
Availability of relatively complete clinical information in the form of a narrative case report.

Twenty-six cases

RESULTS

There were 20 men and ten women presenting at a mean age of 45 years and ranging in age between 18 and 76 years. Noteworthy in the age distribution of patients is that 73 percent (22/30) of patients were less than 60 years old when they came to medical attention.

Table 2 illustrates the symptoms present in the 30 patients with unresolved pulmonary embolism. Twenty-nine individuals (97 percent) complained of dyspnea which was initially episodic but characteristically became more persistent and

DISCUSSION

Patients with unresolved pulmonary embolism usually present with dyspnea and a history consistent with one or more previous episodes of pulmonary embolism. Physical findings are nonspecific, but usually include some evidence of pulmonary hypertension, most frequently an accentuated P₂. The ECG is usually abnormal but is not likely to demonstrate RVH in the absence of gross right ventricular failure. The chest x-ray film usually reveals dilated proximal pulmonary arterial segments. Arterial

ACKNOWLEDGMENT

The assistance of Jane McCue, RN, is appreciated.

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Citation Excerpt :
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: Manuscript received March 8; revision accepted May 12.

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Chest

The Clinical Profile of Unresolved Pulmonary Embolism

Section snippets

CASE 1

METHODS

RESULTS

DISCUSSION

ACKNOWLEDGMENT

Am J Med

J Thorac Cardiovasc Surg

Am J Med

Am J Cardiol

Chest

Am J Med

Am J Med

Am J Med

Am J Med

Am J Cardiol

Prog Cardiovasc Dis

Resolution rate of acute pulmonary embolism in man

N Engl J Med

Late prognosis of acute pulmonary embolism

N Engl J Med

Long-term prognosis of treated acute massive pulmonary embolism

Br Heart J

Clinical course and late prognosis of treated subacute massive, acute minor and chronic pulmonary thromboembolism

Br Heart J