Does Pulmonary Embolism cause unilateral or bilateral pleuritic chest pain?

Answer 1

In my 13 years of emergency care, I don't recall any patient of mine diagnosed with Pulmonary Embolism complaining of bilateral pleuritic chest pain. It was always unilateral.

Then again, life is a mystery as they say. So I'm sure bilateral pleuritic chest pain in pulmonary embolism must have occured somewhere sometime.

Answer 2

My what a lot of Latin.

An embolism is an interruption of the blood flow at a specific point caused by anything from a blood clot to air in the vessel.

Pulmonary embolism simply means one of these in the lung/s

unilateral and bilateral is Latin for one sided and two sided respectively and the pleura means the serous membrane lining the thorax and enveloping each lung. Pleuritic means of the pleura, so technically pulmonary embolism does not cause pleuritic chest pain, which is more normally caused by pleurisy, or inflammation of / infection in the pleura.

Taking pleuritic chest pain in its' less technical sense of meaning pain within the pleural cavity including the lungs, then Pulmonary Embolism is most likely to be unilateral, (or mono-lateral), as you would be unlucky, and possibly dead if both lungs were affected.

Answer 3

Pulmonary embolism doesn't typically cause pleuritic chest pain. In fact, there is seldom any pain involved at all. Pleuritic chest pain is where the lining of the chest wall itself is irritated. This is localizable - i.e., you can tell exactly where it is irritated, and typically the pain is exacerbated by the action of the lung rubbing up and down over that spot during the respiratory cycle. Sometimes this can actually be appreciated with a stethoscope as a "friction rub". Infection or injury to the surface of the lung or chest lining would cause this. It must be differentiated from chest wall pain, which occurs in the musculoskeletal layer and is completely different.

PE (pulmonary embolus) is where a blood clot forms in the venous system and then breaks loose, floating into and through the right side of the heart before being pumped out into the lung by way of the pulmonary arteries. For people who have normal hearts, lungs and blood vessels, a fairly large pulmonary embolus (or large shower of small emboli) can be tolerated. Smaller embolic events can be very difficult to detect.

The larger events are associated with clots which form in the deep veins of the leg. These clots can be fairly long and reasonably girthy. When they wedge in the lung vessels, they block flow to a large amount of lung tissue, and the result is that the body's ability to oxygenate blood is significantly compromised. Additionally, if there is a large enough blockage to the out-flow from the right side of the heart, there can be heart strain as well.

Signs and symptoms of a PE can range from nothing at all, to mild tachycardia (high heart rate) with shortness of breath, to frank respiratory distress with obvious laboratory evidence of severe hypoxia, to cardiac chest pain, and even to sudden death without any warning.

The MOST IMPORTANT aspect of evaluating someone who is at risk for PE is to ultrasound the veins of the legs. If they have a clot, they need to be anticoagulated immediately. Someone who has a clot which grows despite anticoagulation needs to have a filter device deployed within the vena cava.

For people who have already had a PE, the treatment is also anticoagulation. The reason for this is not to make the clot dissolve! Anticoagulating medicines do not dissolve clots, they stop new clot from forming. The reason that we anticoagulate is to prevent the NEXT PE since this one, by assumption, didn't kill the patient.

For severe cardiac compromise that results from a PE, and where the patient is detected early using high resolution CT scans of the chest or using pulmonary arteriograms, there are occassionally cases where the clot can actually be taken out of the pulmonary artery and the life saved. This is rare. Open chest surgery for PE is almost uniformly fatal. Suction catheters delivered into the pulmonary artery to suck the clot out have been utilized at some centers with limited success, but this is by no means the standard of care.

Pulmonary emboli which block more than 50% of the flow out of the right side of the heart into the lungs are severe. With this much flow obstruction, there will certainly be severe loss of oxygenation, as well as problems with heart rate and blood pressure. Not everyone survives.

Answer 4

Wow. It seems like your describing something similar to what I experienced as a kid and occasionally as an adult. I get those achy, sharp pain in my chest / rib area. Often the pain is mild but sometimes it's so bad I can barley take a breath. It also feels like it starts at the bottom of my rib cage and then travels up my side as it slowly goes away. I was told by my doctor it was "growing" pains. Then when I was older, I brought it up again and he said it could be a muscle spam. It's been months since I've had one. With me, the pain only last a few seconds and at the most a minute or two. They also only seem to happen once or twice in a day when i do have them. I would suggest that if they occur more frequently, multiple times in a day I'd see someone about it. It could be nothing or it could be something (kind of obvious answer).

Answer 5

If there is only one clot, it would be unilateral, although other features of pulmonary embolus are more important and deadly.

Answer 6

Why? Are you having one?

Answer 7

unilateral