Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei
Hayeshua Hospital
Sometimes the lungs are affected by diseases that have
little to do with them. One of the most feared diseases is
pulmonary embolism. Embolism is a medical word describing
the sending of a clot or other solid material from one place
in the body to another, where it could cause havoc. We have
described such a case with the heart and atrial fibrillation
where clots in the heart can reach the brain and cause a
stroke.
If there is a clot in the legs, the legs will usually puff
up and get red. It can look almost like an infection. Should
a piece of this clot break off and reach the major vessels
of the lungs it could stop up the vessel and create a
situation where little blood reaches the lung and death can
occur.
The problem is that this clot in the legs, which is called
DVT, can be hard to notice or it may be hard to say it is a
clot and not an infection. A pulmonary embolus, that is a
clot to the lung, may be really hard to pick up and no test
is that close to 100%. It simply causes shortness of breath
and a negative x- ray.
When one has a tough disease like this, we start to depend
on risk factors. These include cancer, especially a new one
and this may be the first sign; prolonged immobilization
(this is why one should walk around in a plane and make
frequent stops to walk around while on a long drive); recent
surgery, especially pelvic surgery or fractures of the
pelvis or the hip; clotting disorders, and pregnancy. A
swollen leg or shortness of breath with one of these risk
factors should raise a red flag.
The treatment is prolonged anticoagulants, that is blood
thinners. During therapy, one must be very careful about
falls or other things that cause bleeding; and have the
thinning be monitored by blood tests.
Other things can embolize to the lungs but are a lot rarer.
Two of these of note are amniotic fluid embolism, where some
of the fluid surrounding the baby escapes into the mother's
blood stream and blocks up a vessel, and fat embolism, where
a break in a major bone causes the fat in the bone to also
get into a vessel. These conditions are both rare and
dangerous.
This is all scary, but like everything else, being aware and
cautious may save your life. Write me in care of the Yated.
(A special hello to the Rabins from Kiryat Sefer who met me
in the supermarket and said such nice things about this
column. I appreciate your comments!)
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