Case 16: Acute Versus Chronic Thromboembolic Disease—Beware!

  • Dianne L. Zwicke
  • Sara Paulus
  • Deepa Gopalan
  • William R. Auger
Part of the Clinical Cases in Cardiology book series (CCC)


The distinction between acute and chronic thromboembolic disease is frequently difficult at the time of initial presentation. However, the importance in making this distinction is underscored by the considerable differences in treatment strategies required for these clinical problems. Not only are there historical clues, but an understanding of the disparate radiographic appearance between acute and chronic thrombi can often prevent an inappropriate intervention. This case presentation highlights these important considerations.


Acute pulmonary thromboembolism Right heart dysfunction 

Further Reading

  1. Castañer E, Gallardo X, Ballesteros E, et al. CT diagnosis of chronic pulmonary thromboembolism. Radiographics. 2009;29(1):31–50.CrossRefGoogle Scholar
  2. Eischer L, Eichinger S, Kyrle PA. The risk of recurrence in women with venous thromboembolism while using estrogens: a prospective cohort study. J Thromb Haemost. 2014;12(5):635–40.CrossRefGoogle Scholar
  3. Guérin L, Couturaud F, Parent F, et al. Prevalence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. Prevalence of CTEPH after pulmonary embolism. Thromb Haemost. 2014;112(3):598–605.CrossRefGoogle Scholar
  4. Meinel FG, Nance JW Jr, Schoepf UJ, Hoffmann VS, Thierfelder KM, Costello P, Goldhaber SZ, Bamberg F. Predictive value of computed tomography in acute pulmonary embolism: systematic review and meta-analysis. Am J Med. 2015;128(7):747–59.CrossRefGoogle Scholar
  5. Nijkeuter M, Hovens MM, Davidson BL, Huisman MV. Resolution of thromboemboli in patients with acute pulmonary embolism: a systematic review. Chest. 2006;129:192–7.CrossRefGoogle Scholar
  6. Sutton GC, Hall RJC, Kerr IH. Clinical course and late prognosis of treated subacute massive, acute minor, and chronic thromboembolic disease. Br Heart J. 1977;39:1135–42.CrossRefGoogle Scholar
  7. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2015;350:h2135.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Dianne L. Zwicke
    • 1
  • Sara Paulus
    • 1
  • Deepa Gopalan
    • 2
  • William R. Auger
    • 3
  1. 1.Pulmonary Hypertension ClinicAurora St. Luke’s Medical CenterMilwaukeeUSA
  2. 2.Department of RadiologyImperial College HospitalsLondonUK
  3. 3.Lewis Katz School of MedicineTemple UniversityPhiladelphiaUSA

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