Pulmonary embolism. How to 'nail down' the diagnosis

Pulmonary embolism in children

Pulmonary embolism is an uncommon diagnosis in the pediatric patient, often discovered on autopsy. The mortality rate of untreated pulmonary embolism approaches 30%, and the best way to prevent death is by swift diagnosis and initiation of therapy. This article reviews the risk factors, clinical presentation, pathophysiology, diagnostic modalities, and treatment of pulmonary embolism in children.

Noninvasive imaging of the lower extremity for deep venous thrombosis

Noninvasive imaging for LE DVT has advanced remarkably in the past decade. Currently, IPG and ultrasound techniques (RTU and DS) have been proven to be quick, accurate, relatively inexpensive, and widely available methods for detecting proximal LE DVT and can be used as the initial diagnostic studies in many settings. Color-flow Doppler ultrasound studies may be more accurate than other ultrasound techniques in diagnosing calf DVT and in differentiating acute from chronic LE DVTs, though this bears further review. Many concerns remain regarding noninvasive LE DVT imaging, including: The accuracy of the above studies in nonreferral centers. The need for and optimal frequency of follow-up studies to detect clots that propagate proximally. The optimal noninvasive techniques for imaging in the setting of recurrent DVT and other specialized settings (e.g., high-risk patients).

Pulmonary embolism confirmed by transoesophageal echocardiography

A 60-year-old patient suffered a pulmonary embolism following the application of an Esmarch and pneumatic tourniquet before arthroscopy of the knee. The diagnosis was suspected because of sudden hypotension, ECG changes, a decrease in end-expiratory carbon dioxide concentration and oxygen desaturation as indicated by pulse oximetry. Before performing a sternotomy and cardiopulmonary bypass for removal of pulmonary artery clots, the diagnosis was confirmed by the demonstration of severe right ventricular strain using transoesophageal echocardiography.