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Pulmonary Thromboembolism G025

Document
Last amended 
5 February 2018
Current RMA Instruments
Reasonable Hypothesis
56 of 2012
Balance of Probabilities
57 of 2012
Changes from previous Instruments

SOP Bulletin 161

ICD Coding
  • ICD-9-CM Codes: 415.1
  • ICD-10-AM Codes: I26
Brief description

This SOP covers blood clots that have lodged in the lungs, having broken off from: the deep veins draining the limbs; the right side of the heart; or the veins draining other organs (e.g. liver, kidney).

Clinical manifestations depend on the size and number of the clots. They may be asymptomatic, or cause acute shortness of breath, pleuritic chest pain, or, if large enough, sudden death.

Confirming the diagnosis

This is a complicated diagnosis normally requiring arterial blood gases, and a Lung scintiscan, also known as a Ventilation Perfusion scan or V/Q scan. Diagnosis may also be made using spiral CT angiography, or an autopsy.

The relevant medical specialist is an emergency physician or a respiratory physician.

Additional diagnoses covered by SOP
  • Nil
Conditions not covered by SOP

Pulmonary embolism due to other than a blood clot (all non-SOP conditions), i.e.:

  • Air embolism
  • Fat embolism
  • Amniotic fluid embolism
  • Arthroplasty cement emboli
  • Catheter emboli
  • Emboli of other foreign substance or hair
Clinical onset

The presentation can be anywhere from no symptoms to shock or sudden death.  An acute presentation with rapid onset of shortness of breath and/or pleuritic chest pain is most common, but symptoms can also be mild and non-specific.  Diagnosis can be delayed by days or weeks after the initial event.  With chronic recurrent pulmonary embolism the first sign may be the detection of pulmonary hypertension years later.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical managment.  This factor is most likely to be relevant in the immediate period (hours to weeks) following an embolism, where appropriate treatment could potentially prevent recurrences and complications.