Precapillary Pulmonary Arterial Hypertension Despite Contrary Anchoring Bias:
What Is A Subsegmental Pulmonary Embolism?
A subsegmental pulmonary embolism is a blood clot located on a distal, or distant and less central, branch of the pulmonary arteries. Treatment can depend on symptoms and risk factors.
A subsegmental pulmonary embolism is a type of blood clot on the lung. Subsegmental describes the location of the blood clot.
The arteries in your lungs have a branching pattern. One main branch divides into smaller branches, or segments. These segments are divided further into subsegments.
Compared with pulmonary embolisms located in the segments or in more central locations, blood clots located in the subsegments may have fewer or less defined symptoms, risk factors, and diagnostic markers. Sometimes, doctors may recommend monitoring rather than treating them, but this can depend on individual factors.
Continue reading to learn more about subsegmental pulmonary embolisms, including what causes them, what symptoms they may cause, and how doctors manage them.
Sometimes, doctors discover subsegmental pulmonary embolisms when performing imaging for another health condition. They may also suspect a blood clot based on the results of routine testing and then run additional tests to confirm the diagnosis.
Doctors usually diagnose pulmonary embolisms, including subsegmental pulmonary embolisms, with computed tomography pulmonary angiography, which is a type of CT scan. This test takes images of the blood between the heart and the lungs.
A doctor may order this test if they suspect that you have a pulmonary embolism or DVT based on your symptoms or other test results.
They may also order additional tests to confirm the diagnosis and understand your heart and lung function. These tests may include:
Not every subsegmental pulmonary embolism requires treatment, especially if you don't have risk factors for blood clots and you only have one clot. Instead, a doctor may recommend monitoring the subsegmental pulmonary embolism until it goes away on its own.
However, they may recommend treatment if you:
Treatment for a subsegmental pulmonary embolism involves taking anticoagulants, or blood thinners.
Anticoagulants help break up blood clots. But because they reduce your blood's ability to clot, they can potentially cause side effects like increased bleeding and bruising.
A subsegmental pulmonary embolism is a type of blood clot in a noncentral part of the lung's arteries.
It may cause symptoms like chest pain, or you may have no symptoms at all and only find out about the blood clot during testing for another condition.
Treatment can depend on whether you have other risk factors for blood clots, including a history of blood clots. Doctors typically treat subsegmental pulmonary embolisms with blood thinners.
COVID-19 And Pulmonary Embolism: Is There A Connection?
Cases of COVID-19, particularly severe ones, may increase a person's risk of developing a pulmonary embolism.
COVID-19 is a highly contagious, rapidly spreading illness. It can cause pneumonia, cold, or flu-like symptoms. The condition is often mild, but in some cases, it can be severe or even fatal.
The virus can affect several areas of the body. Even people with mild or no symptoms may develop long lasting issues.
A pulmonary embolism is a blood clot that breaks free and travels to the lungs. The clot cuts off blood supply to the lungs and can be fatal.
Several studies suggest that having COVID-19 may increase a person's risk of developing a pulmonary embolism.
This article explores what scientists have learned about COVID-19 and pulmonary embolism.
Several studies examined how COVID-19 may connect to pulmonary embolism. Researchers started exploring this relationship in 2020, during the height of the pandemic.
In a 2020 case study, researchers described the case of a bilateral pulmonary embolism that occurred following a positive COVID-19 case. The researchers could not draw any firm conclusions about COVID-19 and pulmonary embolism. However, they noted that future studies should further investigate a possible risk factor link, as the person in the study did not have any other risk factors for a pulmonary embolism.
In a 2021 study of over 400 people with COVID-19 in a hospital setting, researchers diagnosed pulmonary embolism in 25% of the individuals, or just over 100. They noted that their findings were a bit higher than those of other studies and reports. In other studies, this figure was about 17% overall and 21% among people with severe cases of COVID-19.
They also noted that people assigned male at birth had a higher overall risk of developing a pulmonary embolism. Additionally, people with severe infection may have a higher risk of developing a pulmonary embolism.
A 2022 study from Sweden examined over 1 million people diagnosed with COVID-19 between 2020 and 2021. The authors found that COVID-19 is an independent risk factor for pulmonary embolism, deep vein thrombosis (DVT), and bleeding events.
Studies also explore how having a pulmonary embolism increases mortality and severe infection risk in those who develop COVID-19.
In a 2023 study, researchers found that duel cases of COVID-19 and pulmonary embolism increased the risk of several severe events, which include:
Another 2023 study found similar results. It concluded that having concurrent cases of both conditions increases the risk of mortality.
It may not be possible to prevent all cases of pulmonary embolism associated with COVID-19.
The long-term complications of COVID-19 are not well understood. It is unknown how COVID-19 may influence post-infection pulmonary embolism events or for how many months following infection a person may be susceptible.
To reduce the risk of pulmonary embolism due to COVID-19, a person should consider a COVID-19 vaccination and stay up to date on booster shots. These can help reduce the risk of infection as well as the potential severity of infection if it occurs.
Some general ways to help prevent DVT, which can lead to pulmonary embolism, include:
Not everyone who has COVID-19 will need treatment or screening for pulmonary embolisms.
Research indicates that people with the highest risk of a pulmonary embolism with COVID-19 are those with severe infection or those who are hospitalized for the infection.
People already taking anticoagulant medication for other conditions may have a protective effect against pulmonary embolism due to COVID-19.
The following sections provide answers to some frequently asked questions about pulmonary embolisms and COVID-19.
What is the life expectancy after pulmonary embolism?
The average life expectancy following a pulmonary embolism can vary.
Healthcare professionals use a pulmonary embolism severity scale when determining the chances a person will survive for 30 days or longer.
A score of 65 or less on the scale means a person has a 1–6% chance of dying within 30 days. A score of 125 or more means a person has a 10 to 24.5% chance of dying within 30 days following a pulmonary embolism.
What are the chances of surviving a blood clot in the lung?
Pulmonary embolism is the third leading cause of cardiovascular-related death in the United States.
Prompt treatment can help improve a person's chances of survival.
The type of blood clot can influence survival. According to an older study from 2013, nearly 25% of people with an acute massive pulmonary embolism die suddenly.
Long-term follow-up studies show that cancer is the leading cause of death in 3- and 5-year follow-ups.
Are blood clots in the lungs common with COVID-19?
Several studies show that COVID-19 is a risk factor for blood clots, particularly in severe cases of the illness.
Scientists generally consider COVID-19 a risk factor for pulmonary embolism. People with severe cases and those who are hospitalized for COVID-19 may have a greater risk.
A person may not be able to prevent a pulmonary embolism due to COVID-19 infection. However, getting the vaccination and boosters may help prevent infection or severe infections.
Pulmonary Embolism Treatments Are Evolving, Says Dr Parth Rali
Therapies for acute pulmonary embolism (PE)—the third most common cause of cardiovascular morbidity and mortality—are transitioning to more specific, localized treatments, said Parth Rali, MD, an associate professor of thoracic medicine and surgery at the Lewis Katz School of Medicine, director of the Temple University Health System Pulmonary Embolism Response Team (PERT), and chair of the National PERT Consortium Protocol Committee.
Transcript
Can you discuss the trials mentioned in your CHEST 2022 session about the latest in acute pulmonary embolism (PE)?
I think it's an exciting world. In 2022, we have come a long way in terms of the treatment. PE treatment has evolved a lot. And at least this year, we have actually not only 1, 2, but at least 4 to 5 clinical trials. And the reason being clinical trials is that they are big, randomized, multi-center, multi-country trials, and they are looking at the various PE treatment options. Some of them are comparing different types of catheter-based therapies. Some of them are comparing standard of care anticoagulation with catheter-based therapy. It's an exciting time. I think the field of PE is at the journey where the treatments are evolving. And I think very soon, we'll have the answers to all these randomized control trials. So hopefully, when we present next year, we would have some of the trial results—we don't have to discuss just the trial designs that we did just in the session today.
What are the key takeaways that you want people to know about pulmonary embolism?
For so long, the treatment of PE consists of 2 treatments, mainly one of them is anticoagulation, which is still the standard of care that everybody with a blood clot should be on—blood thinner. And other form of treatment was a thrombolysis, which is a systemic, meaning that you give a clot buster medication through the IV. And some patients still need that. But clot buster carries the risk of bleeding.
The field has evolved into having different types of local procedures, where you place the catheters into the clot and dissolve the clot. Or sometimes you can place the catheter in the clot and suck out the clot. And those seem to be much safer, but obviously needs a lot of coordination and needs a robust clinical data.
I think some of the catheter-directed treatments needs to be related in terms of safety, in terms of efficacy, and in terms of patient-centered outcomes.
For some of the clinical trials, we're looking at different endpoints. Some of them are looking at, "Are we preventing a patient from getting much sicker into their course?" Some of them are looking at, "What are those patients doing 6 months, 8 months, a year out after the treatment, and what are the long-term consequences of pulmonary embolism?"
We know that 15% of patients who get an acute blood clot will be short of breath or will be impaired after an acute event. And I think this is where we need to have robust clinical data. I think it's not only 1 trial, but all the trials have slightly different endpoints, which is extremely meaningful to the patient-centered outcomes.
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