TROMBOEMBOLISMO PULMONAR Clínica Gasometría ECG Dímero-D (alto VPN) PRUEBAS DE IMAGEN: Diagnóstico de certeza de TEP para garantizar el uso corecto del tratamiento anticoagulante Descartar otras causas de los síntomas Dímero D: productos de degradación del fibrinógeno

TROMBOEMBOLISMO PULMONAR Excluir otras causas de dolor torácico Normal (10-20 %) Atelectasia Derrame pleural Vasoconstricción local (s. de Westermak) Aumento brusco del calibre de una arteria pulmonar (s.de Fleischner) Cor pulmonare agudo Infarto pulmonar: joroba de Hampton RX ANGIOTC (protocolo TEP) Defectos de replección intraluminales arterias pulmonares ECO-DOPPLER MMII TVP Pregnancy is a known risk factor for thromboembolic disease. Diagnosis of PE in the pregnant patient is a challenge because there is concern about iodinizing radiation to the developing fetus. It is generally agreed that the risk of misdiagnosis of PE outweighs the risk of radiation. In a 2002 study of 120 pregnant women who were imaged with VQ scans, there were no adverse effects on 110 live births that were followed to a median of 20.5 months of age [89]. Although the concern for fetal radiation has led some investigators to dismiss CT as a diagnostic tool in pregnancy, a 2002 study found that the average fetal radiation dose for CTPA was less than VQ scans during all trimesters [90]. Despite limited data on CT scan radiation in pregnant women, a survey of thoracic radiologists reported that more than 75% of practices use CTPA in pregnant patients for the diagnosis of PE. Of those, 53% perform CTPA without a nuclear study first [91]. The use of MR imaging has been considered for the pregnant patient because of its lack of radiation; however, until MR imaging improves in availability and accuracy, it seems that helical CTPA with adequate shielding and dose-reduction protocols is likely to be used. Further study is warranted in the diagnosis of PE in the pregnant patient. GAMMAGRAFÍA V/P Rx – y TC contraindicado o no diagnóstico ANGIOGRAFÍA PULMONAR Alta sospecha y TC no concluyente RM Alternativa a gammagrafía en alergia a contraste yodado Trombo arterias principales Función ventrículo derecho ECOCARDIOGRAFÍA

TROMBOEMBOLISMO PULMONAR: Situaciones especiales EMBARAZO1,2 ALERGIA CONTRASTE (CI TC) TC (protocolos baja dosis y protectores bismuto) GAMMAGRAFÍA V/P GAMMAGRAFÍA V/P RM RM 1 Chan WS, Ray JG, Murray S, et al. Suspected pulmonary embolism in pregnancy: clinical presentation, results of lung scanning, and subsequent maternal and pediatric outcomes. Arch Intern Med 2002;162(10):1170–5. 2 Winer-Muram HT, Boone JM, Brown HL, et al. Pulmonary embolism in pregnant patients: fetal radiation dose with helical CT. Radiology 2002; 224(2):487–92.

Infartos pulmonares (joroba de Hampton) y su evolución. tep: evolución infartos pulmonares Infartos pulmonares (joroba de Hampton) y su evolución.

Defectos de repleción en arterias pulmonares y ventrículo derecho

Defectos de repleción en arterias pulmonares Sobrecarga ventrículo derecho