title: The origin of fatal pulmonary emboli: a postmortem analysis of 500 deaths from pulmonary embolism in trauma, surgical, and medical patients.
abstract: BACKGROUND
  The traditional theory that pulmonary emboli (PE) originate from the lower extremity has been challenged.
  
  
  METHODS
  All autopsies performed in Los Angeles County between 2002 and 2010 where PE was the cause of death were reviewed.
  
  
  RESULTS
  Of the 491 PE deaths identified, 36% were surgical and 64% medical. Venous dissection for clots was performed in 380 patients; the PE source was the lower extremity (70.8%), pelvic veins (4.2 %), and upper extremity (1.1%). No source was identified in 22.6% of patients. Body mass index (adjusted odds ratio [AOR] 1.044, 95% confidence interval [CI] 1.011 to 1.078, P = .009) and age (AOR 1.018, 95% CI 1.001 to 1.036, P = .042) were independent predictors for identifying a PE source. Chronic obstructive pulmonary disease (AOR .173, 95% CI .046 to .646, P = .009) was predictive of not identifying a PE source.
  
  
  CONCLUSIONS
  Most medical and surgical patients with fatal PE had a lower extremity source found, but a significant number had no source identified. Age and body mass index were positively associated with PE source identification. However, a diagnosis of chronic obstructive pulmonary disease was associated with no PE source identification.
authors: Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA.
authors: Matthew D
authors: MD
authors: Tadlock
authors: Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA.
authors: Konstantinos
authors: K
authors: Chouliaras
authors: Los Angeles County Forensic Medical Division, Los Angeles, CA, USA.
authors: Martina
authors: M
authors: Kennedy
authors: North Estonia Medical Center, Tallinn, Estonia.
authors: Peep
authors: P
authors: Talving
authors: Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA.
authors: Obi
authors: O
authors: Okoye
authors: Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA.
authors: Hande
authors: H
authors: Aksoy
authors: Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA.
authors: Efstathios
authors: E
authors: Karamanos
authors: Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA.
authors: Ling
authors: L
authors: Zheng
authors: Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA.
authors: Daniel J
authors: DJ
authors: Grabo
authors: Los Angeles County Forensic Medical Division, Los Angeles, CA, USA.
authors: Christopher
authors: C
authors: Rogers
authors: Los Angeles County Forensic Medical Division, Los Angeles, CA, USA.
authors: Thomas
authors: T
authors: Noguchi
authors: Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA.
authors: Kenji
authors: K
authors: Inaba
authors: Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA. Electronic address: demetria@usc.edu.
authors: Demetrios
authors: D
authors: Demetriades
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D011655:Pulmonary Embolism / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D034941:Upper Extremity / Q000098:blood supply; D020246:Venous Thrombosis / Q000150:complications*; D014947:Wounds and Injuries / Q000150:complications*
keywords: De novo pulmonary embolism; Deep vein thrombosis; Primary pulmonary thrombosis; Pulmonary embolism