Recurrent pulmonary embolism

Five cases with recurrent pulmonary embolism (RPE), all having severe chronic cor pulmonale due to marked pulmonary hypertension, were reported. None of them had a history of thrombophlebitis of the legs. Dyspnea was the common symptom and signs of pulmonary hypertension were usual. Focal oligemia, cardiomegaly and plump pulmonary arteries on chest X-ray films, right axis deviation, clockwise rotation, ST-segment depression and T-wave inversion on electrocardiograms, and dilatations of the pulmonary arterial trunk, the right ventricle and the right atrium, and the posterior displacement of a small, compressed left ventricle on echocardiograms were the common findings. Gas exchange abnormalities were severe and they were considered the characteristic findings of this disease. Multiple perfusion defects were observed by a lung scan in all cases. Marked pulmonary hypertension with low cardiac output was the usual feature of RPE. Actual cutoffs or filling defects were demonstrated on a pulmonary angiogram. Deep vein of the legs were all intact and no thrombi were found. Pulmonary embolectomy was performed on one case. The importance of early diagnosis and early treatment of acute pulmonary embolism was emphasized for preventing the progress of this debilitating disease.