Massive pulmonary embolism: a comparison of radiological and clinical characteristics and outcomes.
OBJECTIVE
To describe the clinical features of radiographically massive pulmonary embolism (MPE).


METHODS
Retrospective analysis.


METHODS
A 1,368-bed teaching hospital.


METHODS
Patients with pulmonary embolism between June 1997 and December 1999.


METHODS
Radiographic reports of patients with a radiographic diagnosis of pulmonary embolism were reviewed to determine whether MPE (>50% vascular occlusion) was present. For patients with MPE, vital signs, respiratory and cardiac symptoms, medical history, arterial blood gases, electrocardiographic (ECG) and echocardiographic results, treatment, and hospital mortality were recorded.


RESULTS
Fifty-four patients with MPE were identified. Patient age range was 28-91 years (mean 71 years). Symptoms were: dyspnea in 38 (70%), chest pain in 21 (38%), syncope in 12 (22%), palpitations in 6 (11%), systolic blood pressure <90 mmHg in 12 (22%), tachycardia (>120 beats/min) in 15 (28%) and tachypnea (respiratory rate >30) in 15 (28%). Pa O(2) (arterial partial pressure of oxygen) was less than 60 mmHg in 28 (71%) and the alveolar-arterial oxygen gradient was always greater than 20. ECG had an S1Q3T3 pattern in 6 (12%). Echocardiography revealed right ventricular dilatation in 12/31 (38%). Forty-nine patients received anticoagulation treatment, 4 (7%) received thrombolytic therapy with anticoagulation, 5 had inferior vena cava filters (IVC) alone, 6 received IVC filters with anticoagulation, and 2 received thrombolytic therapy, anticoagulation, and IVC filters. Eighteen (33%) patients were treated in the intensive care unit, 3 (5.5%) with mechanical ventilation. Fifty (93%) patients were eventually discharged and 4 (7%) died. Two of the deaths were not attributable to MPE.


CONCLUSIONS
Patients with MPE usually present with dyspnea and hypoxemia, and most survive without thrombolytic therapy.
Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, 1st Avenue at 16th Street, New York, NY 10003, USA. RSchneider@BethIsraelNY.org
Roslyn F
RF
Schneider
Francis D
FD
Ntimba
Aman
A
Hourizadeh
Jonathan B
JB
Schwartz
Corey D
CD
Eber
Madhavi
M
Patnana
Richard
R
Goldfarb