ABSTRACT
Emboli are characterized from small-moderate to submassive low risk to submassive high risk to massive. These categories are based on a combination of the patient's clinical picture and pulmonary embolism (PE) characteristics. Treatment ranges from systemic anticoagulation alone to fibrinolysis to thrombectomy. For submassive high risk to massive PE, anticoagulation in addition to thrombolysis or thrombectomy may be indicated. Inferior vena cava (IVC) filter placement for PE and treatment of subsegmental PE are both controversial. The PREPIC2 randomized trial compared IVC filter plus anticoagulation versus anticoagulation therapy alone for treatment of acute PE. The incidence of PE appears to be increasing, likely due to earlier diagnosis with spiral computed tomography (CT). More than 90% of pulmonary emboli originate from deep venous thrombosis in the lower extremities. If suspicion for PE is high, then imaging confirmatory tests are indicated. CT angiography is the modern gold standard since its noninvasive and can diagnose other intrathoracic diseases contributing to the patient's condition.
