الفهرس 
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Abstract
Pulmonary embolism (PE) is a relatively common cardiovascular emergency. Acute PE is the most serious clinical presentation of VTE. PE is the consequence of deep vein thrombosis (DVT). PE may be completely asymptomatic and be discovered incidentally during diagnostic work-up for another disease or at autopsy.
Venous thromboembolism (VTE) encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE). It is the third most frequent cardiovascular disease. VTE may be lethal in the acute phase or lead to chronic disease and disability, but it is also often preventable.
Risk factors:
Approximately half of diagnosed venous thromboembolic events are classed as reversible (caused by a known risk factor or factors), the other half are (idiopathic), meaning that the cause is not known. Known risk factors for VTE are either reversible (temporary) or not (intrinsic) which are:
Surgery “especially major orthopaedic surgery ”, trauma, immobilization, pregnancy, oral contraceptive use or hormone replacement therapy, Infection ,Blood transfusion and erythropoiesis-stimulating agents and because of VTE may be viewed as part of the cardiovascular disease, it shared common risk factors of atherosclerosis as cigarette smoking, obesity, hypercholesterolaemia, hypertension and diabetes mellitus.
Natural history:
Thrombosis that occurs in association with surgery usually starts in the deep veins of the calf, often originating in the valve cusps. Leg scanning and venographic studies have shown that such thrombi often begin intraoperatively. About half of such calf DVTs resolve spontaneously within 72 hours, and only about one sixth extend to involve the proximal veins. Extension to the proximal veins greatly increases the risk of PE.
Moreover, the natural history of treated VTE via: anticoagulation is the mainstay of treatment of symptomatic VTE. Anticoagulation prevents further thrombus deposition, allows established thrombus to undergo stabilization and/or endogenous lysis, and reduces the risk of interval recurrent thrombosis.
Pathophysiology:
Acute PE interferes with both the circulation and gas exchange.
Symptoms:
PE may escape prompt diagnosis since the clinical signs and symptoms are non-specific.
In most patients, PE is suspected on the basis of acute onset of shortness of breath; dyspnea is the most frequent symptom of PE). Syncope (with a massive PE), chest pain.
The diagnosis of acute PE is based on direct evidence of a thrombus in two projections, either as a filling defect or as amputation of a pulmonary arterial branch in CT pulmonary angiography.
Assessment of clinical probability(by wells score)
Diagnosis
PE is assayed by D-dimers test, computed tomographic (CT) angiography has become the method of choice for imaging the pulmonary vasculature in patients with suspected PE, Magnetic resonance angiography, Echocardiography and Compression venous ultrasonography.
Treatment in the acute phase:
• Haemodynamic and respiratory support
• Anticoagulation
• Thrombolytic treatment
• Percutaneous catheter-directed treatment
The aim of this study to assess clinical presentation, risk stratification and management of different patients admitted to main university hospitals with confirmed diagnosis of acute pulmonary embolism.
This study will be carried out on patients admitted at least one hundred patients with confirmed diagnosis of ACUTE PULMONARY EMBOLISM to Alexandria university hospitals.
Our study is in accordance with the study of Paul D. Stein and Michel Meignan from that, patients with proximal DVT are more likely to have a symptomatic PE than those with distal DVT.