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Pulmonology738 papers

Pulmonary embolism with pulmonary infarction

Last edited: 4/23/2026

Overview

Pulmonary embolism (PE) with pulmonary infarction involves blockage of pulmonary arteries by thrombi, often leading to compromised blood flow and tissue infarction in the lungs. This condition is life-threatening and requires prompt diagnosis and management to prevent severe complications 1251125.

Diagnosis

  • Clinical Presentation: Symptoms include dyspnea, chest pain, tachycardia, and hypoxemia 111.
  • Imaging: CT pulmonary angiography is highly sensitive and specific for diagnosing PE 125.
  • D-dimer Testing: Useful for ruling out PE in low-risk patients; elevated levels support the diagnosis 18.
  • Echocardiography: Can reveal right ventricular strain indicative of PE 133.
  • Thrombus Characterization: Advanced imaging techniques like optical coherence tomography can assess thrombus composition 36.
  • Management

  • Anticoagulation: Initiate with direct oral anticoagulants (DOACs) such as rivaroxaban, apixaban, or edoxaban 82333.
  • Thrombolysis: Consider for massive PE with hemodynamic instability; tissue plasminogen activator (tPA) may be used under strict monitoring 2430.
  • Ventilation Support: Mechanical ventilation may be necessary in cases of severe hypoxemia or respiratory failure 125.
  • Surgical Intervention: Rarely, surgical embolectomy or catheter-directed thrombolysis may be required for massive or recurrent PE 2237.
  • Risk Factor Management: Address underlying conditions like immobility, malignancy, or hypercoagulable states 11155.
  • Special Populations

  • Pregnancy: Increased risk of thromboembolism; careful anticoagulation management with low molecular weight heparin (LMWH) or DOACs is crucial 1155.
  • Elderly: Higher risk of complications; individualized anticoagulation dosing and close monitoring are essential 717.
  • Comorbidities: Patients with conditions like heparin-induced thrombocytopenia require alternative anticoagulants such as argatroban 528.
  • Key Recommendations

  • Initiate anticoagulation with DOACs for most patients with PE, balancing efficacy and safety 8 (Evidence: Strong).
  • Consider thrombolysis in patients with massive PE and hemodynamic instability, under expert supervision 24 (Evidence: Moderate).
  • Use CT pulmonary angiography for definitive diagnosis of PE 125 (Evidence: Strong).
  • Monitor and manage underlying risk factors to prevent recurrence 111 (Evidence: Moderate).
  • Tailor anticoagulation strategies in special populations like pregnancy and the elderly, considering specific risks and benefits 11557 (Evidence: Moderate).
  • References

    Showing 100 most recent of 677 indexed papers.

    1 O'Halloran K, Pentony M, McMahon CJ. Rudimentary Right Ventricle Thrombus Leading to Multifocal Stroke in Fontan Circulation. Irish medical journal 2026. link 2 Fang CL, Liang SH. Intelligent evaluation system for anticoagulant and antiplatelet therapy in surgical patients. International journal of surgery (London, England) 2026. link 3 Huang Y, Yu X, Zhang Q, Guo Y, Wan S, Yao T et al.. Honeybee-mimicking microenvironment-responsive theranostic nanovesicles for enhanced magnetic resonance imaging and targeted thrombolytic therapy. Journal of controlled release : official journal of the Controlled Release Society 2026. link 4 Hu Y, Xiong Y, Zheng T, Wang J, Liu J, Luo R et al.. A dual-functional anti-thrombotic hydrogel coating integrating immunomodulation and surface passivation for vascular implants under inflammatory conditions. Acta biomaterialia 2026. link 5 Yang Y, Xiong Z, He Y, Wang A, Huang X, Liang W. Fatal Pulmonary Embolism Secondary to Heparin-Induced Thrombocytopenia in Hemodialysis: A Case Study. Hemodialysis international. International Symposium on Home Hemodialysis 2026. link 6 Tsante K, Petrou E, Tsalas S, Tsantes AG, Lianou A, Kartelias G et al.. Do we Have the Gut to Beat Thrombosis?. Seminars in thrombosis and hemostasis 2026. link 7 Bulman JC, McNamara SL, Weinstein JL, Kazim N, Khan WQ, Sarwar A. Utilization of Arterial and Venous Thrombectomy in the United States: A 6-Year Evaluation of Medicare Claims. Journal of the American College of Radiology : JACR 2026. link 8 Tran HA, Merriman E, Baker R, Curnow J, Young L, Tan CW et al.. 2025 Guidelines for direct oral anticoagulants: a practical guidance on the prescription, laboratory testing, peri-operative and bleeding management. Internal medicine journal 2025. link 9 Ishida N, Shibata T, Suga Y, Ishizaki J. JADER Database-based Analysis of the Association Between Tranexamic Acid and Thromboembolism and Related Risk Factors. In vivo (Athens, Greece) 2025. link 10 Wong AKC, Chu RYK, Nan Y, Cheng H, Tong D, Leung M et al.. Injection Techniques to Reduce Adverse Effects of Subcutaneous Low-Molecular-Weight Heparin Among Patients With Cardiovascular Diseases: A Scoping Review. Journal of advanced nursing 2025. link 11 Merz LE, Bassa B, Ní Áinle F, Fogerty AE. Thrombotic complications in pregnancy: a case-based review of the evidence. Journal of thrombosis and haemostasis : JTH 2025. link 12 Shaw JR, Nopp S, Stavik B, Youkhana K, Michels AL, Kennes S et al.. Thrombosis, Translational Medicine, and Biomarker Research: Moving the Needle. Journal of the American Heart Association 2025. link 13 Xiang Z, Chen H, Wu F, Pan H. Polyamino Acid Based Zwitterionic Coating can Inhibit Coagulation and Inflammation Through Anti-Fouling and Restoring Microenvironment. Macromolecular bioscience 2025. link 14 Awashra A, Salameh AA, Milhem F, Karmi HB, Thabet TM, Madi H. Right atrial thrombus mimicking cardiac myxoma: surgical and postoperative management. Journal of cardiothoracic surgery 2025. link 15 Jang SY, Roh S, Seo K, Jung Y, Thi HYN, Kim JF et al.. Synergistic coating of Laponite swollen-layer and heparin composite for enhanced antifouling and antithrombotic performance. Carbohydrate polymers 2025. link 16 Igiebor O, Cooper SL, Orr B, Eldredge-Hindy H. Anticoagulation management in gynecologic brachytherapy patients with perioperative or chronic thromboembolic disease: A retrospective analysis. Brachytherapy 2025. link 17 García M, Albizua Madariaga I, Sainz-Gil M, Lertxundi U. Acetazolamide-induced pulmonary oedema: A disproportionality analysis from the EudraVigilance database. British journal of clinical pharmacology 2024. link 18 Prakash S, Mares AC, Porres-Aguilar M, Mukherjee D, Barnes GD. Factor XI/XIa inhibitors for the prevention and treatment of venous and arterial thromboembolism: A narrative review. Vascular medicine (London, England) 2024. link 19 Shen Y, Yu Y, Zhang X, Hu B, Wang N. Progress of nanomaterials in the treatment of thrombus. Drug delivery and translational research 2024. link 20 Lojo-Lendoiro S, Calvin-Álvarez P, Mosquera-Barreiro M. Large thrombus in non-atherosclerotic thoracic ascending aorta as the source of acute upper limb ischemia in a young cocaine user. Vascular 2024. link 21 Sun I, Lee ST, Chen YG, Mao YC, Chen FC, Chen YH et al.. Thromboembolic events following a pit viper bite from Protobothrops mucrosquamatus (Taiwan Habu): A report of two cases. Toxicon : official journal of the International Society on Toxinology 2024. link 22 Tyrka A, Stepniewski J, Hymczak H, Szlósarczyk B, Komar M, Filip G et al.. Percutaneous aspiration of a right atrial thrombus with the AngioVac system. Cardiology journal 2023. link 23 Li YK, Guo CG, Cheung KS, Liu KSH, Leung WK. Risk of Postcolonoscopy Thromboembolic Events: A Real-World Cohort Study. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2023. link 24 Sun M, Hao Pontius MH, Yang S, Pendekanti T, Raghunathan S, Shavit JA et al.. Direct delivery of plasmin using clot-anchoring thrombin-responsive nanoparticles for targeted fibrinolytic therapy. Journal of thrombosis and haemostasis : JTH 2023. link 25 Wang Q, Yin M, Shi Q, Duan Y, Zhao S, Zhou Y. Inferior vena cava injury during percutaneous vertebroplasty: a rare cause of fatal pulmonary thromboembolism. Forensic science, medicine, and pathology 2023. link 26 Messina P, Garcia C, Rambeau J, Darcourt J, Balland R, Carreel B et al.. Impedance-based sensors discriminate among different types of blood thrombi with very high specificity and sensitivity. Journal of neurointerventional surgery 2023. link 27 James AH, Sugrue R, Federspiel JJ. Novel Antithrombotic Agents in Pregnancy Anticoagulants and Antiplatelet Agents. Clinical obstetrics and gynecology 2023. link 28 Woo EJ, Mba-Jonas A, Thomas A, Baer B, Day B, Kim Y et al.. Thromboembolic events after Ad.26.COV2.S COVID-19 vaccine: Reports to the Vaccine Adverse Event Reporting System. Pharmacoepidemiology and drug safety 2022. link 29 Al Rowily A, Jalal Z, Price MJ, Abutaleb MH, Almodiaemgh H, Al Ammari M et al.. Prevalence, contributory factors and severity of medication errors associated with direct-acting oral anticoagulants in adult patients: a systematic review and meta-analysis. European journal of clinical pharmacology 2022. link 30 Disharoon D, Trewyn BG, Herson PS, Marr DWM, Neeves KB. Breaking the fibrinolytic speed limit with microwheel co-delivery of tissue plasminogen activator and plasminogen. Journal of thrombosis and haemostasis : JTH 2022. link 31 Aludin S, Schäfer PJ, Borzikowsky C, Jansen O, Pfarr J, Berndt R et al.. Experimental Evaluation of the Effectiveness of Aspiration-Based Techniques to Treat Different Types of Acute Thromboembolic Occlusions in the Femoropopliteal Vascular System Using an In Vitro Flow Model. Cardiovascular and interventional radiology 2022. link 32 Chang H, Rockman CB, Narula N, Sabari JK, Garg K. Presentation, Diagnosis and Management of Innominate Artery Thromboembolism. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2022. link 33 Vassallo M, Bhakta P. Echocardiography with tissue Doppler imaging may help in bedside differential diagnosis of pulmonary oedema in pregnancy: case report. Anaesthesiology intensive therapy 2022. link 34 Morita N, Sakota D, Oota-Ishigaki A, Kosaka R, Maruyama O, Nishida M et al.. Real-time, non-invasive thrombus detection in an extracorporeal circuit using micro-optical thrombus sensors. The International journal of artificial organs 2021. link 35 Miyaoka M, Hatanaka K, Nakamura N. Hydrophilic Polymer in Thrombus Specimens Obtained During Thrombus Aspiration in the Setting of Percutaneous Interventions in Japan. International journal of surgical pathology 2021. link 36 Liu HC, Abbasi M, Ding YH, Polley EC, Fitzgerald S, Kadirvel R et al.. Characterizing thrombus with multiple red blood cell compositions by optical coherence tomography attenuation coefficient. Journal of biophotonics 2021. link 37 Haupt B, Merkle F, Dreizler T, Falk V, Starck C. Technical implementation of percutaneous thrombus aspiration using the AngioVac system. Perfusion 2021. link 38 Fantoni C, Bertù L, Faioni EM, Froiio C, Mariani N, Ageno W. Safety and effectiveness of biosimilar enoxaparin (Inhixa) for the prevention of thromboembolism in medical and surgical inpatients. Internal and emergency medicine 2021. link 39 Sifuna MW, Koishi M, Uemura T, Tatekawa H, Haneishi H, Sapkota A et al.. Connector sensors for permittivity-based thrombus monitoring in extracorporeal life support. Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 2021. link 40 Wilkowska A, Kujawska-Danecka H, Hajduk A. Letter to Editor. Thromboembolic complications in psychiatry from the perspective of legal claims - authors response. Psychiatria polska 2020. link 41 Newman RJ, Egeler KM, Conkling AL, Savage MY. Multimodality imaging of an azygous continuation of the caudal vena cava in a dog with pulmonary thromboembolic disease. Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association 2020. link 42 Haller PM, Stojkovic S, Piackova E, Andric T, Wisgrill L, Spittler A et al.. The association of P2Y. Platelets 2020. link 43 Khoury H, Lyons R, Sanaiha Y, Rudasill S, Shemin RJ, Benharash P. Deep Venous Thrombosis and Pulmonary Embolism in Cardiac Surgical Patients. The Annals of thoracic surgery 2020. link 44 Scheller I, Stritt S, Beck S, Peng B, Pleines I, Heinze KG et al.. Coactosin-like 1 integrates signaling critical for shear-dependent thrombus formation in mouse platelets. Haematologica 2020. link 45 Douglas A, Fitzgerald S, Pandit A, Doyle KM. Storage of blood clots for histological analysis: How long is too long in saline and paraformaldehyde?. Histology and histopathology 2020. link 46 Karangelis D, Avramidis D, Mousiama T, Karamitsos TD, Mitropoulos F, Tzifa A. Levoatriocardinal Vein: A Rarely Recognized Cause of Recurrent Cardiac and Cerebral Thromboembolic Events. The Canadian journal of cardiology 2020. link 47 Schurman AM, Cain MT, Joyce DL, Durham LA, Ishizawar D, Mohammed A et al.. Minimally Invasive Mechanical Circulatory Support Through the Perioperative Pulmonary Thromboendarterectomy Period: A Case Report. Innovations (Philadelphia, Pa.) 2020. link 48 Skowronek R, Krzystanek M, Chudek J. Letter to Editor. Thromboembolic complications in psychiatry from the perspective of legal claims. Psychiatria polska 2019. link 49 Domingues CM, Matos V, Ferreira A, Jorge E, Bernardo J, Gonçalves L. Closure of bronchopleural fistula by a septal occluder device: a case for close collaboration between heart and lung specialists. BMJ case reports 2019. link 50 Lee SN, Yoo KD, Jo MS. Successful Endovascular Management of Common Femoral Artery Perforation During Cannulation for Extracorporeal Membrane Oxygenation. International heart journal 2019. link 51 Wu X, Gong Y, Ding X, Cheng G, Yan W, She X et al.. Retrovirus-Mediated Transfection of the Tissue-type Plasminogen Activator Gene Results in Increased Thrombolysis of Blood Clots. Biochemical genetics 2019. link 52 Sousa Gomes M, Guimarães M, Montenegro N. Thrombolysis in pregnancy: a literature review. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2019. link 53 Peng S, Xue G, Chen S, Chen Z, Yuan C, Li J et al.. tPA Point Mutation at Autolysis Loop Enhances Resistance to PAI-1 Inhibition and Catalytic Activity. Thrombosis and haemostasis 2019. link 54 Byard RW. Differential intimal staining of the aortic root and pulmonary trunk following pulmonary thromboembolism. Forensic science, medicine, and pathology 2019. link 55 . ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy. Obstetrics and gynecology 2018. link 56 Reis J, Alomari AI, Trenor CC, Adams DM, Fishman SJ, Spencer SA et al.. Pulmonary thromboembolic events in patients with congenital lipomatous overgrowth, vascular malformations, epidermal nevi, and spinal/skeletal abnormalities and Klippel-Trénaunay syndrome. Journal of vascular surgery. Venous and lymphatic disorders 2018. link 57 Sirachainan N, Chuansumrit A, Sasanakul W, Yudhasompop N, Mahaklan L, Vaewpanich J et al.. R147W in PROC Gene Is a Risk Factor of Thromboembolism in Thai Children. Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis 2018. link 58 Moffett BS, Lee-Kim Y, Galati M, Mahoney D, Shah MD, Teruya J et al.. Population Pharmacokinetics of Enoxaparin in Pediatric Patients. The Annals of pharmacotherapy 2018. link 59 Kim JH, Lee KA, Jung MY, Kim AR, Yoon JM, Shim HJ et al.. Pulmonary thromboembolism in patient with coexistence of Behçet's disease and antiphospholipid syndrome. International journal of rheumatic diseases 2018. link 60 Später T, Müller I, Eichler H, Menger MD, Laschke MW, Ampofo E. Dual inhibition of PI3K and mTOR by VS-5584 suppresses thrombus formation. Platelets 2018. link 61 Sirachainan N, Limrungsikul A, Chuansumrit A, Nuntnarumit P, Thampratankul L, Wangruangsathit S et al.. Incidences, risk factors and outcomes of neonatal thromboembolism. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2018. link 62 Burgos LM, Costabel JP, Galizia Brito V, Sigal A, Maymo D, Iribarren A et al.. Floating right heart thrombi: A pooled analysis of cases reported over the past 10years. The American journal of emergency medicine 2018. link 63 Jacobs A, Kabra R, Das P, Oliphant CS. Update on the use of direct oral anticoagulants for the prevention and treatment of thromboembolism. Future cardiology 2018. link 64 Yu L, Guo X, Jia S, Xiang Y, Ding Z, Guo R. Pharmacodynamic properties and bioequivalence of dalteparin sodium subcutaneous injection in healthy Chinese male subjects. Xenobiotica; the fate of foreign compounds in biological systems 2018. link 65 Walters KJ, Meador A, Galdo JA, Ciarrocca K. A pharmacotherapy review of the novel, oral antithrombotics. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry 2017. link 66 Jacobs A, Bassa F, Decloedt EH. A preliminary review of warfarin toxicity in a tertiary hospital in Cape Town, South Africa. Cardiovascular journal of Africa 2017. link 67 Kurtipek E, Büyükterzi Z, Büyükterzi M, Alpaydın MS, Erdem SS. Endothelial dysfunction in patients with pulmonary thromboembolism: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio. The clinical respiratory journal 2017. link 68 Adivitiya, Khasa YP. The evolution of recombinant thrombolytics: Current status and future directions. Bioengineered 2017. link 69 Foschi N, Ragonese M, Grassi VM, De Matteis V, De-Giorgio F. The periprostatic venous plexus: an unusual source of fatal pulmonary embolism during corporoplasty. International journal of legal medicine 2017. link 70 Shirai S, Hirano K, Kobayashi N. New endovascular technique for thrombus in the non-stenting zone-the Grab a Clot and Hold ON "(GACHON) technique": Case report. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2017. link 71 Xie Z, Oscar B, Zhao L, Ding X, Cao C, Feng S et al.. Design, synthesis and evaluation of novel 2-amino-3-(naphth-2-yl)propanoic acid derivatives as potent inhibitors of platelet aggregation. European journal of medicinal chemistry 2017. link 72 Tepper NK, Dragoman MV, Gaffield ME, Curtis KM. Nonoral combined hormonal contraceptives and thromboembolism: a systematic review. Contraception 2017. link 73 Komwilaisak P, Sasanakul W, Chuansumrit A, Kanjanapongkul S, Wangruangsathit S, Lusawat A et al.. Genotypes and phenotypes of protein S deficiency in Thai children with thromboembolism. Pediatric blood & cancer 2017. link 74 Erer OF, Cimen P, Unlu M, Katgi N. Four cases of pulmonary thromboembolism diagnosed by endobronchial ultrasound. Journal of clinical ultrasound : JCU 2017. link 75 Vaidya B, Nayak MK, Dash D, Agrawal GP, Vyas SP. Development and characterization of highly selective target-sensitive liposomes for the delivery of streptokinase: in vitro/in vivo studies. Drug delivery 2016. link 76 Liu M, Menzoian JO. 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    Original source

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      Rudimentary Right Ventricle Thrombus Leading to Multifocal Stroke in Fontan Circulation.O'Halloran K, Pentony M, McMahon CJ Irish medical journal (2026)
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      Honeybee-mimicking microenvironment-responsive theranostic nanovesicles for enhanced magnetic resonance imaging and targeted thrombolytic therapy.Huang Y, Yu X, Zhang Q, Guo Y, Wan S, Yao T et al. Journal of controlled release : official journal of the Controlled Release Society (2026)
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      Fatal Pulmonary Embolism Secondary to Heparin-Induced Thrombocytopenia in Hemodialysis: A Case Study.Yang Y, Xiong Z, He Y, Wang A, Huang X, Liang W Hemodialysis international. International Symposium on Home Hemodialysis (2026)
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      Do we Have the Gut to Beat Thrombosis?Tsante K, Petrou E, Tsalas S, Tsantes AG, Lianou A, Kartelias G et al. Seminars in thrombosis and hemostasis (2026)
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      Utilization of Arterial and Venous Thrombectomy in the United States: A 6-Year Evaluation of Medicare Claims.Bulman JC, McNamara SL, Weinstein JL, Kazim N, Khan WQ, Sarwar A Journal of the American College of Radiology : JACR (2026)
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      Synergistic coating of Laponite swollen-layer and heparin composite for enhanced antifouling and antithrombotic performance.Jang SY, Roh S, Seo K, Jung Y, Thi HYN, Kim JF et al. Carbohydrate polymers (2025)
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