Snapshot A 36-year-old woman presents to the emergency department with worsening shortness of breath and pleuritic chest pain. She recently returned to the United States from a business meeting overseas. She takes an oral contraceptive. Her temperature is 98.6°F (37°C), blood pressure is 135/82 mmHg, pulse is 112/min, respirations are 24/min, and oxygen saturation is 89% on room air. A CT angiogram demonstrates a filling defect in the pulmonary vasculature. She is started on supplemental oxygen and heparin. Summary Pulmonary embolism is mechanical obstruction of the pulmonary vasculature secondary to a blood clot login to view 1 more bullet Diagnosis is made login to view 3 more bullets Treatment is usually login to view 3 more bullets Epidemiology Risk factors login to view 8 more bullets Etiology DVT (most common) login to view 1 more bullet Phlegmasia cerulea dolens login to view 3 more bullets Septic embolism from right-heart endocarditis Fat embolism Amniotic fluid embolism Cement embolism from kyphoplasty Pathophysiology login to view 7 more bullets Presentation Symptoms login to view 6 more bullets Physical exam login to view 6 more bullets Imaging CT angiography of the chest login to view 3 more bullets Chest radiography (typically normal and neither sensitive nor specific) login to view 3 more bullets V/Q scan login to view 6 more bullets Venous duplex ultrasound of the lower extremities login to view 3 more bullets Echocardiography login to view 1 more bullet Studies ECG login to view 7 more bullets Arterial blood gas login to view 5 more bullets D-dimer login to view 3 more bullets Differential Acute coronary syndrome login to view 3 more bullets Costochondritis login to view 2 more bullets Aortic dissection login to view 3 more bullets Treatment Medical login to view 17 more bullets Operative login to view 6 more bullets Prognosis High mortality without treatment PERC - if meet all criteria in a low-risk patient can avoid further workup for PE login to view 8 more bullets Wells Criteria login to view 17 more bullets