Pulmonary Thromboembolism: Definition, Symptoms, Diagnosis, and Interventional Radiological Treatment Options

Pulmonary thromboembolism (PTE) typically occurs when a blood clot, usually originating from deep vein thrombosis (DVT), embolizes into the pulmonary arteries. This condition can increase the risk of acute or chronic respiratory failure, heart failure, and death. While the treatment of PTE generally begins with anticoagulation and thrombolytic therapies, interventional radiological methods may be necessary in some cases. This article will discuss the definition, symptoms, diagnostic methods, and interventional radiological treatment options for PTE in detail.  

What is Pulmonary Thromboembolism?

Pulmonary thromboembolism is the blockage of the pulmonary arteries by blood clots that have traveled to the lungs. The clots usually form in the legs (deep vein thrombosis) and are carried to the lungs through the bloodstream. This condition can reduce the oxygenation capacity of the lungs and lead to serious respiratory and cardiovascular problems.  

Pathophysiology

PTE typically arises when clots (thrombi) that form in the deep veins travel towards the pulmonary arteries. The clot causes an obstruction in the pulmonary arteries, leading to a reduction in the blood carrying oxygen to the lungs. This condition disrupts blood flow in the lungs and consequently can cause impairments in respiratory and cardiovascular functions.

Symptoms and Clinical Findings

The symptoms of PTE can vary depending on the size of the clot and the degree of obstruction in the lungs. Common symptoms include:

• Shortness of Breath (Dyspnea): Sudden onset or progressively worsening difficulty breathing.
• Chest Pain: Typically sharp, stabbing, or constricting in nature.
• Cough: May be accompanied by bloody sputum (hemoptysis).
• Rapid Breathing (Tachypnea): Increased respiratory rate.
• Tachycardia: Increased heart rate.
• Fever and General Malaise: Some patients may experience fever and general fatigue.

Diagnostic Methods

Accurate diagnosis of PTE is crucial for guiding appropriate treatment. Diagnostic methods include:

1. Clinical Evaluation:

   The patient's symptoms, medical history, and physical examination are the fundamental stages of evaluation.

   Imaging Tests:

   • Computed Tomography Pulmonary Angiography (CTPA): Used to assess the presence and size of clots in the pulmonary arteries.
   • Pulmonary Angiography: This procedure, performed with contrast dye, shows the location and extent of the clots. It is usually used when there is a discrepancy with other tests.
   • Ventilation/Perfusion (V/Q) Scan: Shows mismatches between blood flow and air movement in the lungs.

   Laboratory Tests:

   • D-dimer Test: Measures the levels of the D-dimer molecule, which is formed as a result of the breakdown of clots. However, this test alone may not be sufficient for a definitive diagnosis of PTE.

   Interventional Radiological Treatment

   Interventional radiological methods play a significant role in the treatment of PTE, especially in cases where symptoms do not improve despite anticoagulation therapy or when serious complications develop.

   Endovascular Thrombolysis

   • Method: Endovascular thrombolysis involves the use of intravenous or catheter-directed thrombolytic drugs to dissolve the clot. It is generally preferred for the treatment of large clots.
   • Procedure: A catheter is inserted through the groin or wrist and guided into the pulmonary arteries. Thrombolytic drugs are delivered directly onto the clot to dissolve it.
   • Advantages:
     • Provides rapid and effective clot dissolution.
     • Can target a large clot burden.
   • Disadvantages:
     • May have a higher risk of bleeding.
     • May be effective especially on large clots; generally not recommended for small clots.

   Endovascular Mechanical Thrombectomy

   • Method: Mechanical thrombectomy involves the physical removal of blood clots. This procedure is often preferred for large and/or life-threatening clots.
   • Procedure: A thrombectomy device is placed over the clot via a catheter. The device captures the clot, allowing for its removal.
   • Advantages:
     • Allows for the physical removal of large clots.
     • Faster results can be obtained.
   • Disadvantages:
     • Risk of bleeding during or after the procedure.
     • It is a more complex and invasive procedure.

   Inferior Vena Cava (IVC) Filters

   • Method: IVC filters are placed to prevent clots from the legs from traveling to the lungs.
   • Procedure: They are usually inserted through the groin or neck and placed inside the inferior vena cava.
   • Advantages:
     • Prevents clots from passing into the lungs.
     • Provides long-term protection.
   • Disadvantages:
     • The filter itself can lead to complications, such as clot accumulation or filter migration, creating a risk of bleeding.

   Complications and Management

   Interventional radiological treatment methods may have some complications:

   • Bleeding: There may be a high risk of bleeding after thrombectomy or thrombolytic therapy. Careful monitoring is necessary for bleeding control and to reduce the risk of bleeding.
   • Infection: There is a risk of infection during the use of catheters or other devices. The use of sterile techniques and appropriate antibiotic prophylaxis are important.
   • Reactions and Allergic Reactions: Allergic reactions to contrast dye may occur. Caution should be exercised in patients with a history of allergies.

   Recovery and Follow-up

   Regular monitoring of patients is necessary after interventional radiological treatment:

   • Monitoring: Patients are monitored in the hospital for a period after the procedure and followed up for potential complications.
   • Check-ups: Additional imaging tests are usually performed to evaluate the effectiveness of the treatment.
   • Anticoagulation Therapy: Anticoagulation therapy usually continues after treatment. Patient compliance with this treatment is monitored and adjusted.

   Conclusion

   Pulmonary thromboembolism (PTE) is a serious and potentially fatal condition. Interventional radiological methods offer effective treatment options, especially in cases that do not respond to anticoagulation therapy or in severe cases. Methods such as endovascular thrombolysis, mechanical thrombectomy, and IVC filters play an important role in the treatment of PTE. Successful application of these methods can accelerate the patient's recovery process and improve their quality of life. A multidisciplinary approach and careful monitoring during the treatment process are critical to reduce the risks of complications and increase treatment success.

   This information has been verified with medical information confirmed by specialist physician İbadat Hasanov and aims to inform individuals. In any case, the treatment plan is determined specifically for you, and this decision is meticulously evaluated by your doctors.