# **🫁 Pulmonary Embolism (PE) — Prof Buster Style Notes (Dr. Priyanka Sachdev Style)** --- # **Pulmonary Embolism (PE)** ## **Definition** * **Pulmonary embolism (PE)** = Blockage of the **pulmonary arterial tree** by an **embolus**, usually a thromboembolus from **deep vein thrombosis (DVT).** --- # **Site of Origin of Emboli (Most Important)** 👉 **≈95% arise from Deep Vein Thrombosis (DVT) of lower limb** Deep veins involved: * Popliteal vein * Femoral vein * Iliac vein ⭐ (Most fatal emboli arise from **iliofemoral veins**) Other sources: * Pelvic veins * Inferior vena cava (IVC) --- # **Risk Factors** Remember: **"POST-OP + OLD + OBESE + CANCER + VEINS"** * Prolonged surgery/immobilization * Postoperative infection * Major surgery * Increasing age * Obesity * Malignancy (Cancer) * Pre-existing venous disease --- # **Mechanism (Flowchart)** ``` Deep Vein Thrombosis (DVT)             ↓  Fragmentation of thrombus             ↓      Thromboemboli formed             ↓      Inferior vena cava             ↓       Right atrium             ↓      Right ventricle             ↓  Pulmonary artery & branches             ↓  Pulmonary embolism (PE) ``` --- # **Fate of Pulmonary Embolism** ## **1. Resolution / Organization (Small PE)** * Travels into small pulmonary arteries * **60–80% are clinically silent** * Resolves completely **OR** * Gets organized and incorporated into vessel wall --- ## **2. Massive Pulmonary Embolism** ### Definition * Obstruction of **≥60% of pulmonary circulation** ### Significance * Most dramatic fatal complication of DVT ### Saddle Embolus ⭐ **Definition** * Large embolus lodged at **bifurcation of main pulmonary artery** ### Effects * Blocks blood flow to **both lungs** * Acute right ventricular failure * ↓ Left ventricular cardiac output * Severe hypotension (Shock) * **Sudden death** --- ## **3. Multiple Recurrent Pulmonary Emboli** * Repeated emboli may fuse into one large mass * Patients with one PE are prone to recurrent PE --- ## **4. Paradoxical Embolism** * Rare * Venous embolus passes through:   * ASD   * VSD * Enters systemic circulation --- # **Consequences of Pulmonary Embolism** ## **1. Pulmonary Infarction** ### Occurrence * **75% of small emboli do NOT cause infarction** * More common in:   * Congestive heart failure (CHF)   * Chronic lung disease ### Gross Features **Type** * Hemorrhagic (red) infarct * Due to dual blood supply from bronchial arteries **Shape** * Wedge/Pyramidal * Base → Pleural surface * Apex → Hilum * Later blood is resorbed → Center becomes pale ### Fate * Granulation tissue develops * Organization * Fibrous scar formation ### Clinical Features * Cough * Stabbing pleuritic chest pain * Dyspnea (Shortness of breath) * Hemoptysis * Blood-stained pleural effusion --- ## **2. Pulmonary Hemorrhage** Cause: * Embolus blocks medium-sized pulmonary artery * Vessel ruptures * Pulmonary hemorrhage occurs --- ## **3. Pulmonary Hypertension** Cause: * Multiple recurrent emboli * Mechanical obstruction of pulmonary arterial bed Leads to: * Pulmonary hypertension * Right ventricular failure (Cor pulmonale) --- ## **4. Minimal Effect** * Small end-arteriolar emboli * Usually **no hemorrhage** * No infarction --- Create HTML based illustrated mindmap infographics as per the given text. Nothing must be skipped and changed from given text, include everything.