Immediate post-traumatic pulmonary embolism is not associated with right ventricular dysfunction
Gelbard RB, Karamanos E, Farhoomand A, Keeling WB, McDaniel MC, Wyrzykowski AD, Shafii SM, Rajani RR. Immediate post-traumatic pulmonary embolism is not associated with right ventricular dysfunction. Am J Surg. 2016 Oct;212(4):769-774.
American journal of surgery
BACKGROUND: Post-traumatic pulmonary embolic events are associated with significant morbidity. Computed tomographic (CT) measurements can be predictive of right ventricular (RV) dysfunction after pulmonary embolus. However, it remains unclear whether these physiologic effects or clinical outcomes differ between early (<48 >hours) vs late (≥48 hours) post-traumatic pulmonary embolism (PE).
METHODS: All patients with traumatic injury and CT evidence of PE between 2008 and 2013 were identified. The study population was divided into 2 groups based on the time of diagnosis of the PE. The primary outcome was PE-related mortality.
RESULTS: Fifty patients were identified (14 early PE and 36 late PE). Patients sustaining a late PE had a higher PE-related mortality rate (16.7% vs 0%), larger RV diameters, RV/left ventricular diameter ratios, RV volumes, and RV/left ventricular volume ratios (all P < .05).
CONCLUSIONS: Early post-traumatic PE appears to be associated with fewer RV physiologic changes than late post-traumatic PE and may be representative of primary pulmonary thrombosis. It remains to be seen whether early CT findings of PE should be managed according to previously established guidelines for embolic disease.
Medical Subject Headings
Adult; Computed Tomography Angiography; Female; Heart Ventricles; Humans; Male; Middle Aged; Prognosis; Pulmonary Embolism; Retrospective Studies; Time Factors; Ventricular Dysfunction, Right; Wounds and Injuries