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Pulmonary embolism

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"pulmonary embolism"[MeSH Terms]

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CDC pulmonary embolism symptoms emergency signs diagnosis treatment

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Pulmonary embolism (PE) is a blood clot that blocks one or more arteries in the lungs, most often when part of a deep-vein thrombosis (DVT) in the leg or pelvis breaks off and travels to the lung.

Seek emergency care now

Call emergency services or go to an emergency department immediately for:
  • Sudden unexplained shortness of breath
  • Chest pain, especially sharp pain that worsens with breathing
  • Coughing up blood
  • Fainting, near-fainting, severe dizziness, confusion
  • A very fast heartbeat, blue lips, or severe weakness
PE can be life-threatening and cannot be safely diagnosed at home. The CDC description of PE symptoms includes unexplained breathlessness, pleuritic chest pain, cough or hemoptysis, and syncope.

Common risk factors

  • Recent surgery, injury, hospital admission, or prolonged immobility
  • Long-distance travel or extended sitting
  • Previous DVT or PE
  • Cancer
  • Pregnancy and the first weeks after delivery
  • Estrogen-containing contraception or hormone therapy
  • Smoking, obesity, inherited clotting disorders
  • Leg swelling or pain that may indicate DVT

How it is diagnosed

Clinicians assess probability using symptoms, examination, vital signs, and tests such as:
  • D-dimer blood test in selected low-risk patients
  • CT pulmonary angiography (CTPA), the usual imaging test
  • V/Q scan when CT contrast is unsuitable
  • Leg-vein ultrasound to look for DVT
  • ECG, chest radiograph, troponin, and echocardiography to assess alternative diagnoses and severity
Imaging is needed because symptoms overlap with conditions such as heart attack, pneumonia, anxiety, and asthma. The CDC diagnostic guidance notes that CT pulmonary angiography is the standard PE imaging test and V/Q scanning is a common alternative.

Treatment

Treatment depends on severity and bleeding risk:
  • Anticoagulation is the main treatment. Options may include heparin initially, followed by an oral anticoagulant such as apixaban, rivaroxaban, dabigatran, edoxaban, or warfarin.
  • Thrombolysis or catheter/surgical clot removal may be used for PE causing shock or dangerously low blood pressure.
  • An IVC filter is considered only in limited situations, such as when anticoagulation cannot be given.
Anticoagulants prevent clots from enlarging and new clots from forming, but they increase bleeding risk. Do not start, stop, or change blood-thinning medication without a clinician.
If you are asking because you or someone nearby has chest pain or sudden breathlessness, treat this as urgent and seek emergency evaluation now.

Find the latest clinical guidelines for pulmonary embolism

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2025 2026 clinical practice guideline acute pulmonary embolism diagnosis treatment site:escardio.org OR site:hematology.org OR site:thoracic.org OR site:nice.org.uk

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"pulmonary embolism"[MeSH Terms] AND guideline[pt]

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https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415

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PMID: 41712677

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PMID: 41354154

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PMID: 40531728

The latest major adult clinical guideline is the multisociety 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. It was published February 19, 2026, in Circulation and JACC. Note that PubMed records an associated erratum, so use the publisher-hosted version for the current corrected text.

Key current guideline sources

  1. 2026 AHA/ACC Multisociety Guideline
    • Scope: adult acute PE from diagnostic evaluation through acute treatment and early follow-up.
    • Introduces AHA/ACC Acute PE Clinical Categories A-E to guide severity assessment, prognosis, site of care, and treatment decisions.
    • Covers anticoagulation, catheter-based and surgical therapies, hemodynamic/respiratory support, discharge planning, and follow-up.
    • It recommends early post-discharge contact or review within 1 week, plus a clinical review by 3 months to reassess anticoagulation duration, symptoms, complications, and further investigations. See the ACC guideline announcement.
    • [Practice Guideline . Tier 6 . 2026] Creager et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline... PMID: 41712677.
  2. ISTH 2026 risk-stratification communication
    • Useful companion document for disposition and treatment decisions.
    • Supports Hestia criteria or PESI/sPESI plus clinical judgment for selecting suitable patients for outpatient management.
    • States that, based on current high-quality evidence, routine reperfusion therapy is not supported in hemodynamically stable PE; hemodynamic instability remains the established indication for reperfusion therapy.
    • [Practice Guideline . Tier 6 . 2026] Talerico et al. PMID: 41354154.
  3. Brazilian Thoracic Association pharmacologic guideline, 2025
    • A recent GRADE-based guideline focused specifically on drug treatment of PE.
    • [Practice Guideline . Tier 6 . 2025] Amado et al. PMID: 40531728.
  4. Chinese acute PE guideline, 2025
    • A recent national diagnosis and treatment guideline.
    • [Practice Guideline . Tier 6 . 2025] Guidelines for the diagnosis and treatment of acute pulmonary embolism 2025 PMID: 40528599.

Practical takeaway

For a current adult PE protocol, use the 2026 AHA/ACC multisociety guideline as the primary reference. The ISTH 2026 document is particularly helpful where the question is outpatient eligibility, monitoring level, or whether a stable intermediate-risk patient should receive reperfusion treatment.
These are professional guidelines, not a substitute for emergency assessment. Suspected PE with acute breathlessness, chest pain, fainting, hemoptysis, shock, or hypoxemia needs urgent evaluation.
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