Definition Pulmonary embolism is when one or more pulmonary arteries in your lungs become blocked.

In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs or rarely other parts of the body (deep vein thrombosis, or DVT). Tests and diagnosis Pulmonary embolism can be difficult to diagnose, especially in people who have underlying heart or lung disease. For that reason, your doctor may order a series of tests to help find the cause of your symptoms. Your doctor may order one or more of the following tests. Blood tests Your doctor may order a blood test for the clot-dissolving substance D dimer in your blood. High levels may suggest an increased likelihood of blood clots, although D dimer levels may be elevated by other factors, including recent surgery. Chest X-ray This noninvasive test shows images of your heart and lungs on film. Although X-rays can't diagnose pulmonary embolism and may even appear normal when pulmonary embolism exists, they can rule out conditions that mimic the disease. Ultrasound A noninvasive "sonar" test known as duplex ultrasonography (sometimes called duplex scan or compression ultrasonography) uses high-frequency sound waves to check for blood clots in your thigh veins. In this test, your doctor uses a wand-shaped device called a transducer to direct the sound waves to the veins being tested. These waves are then reflected back to the transducer and translated into a moving image by a computer. The absence of the presence of clots reduces the likelihood of DVT. If clots are present, treatment likely will be started immediately. CT scan Regular CT scans take X-rays from many different angles and then combine them to form images showing 2-D "slices" of your internal structures. In a spiral (helical) CT scan, the scanner rotates around your body in a spiral like the stripe on a candy cane to create 3-D images. This type of CT can detect abnormalities in the arteries in your lungs with much greater precision, and it's also much faster than are

conventional CT scans. In some cases, contrast material is given intravenously during the CT scan to outline the pulmonary arteries. V/Q lung scan This test uses small amounts of radioactive material to study airflow (ventilation) and blood flow (perfusion) in your lungs. For the first part of the test, you inhale a small amount of radioactive material while a camera that's able to detect radioactive substances takes pictures of the movement of air in your lungs. Then a small amount of radioactive material is injected into a vein in your arm, and pictures are taken as the blood flows into the blood vessels of your lungs. Comparing the results of the two studies helps provide a diagnosis. Pulmonary angiogram This test provides a clear picture of the blood flow in the arteries of your lungs. It's the most accurate way to diagnose pulmonary embolism, but because it requires a high degree of skill to administer and carries potentially serious risks, it's usually performed when other tests fail to provide a definitive diagnosis. MRI MRI scans use radio waves and a powerful magnetic field to produce detailed images of internal structures. Because MRI is expensive, it's usually reserved for pregnant women and people whose kidneys may be harmed by dyes used in other tests. Symptom

Shortness of breath. This symptom typically appears suddenly and always gets worse with exertion. Chest pain. You may feel like you're having a heart attack. The pain may become worse when you breathe deeply (pleurisy), cough, eat, bend or stoop. The pain will get worse with exertion but won't go away when you rest. Cough. The cough may produce bloody or blood-streaked sputum. Complications Pulmonary embolism can be life-threatening. About one-third of people with undiagnosed and untreated pulmonary embolism don't survive. When the condition is diagnosed and treated promptly, however, that number drops dramatically.

Pulmonary embolism can also lead to pulmonary hypertension, a condition in which the blood pressure in your lungs and right side of the heart is too high. When you have obstructions in the arteries inside your lungs, your heart must work harder to push blood through those vessels. This increases the blood pressure within these vessels and the heart and can wear out a section of your heart. Treatments and drugs Medications

Blood thinners (anticoagulants). These drugs prevent new clots from forming, but it may take a few days before these medicines begin to work. Risks include bleeding gums and easy bruising. Clot dissolvers (thrombolytics). While clots usually dissolve on their own, there are medications that can dissolve clots quickly. Because these clot-busting drugs can cause sudden and severe bleeding, they usually are reserved for life-threatening situations. Surgical and other procedures

Clot removal. If you have a very large clot in your lung, your doctor may suggest removing it via a thin, flexible tube (catheter) threaded through your blood vessels. Vein filter. A catheter can also be used to position a filter in the main vein called the inferior vena cava that leads from your legs to the right side of your heart. This filter can block clots from being carried into your lungs. This procedure is typically reserved for people who can't take anticoagulant drugs or when anticoagulant drugs don't work well enough or fast enough. The catheter with a filter in the tip is usually inserted in a vein in your neck.