Pulmonary embolism and deep venous thrombosis in trauma: are they related?
OBJECTIVE
Pulmonary embolism (PE) and deep venous thrombosis (DVT) in trauma are related.


METHODS
Retrospective review of medical records.


METHODS
Academic level I trauma center.


METHODS
Trauma patients who underwent computed tomographic pulmonary angiography (CTPA) with computed tomographic venography (CTV) of the pelvic and proximal lower extremity veins over a 3-year period (January 1, 2004, to December 31, 2006) were reviewed. Data on demographics, injury type and severity, imaging findings, hospital length of stay, and mortality were collected.


METHODS
Pulmonary embolism and DVT.


RESULTS
Among 247 trauma patients undergoing CTPA/CTV, PE was diagnosed in 46 (19%) and DVT in 18 (7%). Eighteen PEs were central (main or lobar pulmonary arteries), and 28 PEs were peripheral (segmental or subsegmental branches). Pulmonary embolism occurred within the first week of injury in two-thirds of patients. Seven patients with PE (4 femoral, 2 popliteal, and 1 iliac) had DVT. Pulmonary embolism was central in 5 patients and peripheral in 2 patients. No significant differences were noted in any of the examined variables between patients with PE having DVT and those not having DVT.


CONCLUSIONS
Few patients with PE have DVT of the pelvic or proximal lower extremity veins. Pulmonary embolism may not originate from these veins, as commonly believed, but instead may occur de novo in the lungs. These findings have implications for thromboprophylaxis and, particularly, the value of vena cava filters.
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St, Ste 810, Boston, MA 02114, USA. gvelmahos@partners.org
George C
GC
Velmahos
Konstantinos
K
Spaniolas
Malek
M
Tabbara
Hani H
HH
Abujudeh
Marc
M
de Moya
Alice
A
Gervasini
Hasan B
HB
Alam
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014947:Wounds and Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy
D000925:Anticoagulants