Risk Factors For Pulmonary Thromboembolism Research Articles

Incidence and risk factors of deep vein thrombosis and pulmonary thromboembolism after spinal cord disease at a rehabilitation unit: a retrospective study.

Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are major complications of spinal cord disease. However, studies of their incidence in Korean patients are limited. Thus, this study investigated the incidence and risk factors of DVT and PTE in Korean patients with spinal cord disease. We retrospectively analyzed the medical records of 271 patients with spinal cord disease who were admitted to a rehabilitation unit within 3 months of disease onset at a tertiary hospital. The presence of DVT and PTE was mainly determined using Doppler ultrasonography and chest embolism computed tomography. Risk factor analysis included variables such as sex, age, obesity, completeness of motor paralysis, neurological level of injury, cause of injury, lower extremity fracture, active cancer, and functional ambulation category (FAC) score. The incidences of DVT and PTE in the patients with spinal cord disease were both 6.3%. Risk factor analysis revealed that age of ≥65 years (p=0.031) and FAC score of ≤1 (p=0.023) were significantly associated with DVT development. Traumatic cause of injury (p=0.028) and DVT (p<0.001) were significant risk factors of PTE. Patients with spinal cord disease developed DVT and PTE within 3 months of disease onset with incidence rates of 6.3% and 6.3%, respectively. Age of ≥65 years and an FAC of score ≤1 were risk factors for DVT. Traumatic cause of injury and DVT were risk factors for PTE. However, given the inconsistent results of previous studies, the risk factors for DVT and PTE remain inconclusive. Therefore, early screening for DVT and PTE should be performed in patients with acute-to-subacute spinal cord disease regardless of the presence or absence of these risk factors.

COPD, diabetes, lymphopenia, and increased LDH cause higher mortality in hospitalized COVID-19 patients.

COPD, diabetes, lymphopenia, and increased LDH cause higher mortality in hospitalized COVID-19 patients.

Forensic Pathological Analysis of Death Due to Pulmonary Thromboembolism: A Retrospective Study Based on 145 Cases.

Pulmonary thromboembolism (PTE) is a common cause of sudden unexpected death in forensic and clinical practice. Although the prevention of thrombosis has been paid more attention in clinical practice in recent years, the number of deaths due to PTE remains extensive. In the present study, 145 cases of fatal PTE were collected and retrospectively analyzed from 2001 to 2020 at the School of Forensic Medicine, China Medical University in Liaoning Province, northeast of China. The demographic characteristics, risk factors of PTE, origins of thrombi, and time interval from the occurrence of main risk factors to PTE were retrospectively analyzed. The 40 to 59 age group accounted for the 51.0% of the total cases. Immobilization, trauma (especially fracture of the pelvis, femur, tibia, or fibula), surgery, cesarean section, and mental disorders were the top 5 high-risk factors. Among the involved cases, 92.9% of the PTE (130/140) occurred within 60 days and peak at 8 to 15 days after the exposure of main risk factors. According to the autopsy findings, 87.6% of the thrombi blocked the bilateral pulmonary arteries at pulmonary hilus, with a maximum diameter of 1.6 cm and a maximum length of 21.9 cm, which were mainly derived from lower limb (65.5%) or pelvic veins (10.3%). Although the embolus limited the pulmonary circulation, there is no difference on the ratio of lung-to-heart weight between PTE and the disease-free accident victims. Overall, our present retrospective study provides important information for the forensic analysis on the cause of death and potential guidance on clinical prevention of PTE.

Pulmonary Thromboembolism in Patients After COVID-19: Predictive Indicators for Correct Diagnosis

Background: Infection caused by SARS-CoV-2 can lead to significant procoagulant events, sometimes involving life-threatening pulmonary thromboembolism (PE). Additional conditions complicating the diagnosis are the presence of risk factors for PE in almost all patients with COVID-19 and the overlap of clinical presentation between PE and COVID-19. Objectives: We conducted a single-center study at the Heart and Brain Hospital, Pleven, from December 2020 to February 2021. It included 27 consecutively hospitalized patients with recent pneumonia caused by COVID-19 and clinical presentations corresponding to PE. Methods: The cohort was divided into two groups with and without a definitive diagnosis of PE, proven by CT pulmoangiography. The aim was to find the indicators predicting the presence of PE in patients with acute or post-acute COVID-19 conditions. Results: Our results showed that some ECG criteria, including S-wave over 1.5 mm in leads I and aVL (P = 0.007), Q-wave in leads III and aVF (P = 0.020), and D-dimer as a quantitative variable (P = 0.025), were independent predictors of PE. The RV/LV diameter ratios ≥ 1.0 and right ventricular dysfunction showed a sensitivity (Se) of 62.5%, specificity (Sp) of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 86.4% to verify the PE diagnosis. Besides, the D-dimer cutoff value of 1,032 ng/mL had an optimal Se of 87.5%, Sp of 57.9%, PPV of 46.7%, and NPV of 91.7% for PE diagnosis (P = 0.021). Conclusions: Against the background of acute and post-acute COVID-19 conditions, ECG and EchoCG criteria remain the PE predictors. We suggest that a higher D-dimer cutoff value be applied in COVID-19 and post-COVID-19 patients to confirm/dismiss PE diagnosis.

Correlation between Pulmonary Embolism and Sleep Apnea.

It has been shown that there is a correlation between Obstructive Sleep Apnea Syndrome (OSAS) and pulmonary thromboembolism (PTE); OSAS is a risk factor for PTE. We aimed to evaluate the frequency of OSAS in PTE patients, the correlation of OSAS with the severity of PTE, and its effect on 1-month mortality in PTE patients. This single-center, prospective, comparative case control study contains 198 patients diagnosed with non-massive PTE in our hospital between the dates of 01/07/2018-04/01/2020 who were confirmed by imaging methods. Daytime sleepiness was assessed with Epworth questionnaires, and OSAS risk was assessed with Berlin, STOP, STOP-BANG sleep questionnaires. Alongside demographic and clinical data, comorbidities, Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), WELLS scores, troponin, D-dimer values, echocardiyography (ECHO) findings were also examined. Epworth, Berlin, STOP, STOP-BANG sleep groups were compared in terms of PTE parameters. A hundred and thirty-eight patients (69.6%) was assesed as high risk group according to Berlin, meanwhile STOP-BANG defined 174 patients (87.8%), furthermore STOP has considered 152 patients in the high risk group (76.7%) and Epworth questionnaire determined this number as 127 (64.1%). As a result of the logistic regression analysis, statistically significant correlation was found between Berlin score and heart failure, PESI, sPESI and troponin values; between Epworth score and WELLS score; between STOP-BANG score and PESI score (p<0.05). During the 1-month follow-up period, 9 of the patients were exitus and mortality was 4.5%. OSAS risk is more common in patients with PTE and it may be a risk factor for PTE. It has been shown that the risk of OSAS may aggravate PTE severity and prognosis.

Derivation and validation of a nomogram model for pulmonary thromboembolism in patients undergoing lung cancer surgery.

BackgroundA specific risk-stratification tool is needed to facilitate safe and cost-effective approaches to the prophylaxis of acute pulmonary thromboembolism (PTE) in lung cancer surgery patients. This study aimed to develop and validate a simple nomogram model for the prediction of PTE after lung cancer surgery using readily obtainable clinical characteristics.MethodsA total of 14,427 consecutive adult patients who underwent lung cancer surgery between January 2015 and July 2018 in our institution were retrospectively reviewed. Included in the cohort were 136 patients who developed PTE and 544 non-PTE patients. The patients were randomly divided into the derivation group (70%, 95 PTE patients and 380 non-PTE patients) and the validation group (30%, 41 PTE patients and 164 non-PTE patients). A nomogram model was developed based on the results of multivariate logistic analysis in the derivation group. The cut-off values were defined using Youden’s index. The prognostic accuracy was measured by area under the curve (AUC) values.ResultsIn the derivation group, multivariate logistic analysis was carried out to evaluate the risk score. The risk assessment model contained five variables: age [95% confidence interval (CI): 1.008–1.083, P=0.016], body mass index (95% CI: 1.077–1.319, P=0.001), operation time (95% CI: 1.002–1.014, P=0.008), the serum level of cancer antigen 15-3 (CA15-3) before surgery (95% CI: 1.019–1.111, P=0.005), and the abnormal results of compression venous ultrasonography before surgery (95% CI: 2.819–18.838, P<0.001). All of them were independent risk factors of PTE. To simplify the risk assessment model, a nomogram model was established, which showed a good predictive performance in the derivation group (AUC 0.792, 95% CI: 0.734–0.853) and in the validation group (AUC 0.813, 95% CI: 0.737–0.890).ConclusionsA high-performance nomogram was established on the risk factors for PTE in patients undergoing lung cancer surgery. The nomogram could be used to provide an individual risk assessment and guide prophylaxis decisions for patients. Further external validation of the model is needed in lung cancer surgery patients in other clinical centers.

D-dimer is a predictor of clot resolution in patients with pulmonary thromboembolism: A retrospective cohort study.

This study assessed predictors of pulmonary thromboembolism (PE) resolution and their implications for clinical outcome. A total of 150 patients with acute PE diagnosed by computed tomography pulmonary angiography (CTPA) were included. All patients received anticoagulant therapy for 3-6 months and were followed-up for at least 2years. d-dimer levels in plasma were assayed at the first admission and during follow-up. The rate of CTPA-confirmed PE resolution was 48.67% at 6 months, 68% at 12months, and 78.67% at 24months. Thirty-nine patients had recurrent thrombosis after anticoagulation therapy was stopped, whereas 93 patients had complete resolution. The initial d-dimer level positively correlated with the pulmonary artery obstruction index (PAOI) (r=0.21; P=0.015), but did not significantly differ between patients experiencing resolution or recurrence. In contrast, the follow-up mean d-dimer level was significantly higher in the recurrent group (P<0.001), and this level was an independent risk factor for recurrent PE after the termination of anticoagulation treatment (OR 1.003, 95%CI 1.002 to 1.004; P<0.001). Higher initial thromboembolic burden measured by PAOI was associated with residual thromboemboli (P=0.004) and recurrence (P=0.03), but was not an independent risk factor for either. Elevated d-dimer is an independent risk factor for PE recurrence. A higher initial thromboembolic burden may be associated with unresolved thromboemboli or recurrence.

Fatal pulmonary thromboembolism: deep vein thrombosis incidence at coronial autopsy

Most pulmonary thromboemboli arise from deep vein thrombosis of the lower legs.1 When pulmonary thromboembolism is identified as the cause of death at autopsy, it has been recommended that the calves should be dissected to locate the source of the embolus.2,3 However, it is uncertain how often deep vein thrombosis will be found and if the incidence is altered by risk factors for pulmonary thromboembolism. This research aimed to determine how often deep vein thrombosis of the lower legs was found at Coronial autopsy when death had resulted from pulmonary thromboembolism, and to ascertain if risk factors affect the likelihood of finding deep vein thrombosis. Autopsy reports of pulmonary thromboembolism deaths in the year 2016 were identified on the National Coronial Information System. Dissection information and risk factors for pulmonary thromboembolism were recorded. Risk factors were analysed by logistic regression to determine if there was predictive value on the probability of finding deep vein thrombosis. A total of 235 pulmonary thromboembolism fatalities were identified. Deep vein thrombosis was found in 76.6% full-body autopsies. A recent hospital admission was found to have a statistically significant positive influence (p=0.01) on finding deep vein thrombosis of the lower legs.

Research progress of risk factors of pulmonary thromboembolism

Pulmonary embolism is a clinical and pathophysiological syndrome caused by endogenous or exogenous emboli obstructing the pulmonary artery, and its branches causing acute pulmonary circulatory disturbances.Venous thromboembolism is a complex multifactorial disease that involves the interaction of secondary or hereditary thrombosis and various risk factors such as trauma and surgery.With the characteristics of high incidence, misdiagnosis and high mortality, this study explored the risk factors for pulmonary thromboembolism.Finding its risk factors is the main method to reduce the incidence of pulmonary embolism and reduce the severity of pulmonary embolism. Key words: Pulmonary embolism; Thromboembolism; Upper extremity deep vein thrombosis; Venous thromboembolism; Thrombophilia; Risk factors; Review; Databases, bibliographic

Failure of Therapy at Premortem Diagnosed Pulmonary Thromboembolism

Objectives: We analyzed patients diagnosed premortem with pulmonary thromboembolism (PTE), focusing on causes of failure of therapy together with clinical characteristics. Methods: This was a retrospective study of 25 cases. We classified PTE as massive, submassive and nonmassive. Results: Of the 25 cases, 76% (19/25) had two or more risk factors for PTE. The point of origin of PE could be determined in only 44% of 25 cases. In 20 % (5/25) of cases diagnosed with PTE a maximum 3 months prior to death, the main cause of death was unknown. Of 10/20 (50%) massive and 8/20 (40%) submassive PTE cases, 5 and 3 underwent thrombolysis therapy, respectively. Both of 2/20 (10%) non-massive PTE cases underwent LMWH; in 1 of these cases, autopsy showed thrombus of a large pulmonary artery at 25 days after therapy. Submassive PTE cases were older and had a greater number of risk factors than did massive PTE cases. The point of origin of PTE was a right heart thrombus in six (24%) cases. Surgeries were performed in 3/6 (50 %) cases with right atrial thrombus. The survival duration after therapy in those who underwent surgery was longer than those who received thrombolysis and LMWH therapies. Conclusions: Physicians may provide appropriate information to patients who have certain risk factors (trauma, surgery, pregnancy, etc.) to predict acute PE at a preventable stage. If risk factors are present for a prolonged period, or if new risk factors for PTE are identified, patients should be followed up carefully because of the risk of progression of thrombosis.

PULMONARY EMBOLISM: ISSUES OF CLINICAL MANIFESTATION, DIAGNOSTICS AND THERAPY

In this lecture the author highlights various aspects of pulmonary thromboembolism (PTE) with evidence-based data and his own observations for many years. Risk factors for PTE and deep vein thrombosis of lower extremities are described in details, as well as clinical manifestations of PTE depending on localization of an embolus in pulmonary arterial tree. Current diagnostic approached to PTE are presented, including perfusion scintigraphy, pulmonary angiography, ileocavagraphy, measurement of D-dimer levels. Methods of surgical and medical treatment, including their indications, are described.

The increment of platelet count is risk factor of pulmonary thromboembolism in patients with pancreatic cancer treated with gemcitabine

Methods: A retrospective 1:2 matched cohort study was performed to evaluate the risk of PTE in patient with gemcitabinebased chemotherapy for pancreatic cancer. Clinical parameter including rate of increment of platelet count (Inc-Plt) was checked in PTE group and non-PTE group. Inc-Plt was defined as the difference of platelet count from new cycle day 1 to last cycle day 15. The rate of Inc-Plt was defined as the rate of increased platelet count at new cycle day 1 compared with previous cycle day 15. Each patient in PTE group was matched with two patients in the non-PTE group.

The increment of platelet count is a risk factor of pulmonary thromboembolism in patients with pancreatic cancer treated with gemcitabine

The increment of platelet count is a risk factor of pulmonary thromboembolism in patients with pancreatic cancer treated with gemcitabine

Misdiagnosis of pulmonary embolism and causes

Pulmonary thromboembolism (PTE) is not only one of the prevelant diseases with a high mortality risk but also has a high ratio of delayed diagnosis and misdiagnosis. In this study, it was aimed to determine the demographical characteristics, risk factors, clinical and laboratory findings of the patients that were diagnosed as PTE at their first hospital visit and of the PE patients who were misdiagnosed at their first admission. We aimed to investigate the factors which can leads to misdiagnosis of PE, and to determine the ways to avoid misdiagnosis. One hundred PTE patients who were admitted to University Hospital between the dates January 2007-December 2011 were included in the study. Clinical and laboratory findings of these patients were evaluated. Among these patients, 26 were misdiagnosed at their first admission but diagnosed accurately (as PTE) in our hospital and 74 were diagnosed accurately. Two groups were compared with respect to various data of the patients clinical and demographical characteristics. Between the two groups, there was no difference in terms of physical examination and laboratory findings. The patients with the symptoms onset was over a week ago had a higher misdiagnosis rate (p= 0.002). The patients with no risk of PTE had a higher misdiagnosis rate (p= 0.017). Misdiagnosis rate of the patients with cardiac diseases was lower (p= 0.033) According to Geneva risk score, we observed that the misdiagnosis risk was reduced in the patients with higher clinical probability (p= 0.011). In conclusion, misdiagnosis rate was found to be statistically significant in the patients with low score according to the Geneva risk classification, and whose pre-diagnosis period lasted for more than a week and with no risk factors of PTE or cardiac diseases. We are in the opinion that considering these parameters will help to reduce in misdiagnosis of pulmonary embolism cases.

Risk Factors of a Pulmonary Thromboembolism After Colorectal Surgery.

PurposePrevious studies have revealed that predictors and risk factors of pulmonary thromboembolism (PTE) are malignancy, immobilization, diabetes, and obesity in the postoperative patients. However, in patients undergoing colorectal cancer, studies of PTE have not been enough. Thus, we investigated the risk factors of PTE related to colorectal surgery.MethodsFrom January 2009 to October 2014, 312 patients received colorectal surgery without other organ resection. The postoperative patients with PTE were 14 (4.5%), and they were classified by sex, age, and stage as a 1:3 paired match to the control group. A multiple logistic regression was performed to identify which factors were associated with PTE.ResultsOne patient was in stage I, 3 in stage II, 9 in stage III, and 1 in stage IV. In the binary logistic regression analysis, history of diabetes mellitus (odds ratio, 6.498; P = 0.031) and being overweight (odds ratio, 10.018; P = 0.014) were independent risk factors for PTE in patients undergoing colorectal cancer.ConclusionA history of diabetes mellitus and being overweight were independent risk factors of PTE after colorectal cancer.

Evaluation of Hemodynamic Changes and Respiratory Physical Findings in Patients with Pulmonary Embolism

Introduction: Pulmonary thromboembolism (PTE) is a potentially fatal disease with nonspecific symptoms and signs. Patients with Pulmonary embolism often have dyspnea, chest pain, haemoptysis, tachycardia tachypnea and respiratory physical finding including hypoxia and decreased ETCO 2 . Daily patients with Pulmonary embolism are very few in hospital course and we aimed to determine clinical and paraclinical findings in hospital pulmonary embolism patients. Methods: we assessed in hospital course of 104 patients with pulmonary embolism with symptom (dyspnea, chest pain, and hemoptysis) and signs (tachypnea, tachycardia, DVT signs, blood pressure) and respiratory physical findings (PO 2 , ETCO 2 ). Results: majority of patients had risk factor for PTE; the most common was cancer. 21.2% of patients had apparent DVT in Doppler sonography. Isolated dyspnea (38%), chest pain with and without hemoptysis (60%) and syncope (2%) were observed in patients. Mean duration of dyspnea resolution was 3.4 days. Mean duration of chest pain resolution was 1.76 days. Mean duration of hemoptysis resolution was 2 days. 64.4% of the patients were hypoxic and mean duration of hypoxic resolution was 2.63 days. Mean duration of tachycardia resolution was 2.37 days. No relation was observed between size of PTE and mortality or hypotension and PO 2 . Mean ETCO 2 was 23±2 mmHg and 86.5% of patients had ETCO 2 lower than 28. Mean duration of ETCO 2 resolution was 3.6 days. Most common physical finding that resolved later than others was ETCO 2 . In 32.7% of patients, ETCO 2 did not resolve. Key words: Pulmonary thromboembolism; Tachycardia; Tachypnea; Hemoptysis; Hypoxic; ETCO2

Evaluation of Hemodynamic Changes and Respiratory Physical Findings in Patients with Pulmonary Embolism

Introduction: Pulmonary thromboembolism (PTE) is a potentially fatal disease with nonspecific symptoms and signs. Patients with Pulmonary embolism often have dyspnea, chest pain, haemoptysis, tachycardia tachypnea and respiratory physical finding including hypoxia and decreased ETCO 2 . Daily patients with Pulmonary embolism are very few in hospital course and we aimed to determine clinical and paraclinical findings in hospital pulmonary embolism patients. Methods: we assessed in hospital course of 104 patients with pulmonary embolism with symptom (dyspnea, chest pain, and hemoptysis) and signs (tachypnea, tachycardia, DVT signs, blood pressure) and respiratory physical findings (PO 2 , ETCO 2 ). Results: majority of patients had risk factor for PTE; the most common was cancer. 21.2% of patients had apparent DVT in Doppler sonography. Isolated dyspnea (38%), chest pain with and without hemoptysis (60%) and syncope (2%) were observed in patients. Mean duration of dyspnea resolution was 3.4 days. Mean duration of chest pain resolution was 1.76 days. Mean duration of hemoptysis resolution was 2 days. 64.4% of the patients were hypoxic and mean duration of hypoxic resolution was 2.63 days. Mean duration of tachycardia resolution was 2.37 days. No relation was observed between size of PTE and mortality or hypotension and PO 2 . Mean ETCO 2 was 23±2 mmHg and 86.5% of patients had ETCO 2 lower than 28. Mean duration of ETCO 2 resolution was 3.6 days. Most common physical finding that resolved later than others was ETCO 2 . In 32.7% of patients, ETCO 2 did not resolve. Key words: Pulmonary thromboembolism; Tachycardia; Tachypnea; Hemoptysis; Hypoxic; ETCO2

Pulmonary thromboembolism after air travel: Two case reports, the review of literature and forensic implications

Air travel as a risk factor for pulmonary thromboembolism (PTE) is rarely described in forensic literature. Two cases of PTE after air travel are presented in this report. Each flight was intercontinental and lasted for more than 10h, resulting in typical “traveler's thrombosis” within 2weeks. In both cases, the risk factors were age, duration of flight and also peripheral circulation problems caused by heart (hypertension, arrhythmia), and varicose veins failures. Possible pathophysiological mechanisms of thrombus formation in these cases were blood flow stasis from prolonged recumbence, reduced function of the lower leg muscle pump, dehydration, and hypobaric hypoxia. Legal aspects of death due to PTE after air travel and possible responsibility of air companies are discussed.

Diagnosis of Pulmonary Thromboembolism in Psychiatric Patients

To the Editor: Mortality from cardiovascular causes, including pulmonary thromboembolism, is the second most common cause of mortality in psychiatric patients.1 Intermittent shortness of breath, chest pain, and tachycardia are the most common symptoms of pulmonary thromboembolism,2 but many of these symptoms also accompany the experience of anxiety. The diagnosis of pulmonary thromboembolism in psychiatric patients is substantially confounded by the presence of anxiety symptoms. Case report. We treated a 21-year-old woman following an overdose of 40 mg of diazepam. At presentation in 2010, apart from tachycardia (105 bpm), examination revealed no abnormalities. She gave a history of depressive and anxiety symptoms since the birth of her son 18 months before presentation and was on duloxetine 60 mg/d. During her admission, on 4 occasions she reported feeling anxious and tired and was found to be hyperventilating. On those occasions, she was tachycardic (110–123 bpm) and tachypneic (20–24 breaths/min) and had an oxygen saturation of 97%–99% on room air. On each occasion, it was explained to her that she was experiencing anxiety and was given 2.5 mg of diazepam with good effect. She was reviewed by the ward physician, and apart from tachycardia examinations, revealed no abnormalities. A few hours prior to her discharge (after a 3-day admission), she again reported similar symptoms and collapsed. All efforts to resuscitate her failed. Pulmonary thromboembolism was identified on postmortem examination as responsible for causing her death. This patient had an intermediate clinical probability of pulmonary thromboembolism as per the Revised Geneva Score for the prediction of pulmonary thromboembolism, although she had none of the risk factors or symptoms defined therein.3 However, both the presence of a psychiatric disorder and exposure to antidepressants are risk factors for pulmonary thromboembolism not considered in this risk stratification.4 Also, as clarified from her family after her death, she had never experienced hyperventilation or tiredness when anxious previously. It is important to note that most psychiatric patients with anxiety can describe the experience of anxiety that is typical for them. On the basis of the above, we suggest that even in psychiatric patients with low or intermediate clinical probabilities for pulmonary thromboembolism, the presence of atypical anxiety symptoms should lead to a high index of suspicion for pulmonary thromboembolism. In this setting, a normal enzyme-linked immunosorbent assay D-dimer result avoids further testing.5 Further studies are needed to appropriately incorporate the presence of psychiatric disorder and exposure to antidepressants and/or antipsychotics in scoring systems for pulmonary thromboembolism.

Sarkoidozlu Hastada Gelişen Masif Pulmoner Tromboembolizm: Bir Olgu Nedeni İle

Although sarcoidosis is not a well known risk factor of pulmonary thromboembolism, recent investigations shows increased risk of pulmonary thromboembolism in these patients with the lack of any other risk factor. In this case report, massive pulmonary embolism was presented in a forty seven years old female patient who is followed up under metilprednisolon therapy due to sarcoidosis for five months. This patient was underlined because of that sarcoidosis may be a potential risk factor of pulmonary thromboembolism and must be kept in mind at the patients with sarcoidosis and acute deletoration. Keywords: