ABSTRACT
Pulmonary embolism (PE) is a potentially fatal complication of deep venous thrombosis (DVT). While common, it remains underdiagnosed. The antemortem diagnosis of PE was made in only 30 per cent of patients confirmed as having had PE at autopsy.1 Eighty per cent of patients with angio-proven PE had bilateral leg venography which showed evidence of DVT in 82 per cent, symptomatic in only 42 per cent.2,3
The astute physician must combine a high clinical suspicion for PE, based on presenting features and appropriate risk factors, with timely investigations and empirical therapy. The majority of PEs are caused by portions of thrombi originating in the upper leg and pelvic veins breaking off and travelling to the lungs. The focus of this chapter therefore will be the diagnosis and therapy of thombotic emboli. At all times less frequent causes of PE such as upper extremity thrombi, air, bone marrow, arthroplasty cement, amniotic fluid, talc, fat, septic and tumour emboli should be kept in mind.
