Pulmonary embolism CT scan case Dissertation Example | Topics and Well Written Essays - 2500 words

Pulmonary embolism CT scan case - Dissertation Example Pulmonary embolism Pulmonary embolism is the second most common cause of sudden death. Death occurs within few hours of onset of the condition and in many situations, death occurs much before the diagnosis is made. In those who survive, recurrent embolism and mortality can be prevented by prompt diagnosis and management. However, diagnosis is often missed because of signs and symptoms that are nonspecific. Untreated individuals, who have survived the initial episode, are likely to die due to repeat embolism. Pulmonary embolism can be acute or chronic. Acute embolism occurs when the embolus is situated in the central portion of the vascular lumen or if the embolus occludes the lumen. Chronic embolism occurs when the embolus is eccentric, being contiguous with the wall of the vessel, decreases the diameter of the involved artery by atleast 50 percent and there is evidence of recanalisation or arterial web. Acute embolism distends the the vessel (Ouellette, 2011). Figure 1: Mechanism of pulmonary embolism (medicalook.com) Pulmonary embolism can be peripheral or central based on the branch of the artery located. Main pulmonary artery and its branches, the right and left pulmonary arteries and their subsequent main branches,the anterior trunk, the right and left interlobar arteries, right and left lower lobe arteries, right middle lobe artery and left upper lobe trunk are considered to be central zones. Other branches are peripheral zones (Ouellette, 2011). Pulmonary embolism can be massive or non-massive. Massive embolism occurs when hemodynamic compromise occurs (Ouellette, 2011). The clinical presentation of the condition is highly variable and hence provides scope for missed diagnosis. Classic presentation includes sudden onset of shortness of breath, pleuritic chest pain and hypoxia (Ouellette, 2011). Pulmonary embolism is considered to be a complication of venous thromboembolism like deep vein thrombosis, rather than just a disease. Thus, every individual who is at risk of venous thromboembolism is at risk of developing pulmonary embolism (Ouellette, 2011). In normal individuals, microthrombi, which are nothing but aggregates of platelets, lysed red blood cells and fibrin, are formed and subsequently lysed continuously in the venous system. Through such a mechanism, local hemostasis is possible in response to injury, thus preventing uncontrolled propagation of clot (Ouellette, 2011). In view of nonspecific clinical presentation, every individual with unexplained chest pain, tachypnea or dyspnea must undergo specific diagnostic tests to rule out the disease. Non-specific routine tests ar not helpful in establishing or giving clue for diagnosis. The criterion standard for diagnosis of pulmonary embolism is pulmonary angiography. However, this is rarely performed now and is replaced by computed tomography angiography or CT angiography which is more sensitive and specific (Ouellette, 2011). Famous personality who died of pulmonary embolism O ne of the famous personalities who died of pulmonary embolism is David Bloom, a noted TV journalist (DPSinfo, 2004). Anatomy The key for accurate interpretation of CT angiography is based on the understanding of bronchovascular anatomy (Refer to Figures 2 and 3). It is very important to adopt systematic approach of identifying vessels (Ouellette, 2011). Figure-2: Branches of pulmonary artery (imaios.com) Figure-3: Bronchopulmonary segments (imaios.com). Pathology Both hemodynamic and respiratory consequences arise due to pulmonary