A retrospective study on pattern of pulmonary embolism in chestdepartment-Assiut University

Abstract

Background Pulmonary embolism (PE) is a severe and fatal disease, and its incidence varies widely between countries. Aim To determine the frequency of PE in the Chest Department of Assiut University Hospital, to determine the risk factors and effective treatment, and to study the outcome of the disease in this locality. Patients and methods In this retrospective study, 222 patients suspected to have PE were screened for PE and underwent computed tomography-pulmonary angiogram to confirm or exclude a clinical suspicion of PE. All of the following were collected from patient data sheets: history, clinical examination data, ECG abnormalities, chest radiograph, Doppler ultrasound, echocardiography, chest ultrasound, laboratory reports, treatment lines, and the outcome in the form of mortality, ICU admission, length of hospital stay, and discharge to home. Results Of the included PE cases, all of them received heparin followed by warfarin, except for 10 patients who received rivaroxaban without any toxicity. Warfarin dose needed to reach therapeutic international normalized ratio (between 2 and 3) was 3–9 mg in –85% of the patients. A total of 71 patients needed admission to ICUs, and of them, 24 patients died, but there were no recorded deaths in the ward. Housewives represented 43.7%. The most common symptoms were dyspnea (84%) and chest pain (62%). Tachypnea was the most frequent sign (72%), and hypotension was observed in 13.5%. PE was common in patients with diabetes mellitus, patients with chronic obstructive pulmonary disease (COPD), patients with deep-vein thrombosis, and those who use oral contraceptive pills (18.5, 17.5, 17.1, and 14.4%, respectively). Regarding echocardiography findings, 16.4% of our patients were cardiomyopathic, 74.4% had mild to moderate pulmonary hypertension, with severe pulmonary hypertension detected in only 7% of patients. Computed tomography-pulmonary angiogram revealed main pulmonary artery embolism in 49.09% of the patients, and in 60 (27%) patients, it was bilateral. Conclusion PE is frequent in Upper Egypt. Diabetes and COPD are the most important risk factors of PE. Death owing to PE is markedly associated with OHS and COPD morbidity.