Epidemiology

The incidence of PE in the United States is estimated to be 650,000 cases per year; with over 200,000 patients dying each year, PE is the third leading cause of death. Approximately one-third of these deaths occur within the first hour and over 16,000 patients die despite treatment. Overall mortality ranges from 2 to 10 percent in patients treated for PE and from 20 to 30 percent in those with unrecognized PE. More than 50 percent of fatal PE is diagnosed at autopsy. 1 PE is more common in males than females before the age of 50; this gender difference disappears in older age groups. PE is the most common cause of nonsurgical maternal death in the peripartum period. Pregnant women over the age of 40 and those of African-American descent are at highest risk.2

The overwhelming majority of PEs are caused by thromboemboli. In situ pulmonary artery thrombosis is rare. When sought, deep venous thrombosis (DVT) of the lower extremities proves to be the source of 80 to 90 percent of cases.3 DVT of the upper extremity has been reported to cause 10 to 15 percent of PE, especially if associated with indwelling central venous catheters. 4 Other sources of PE include pelvic vein thrombosis, right heart thrombosis, and amniotic or fat emboli. Septic emboli—associated with valvular vegetations in right-sided endocarditis, infected central venous catheters, and septic thrombphlebitis from intravenous drug use (IDU)—present unique diagnostic and therapeutic challenges.

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