Clinical & CTPA profile of patients presenting with acute pulmonary thromboembolism in a tertiary care hospital in tier II city of India

摘要

Objective: To study the profile of patients admitted with acutepulmonary embolism in our hospital.Methods: This was a retrospective study of clinical andcomputed tomographic pulmonary angiography (CTPA) profilesand management of patients presenting with acute pulmonaryembolism in last two years from August 2015 to July 2017.Thirty patients who were newly diagnosed to have acute pulmonarythromboembolism with a mean age of 53 years wereincluded in the study. Two-thirds of the patients were male andone-third were females. It was found that majority of the patientshad at least one risk factor for embolization (80%) with majorityhad history of limb immobilization. Deep vein thrombosis (DVT)was present in 26%, and recent limb surgery was done in another26%. One patient had history of malignancy while no risk factorwas appreciable in about 20% of cases. Wells criteria score for pulmonarythromboembolism clinical probability was in the range of4.5–9 (mean 6). Dyspnea (86%) and syncope (13%) were the predominantsymptoms, and one patient presented with fever. About86% patients had tachycardia and 26% had hypotension on admission.Echocardiography was done in all patients. Twenty-eightpatients (96%) had moderate pulmonary arterial hypertension, 53%had evidence of right atrium/right ventricle (RA/RV) dysfunction.Diagnosis of massive pulmonary thromboembolism was made in46%, and sub-massive in 54% CT pulmonary angiogram was donein all patients, and it confirmed the diagnosis in all cases. 80% ofpatients were thrombolyzed. About 20% patients underwent anticoagulationwith unfractionated heparin. All patients were startedwith oral anticoagulation.However, independent of the mode of treatment, most patientshad good treatment outcomes with the mortality rate being only6.6%.Conclusion: Pulmonary embolism can have multiple presentationsin terms of clinical symptoms, signs and investigations. Earlydiagnosis and aggressive management is the key to successful outcome.