Book of Medical Disorders in Pregnancy - Tintash

The alveolar capillaries rupture and the
alveoli become tightly packed with
blood cells and finally infarct is formed.
The infarct can extend to the surface of
the lung.
Clinical features:
Pulmonary embolism, like deep venous
thrombosis, manifests itself on the 8th
post operative day, but can occur earlier
if the patient had been kept in hospital
for longer periods before operation. The
longer the patient is kept resting and
immobilized in hospital for medical
investigations, the greater the risk of
embolization. The patient complains of
pleural pain over the affected area of the
lung. Hemoptysis may occur either
before or after the development of pain,
tachycardia and/or slight dyspnea may
be present. The temperature may rise to
about 37.80C (100°F). A pleural rub
may be audible. The diaphragm may be
raised on the affected side due to reflex
paralysis.
X-ray - Lungs may reveal the infarct in
the lower lobe. The complication occurs
more frequently on the right side.
Small embolus with infarction - This
condition is much more common than is
generally realized. There may be no
signs, or symptoms. Sometimes these
small emboli cause transient syncopal
attacks. The patient may feel faint and
sweaty and have tachycardia, but the
attack passes off in a few minutes. This
occurs between the fourth and eighth.
Day of the puerperium. Unfortunately
these symptoms are often dismissed by
the physician as being due to postural
hypotension following long and
continuous stay in bed. If these emboli
could be recognized and anticoagulant
142
therapy is started the risk of further and
larger emboli can be very much reduced.
Minor degrees of embolism - These
may result in peripheral infarction of the
lung and present by way of pain over
one or other lung. This quickly leads to
pleurisy and the pain becomes worse by
deep breathing and by any movement of
the chest wall. Cough and blood stained
sputum may develop. There may also
develop clinical signs of consolidation of
the lung at this stage. Pyrexia is
generally a prominent feature and
persists for a considerable time
especially if a pleural effusion develops.
The sequence of clinical features makes
it easy for the student to confuse it with
a painful muscular condition, and for
pleurisy and pneumonia.
Massive embolism - The patient
complains of sudden violent pain in the
chest; which is followed by shock or
even death from ventricular fibrillation
or cardiac arrest. Severe dyspnea is
usually a leading symptom but generally
this is followed by initial non-fatal chest
pain and collapse. Tachycardia, cyanosis
and congestion of the neck veins, may be
noticeable and the patient becomes
mentally confused or comatose.
Large pulmonary embolus - A large
thrombus may break free and reaches
pulmonary artery through the heart and
occlude it. The pressure in the artery
rises and the right ventricle dilates.
Similarly the neck veins are dilated.
Liver is enlarged, and a gallop rhythm
may be heard at the lower end of the
sternum. Occasionally a pericardial
friction rub may be heard over the
pulmonary artery. The systemic blood
pressure falls, the patient looks pale and