Clinical importance of the distribution of pulmonary artery embolism in acute pulmonary embolism

Abstract

Objective: To explore the clinical importance of the distribution of pulmonary artery embolism in acute pulmonary embolism (APE).

Methods: Sixty-four patients with APE were classified into mixed-type and distal-type pulmonary embolism groups. Their right ventricular systolic pressure (RVSP) and disease duration were recorded, and the diameter of their right ventricles was measured by ultrasound. The computed tomography angiographic clot load was determined as a Mastora score.

Results: Patients with distal-type pulmonary embolisms had significantly lower RVSPs (44.92 ± 17.04 vs 55.69 ± 17.66 mmHg), and significantly smaller right ventricular diameters (21.08 ± 3.06 vs 23.37 ± 3.48 mm) than those with mixed-type pulmonary embolisms. Additionally, disease duration was significantly longer in patients with distal-type pulmonary embolisms (14.33 ± 11.57 vs 8.10 ± 7.10 days), and they had significantly lower Mastora scores (20.91% ± 18.92% vs 43.96% ± 18.30%) than patients with mixed-type pulmonary embolisms. After treatment, RVSPs decreased significantly in patients with both distal-type and mixed-type pulmonary embolisms. Right ventricle diameters also decreased significantly in patients with mixed-type pulmonary embolisms after treatment.

Conclusion: Patients with mixed-type pulmonary embolisms are significantly more susceptible to pulmonary hypertension, enlarged right ventricular diameters, and shorter durations of disease than those with distal-type pulmonary embolisms. The distribution of pulmonary artery embolism in APE can provide a clinical reference.

Keywords: Mastora score; Pulmonary artery; pulmonary embolism; pulmonary hypertension; ventricular diameter; ventricular systolic pressure.

Figure 1.

CT characteristics of a patient with a distal-type pulmonary embolism. No thrombus was seen in the left and right pulmonary arteries or lobar arteries (a). A pulmonary artery embolus was distributed mainly in the pulmonary segment arteries (b). Red arrows represent embolisms. CT, computed tomography.

Figure 2.

CT characteristics of a patient with a mixed-type pulmonary embolism. The embolism was shown to be distributed in left and right pulmonary arteries (a), as well as left and right pulmonary lobe arteries, and pulmonary segment arteries (b). Red arrows represent embolisms. CT, computed tomography.