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Blood Clots in the Lungs

Pulmonary emboli or blockage of lung arteries

  • The arterial blood (oxygen-rich blood) supply to the lungs via the pulmonary artery or one of its branches can be blocked by matter such as a blood clot (most common), fat, air, tumor (abnormal growth) tissue, bone marrow, amniotic fluid (fluid in the womb), or foreign substances.  This is called a pulmonary embolus (plural emboli).

  • Sudden onset
  • One or multiple symptoms
  • Cough -- may be blood-tinged
  • Shortness of breath
  • Chest pain may be worse with breathing or coughing
  • Pain may be on one side and may worsen with bending forward.
  • Anxiety and restlessness
  • Person may faint (syncope)
  • Sweating
  • Wheezing sound when breathing in or out
  • Rapid shallow breaths
  • Bluish coloration of the lips or skin (cyanosis) due to lack of oxygen in the blood (hypoxia)
  • Rapid, pounding, or Racing Heart rate
  • Edema in the legs
  • Pain in the back of the legs
  • Joint pain
  • Dizziness
  • Pain in the pelvic area
  • Sometimes no symptoms appear
  • Sudden death may occur

  • Deep Vein Thrombosis (DVT) -- blood clots or thrombi sometimes form in the leg veins (carrying oxygen-poor blood) and occasionally dislodge (embolize) from the walls of the veins, traveling through the blood stream into the right side of the heart, then to the pulmonary artery, where they block the blood supply to that particular section of the lung.  This section of lung then undergoes an infarction (i.e., it dies).
  • Emboli can also arise from clots in the right side of the heart.
  • Pieces of tumors invading the circulatory system, fat, air, and other foreign substances can also enter the blood stream and block the arteries supplying different sections (i.e., 5 lobes) of the lungs.
  • Hypercoagulability -- increased tendency for clot formation is seen in certain conditions and with certain medications and drugs.
  • 95% cases of Pulmonary Embolism are due to DVT.

  • History:
  1. Symptoms
  2. Illnesses
  3. Surgeries
  4. Habits
  5. Family history
  6. Medications
  7. Allergies
  • Medical exam:
  1. Rapid heart (tachycardia) and respiratory rate (tachypnea)
  2. Cyanosis
  3. Low Blood Pressure
  4. Doctor may (using stethoscope) hear decreased breath sounds over the infarcted area, wheezing, and friction rub (like sandpaper rubbing together).
  5. Distended neck veins
  6. Galloping heart sound
  7. Tenderness or lump in the back of the leg(Deep Vein Thrombosis)
  • Tests:
  1. Arterial blood gas -- may show hypoxia.
  2. Oxygen levels may be normal.
  3. Other blood tests may be normal, but levels of Antithrombin III (measures risk for clot formation) may provide valuable information.
  4. Chest X-Ray may be normal or may show wedge-shaped area, one-sided elevation of the diaphragm (muscle that pulls air into the lungs), fluids, or collapse.
  5. Electrocardiogram (ECG) (records the electrical activity of the heart) may show characteristic patterns.
  6. To find the source of the clot or infarcted area in the lungs, the following tests may be performed:
  • Pulmonary (lung) scanning or ventilation/perfusion scan (V/Q scan) will show the infarcted segment.
  • Angiography -- injection of a dye into arterial supply will identify the location of the blockage.
  • Echocardiography -- sound used to find the clot in the heart.
  • Spiral CAT scan -- computer generates picture
  • Venous duplex scanning, impedance plethysmography, and Doppler Ultrasound -- look for clots inside the veins (legs, thighs, etc).

  • Prolonged bed rest -- after surgery, elderly with fractures, or illnesses
  • Stroke
  • Heart Failure
  • Pregnancy
  • Obesity
  • Cancers
  • Long air flight travel
  • Advanced age
  • Diabetes
  • Poor circulation to the legs due to Peripheral Vascular Disease
  • Burns
  • Hospitalization
  • Oral contraceptives and estrogen-containing medications
  • Edema or swelling in the legs due to fluid
  • Pelvic fractures (pelvis is the bony region between the hips)

  • Hospitalization
  • Depends on the severity
  • Bed rest
  • Administer oxygen or fluids as needed
  • Pain medication if needed
  • Attempt to dissolve the clot (thrombolysis) and prevent further clot formation with intravenous (inside the veins) use of heparin and warfarin (pill form).
  • Potent clot busters such as streptokinase, urokinase, and TPA are also beneficial but less available and more expensive.
  • In patients unable to receive thrombolytic therapy or are doing very poorly, surgical removal of the embolus (embolectomy) may be beneficial.
  • Some patients with repeated emboli to the lungs or those who cannot take anticoagulants (clot busters) may need a surgical procedure to place an umbrella-like filter in the inferior vena cava (major vein to the heart) to catch the incoming clots.

  • Call 911.  Avoid prolonged bed rest, exercise regularly, walk often during long air flights, and avoid smoking while on estrogen-containing drugs.

  • Pleuritis
  • Pericarditis
  • Pneumonia
  • Heart attack
  • Heart Failure


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