N.A. TSIBULKIN¹, E.B. FROLOVA², A.I. ABDRAHMANOVA³, G.V. TUKHVATULLINA⁴

¹Kazan State Medical Academy ― Branch Campus of RMACPE MH Russia, Каzan

²Municipal Clinical Hospital №7, Kazan

³Kazan (Volga region) Federal University, Kazan

⁴Clinical Hospital of Medical Unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Kazan

Contact:

Tsibulkin N.A. ― PhD (medicine), Associate Professor of the Department of Cardiology, Roentgenendovascular and Cardiovascular Surgery

Address: 36 Butlerov Str., Kazan, Russian Federation, 420012, tel. (843) 261-74-11, e-mail: [email protected]

Relevance. Pulmonary embolism (PE) is a frequent urgent cardiovascular conditions. The main cause of PE is thrombosis of deep veins of lower limbs. Simultaneous presence of PE and venous thrombosis is known as venous thromboembolism.

Objective ― to characterize the modern scientific data on PE development mechanisms, epidemiology and diagnostics.

Material and methods. Analysis of modern scientific data from available literary sources devoted to epidemiology, pathogenesis and diagnostics of PE.

Results. There is trend to reduction of PE fatality, but this is attributed to increase in subclinical cases detected by high-tech diagnostic methods. About one third of patients with venous thromboembolism come with signs of PE, while two thirds have symptoms of venous thrombosis. Data indicate that venous thrombosis is not the only cause of PE. About two thirds of patients with venous thrombosis have no data for PE, and about one third of patients with PE have no signs of venous thrombosis. Alternative factors for PE development may be hormonal contraceptives, chemotherapeutic drugs, antiphospholipid syndrome, congenital thrombophilia, transient hypercoagulate states, sickle cell anemia, and systemic vasculitis.

Conclusion. Severe cases of PE are likely associated with venous thrombosis, whereas low-symptom or subclinical variants may have other mechanisms.

Key words: pulmonary embolism, pathophysiology, diagnostics.

(For citation: Tsibulkin N.A., frolova e.b., Abdrahmanova A.I., Tukhvatullina G.V. Current issues of pathogenesis and diagnostics of pulmonary embolism. Practical medicine. 2020. Vol. 18, №1, P. 8-12)

REFERENCES

1. Wendelboe A., Raskob G. Global burden of thrombosis: epidemiologic aspects. Res, 2016, 118, pp. 1340-1347.
2. Office for National Statistics. Deaths registered in England and Wales: 2018, London: Office for National Statistics, 2019, available at: https://www.ons.gov.uk [accessed on: 03.03.2020].
3. Park B., Messina L., Dargon P., et al. Recent trends in clinical outcomes and resource utilization for pulmonary embolism in the United States: findings from the nationwide inpatient sample. Chest, 2009, Oct, 136 (4), pp. 983-990.
4. De Miguel-Díez J., Jiménez-García R., Jiménez D., et al. Trends in hospital admissions for pulmonary embolism in Spain from 2002 to 2011. Respir. J, 2014, Oct, 44 (4), pp. 942-950.
5. Cohen A., Agnelli G., Anderson F., et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost, 2007, 98, pp. 756-764.
6. Keller K., Hobohm L., Ebner M., et al. Trends in thrombolytic treatment and outcomes of acute pulmonary embolism in Germany. Heart J, 2020, 41, pp. 522-529.
7. Lehnert P., Lange T., Moller C. et al. Acute pulmonary embolism in a national Danish cohort: increasing incidence and decreasing mortality. Thromb Haemost, 2018, 118, pp. 539-546.
8. Schattner A. Computed Tomographic Pulmonary Angiography to Diagnose Acute Pulmonary Embolism: The Good, the Bad, and the Ugly: Comment on “The Prevalence of Clinically Relevant Incidental Findings on Chest Computed Tomographic Angiograms Ordered to Diagnose Pulmonary Embolism”. Intern. Med, 2009, 169 (21), pp. 1966-1968.
9. White R. The epidemiology of venous thromboembolism. Circulation, 2003, 107 (23 suppl 1), pp. 14-18.
10. Kearon C. Natural history of venous thromboembolism. Circulation, 2003, 107 (23 suppl 1), pp. 122-130.
11. Moser K., Fedullo P., Litte John J., Crawford R. Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. JAMA, 1994, 271 (3), pp. 223-225.
12. Anderson F. Jr, Spencer F. Risk factors for venous thromboembolism. Circulation, 2003, 107 (23 suppl 1), p. I10.
13. Eckardt P., Raez L., Restrepo A., Temple J. Pulmonary Bone Marrow Embolism in Sickle Cell Disease. South Med. J, 1999, 92 (2), pp. 245-247.
14. Castro O. Systemic Fat Embolism and Pulmonary Hypertension in Sickle Cell Disease. Oncol. Clin. North Am, 1996, 10 (6), pp. 1289-1303.
15. Thickett D., Richter A., Nathani N. et al. Pulmonary manifestations of anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis. Rheumatology (Oxford), 2006, 45, pp. 261-268.
16. Jennette J., Falk R., Bacon P. et al. 2012 revised international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum, 2013, 65, pp. 1-11.
17. Carrier M., Righini M., Wells P.S. et al. Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies. Thromb Haemost, 2010, 8, pp. 1716-1722.
18. Patel S., Kazerooni E., Cascade P. Pulmonary embolism: optimization of small pulmonary artery visualization at multi-detector row CT. Radiology, 2003, 227, pp. 455-460.
19. Newman D., Schriger D. Rethinking testing for pulmonary embolism: less is more. Ann Emerg. Med, 2011, 57 (6), pp. 622-627.
20. Wiener R., Schwartz L., Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Intern. Med, 2011, 171, pp. 831-837.
21. Galli C., Lippi G. High-sensitivity cardiac troponin testing in routine practice: economic and organizational advantages. Transl. Med, 2016, 4 (13), pp. 257. doi:10.21037/atm.2016.07.04.
22. Ceriani E., Combescure C., Le Gal G., et al. Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis. Thromb. Haemost, 2010, 8, pp. 957-970.
23. Righini M., Robert-Ebadi H., Le Gal G. Diagnosis of acute pulmonary embolism. Thromb. Haemost, 2017, 15, pp. 1251-1261.
24. Konstantinides S., Meyer G., Becattini C., et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). European Heart Journal, 2020, 41, pp. 543-603.
25. Kumar P., Clark M. Clinical Medicine, 6^th Elsevier Saunders, 2005. 1508 p., 844.
26. Sengodan P., Grewal H., Gandhi S. Invasive hepatocellular carcinoma with recurrent pulmonary embolism: use of AngioVac cannula thrombectomy device for mechanical aspiration. Invasive Cardiol, 2014, 26 (7), pp. E100-E103.