De novo pulmonary embolism following chest trauma: fact or fiction?

PURPOSE: Post-traumatic pulmonary embolism (PE) may develop directly in the lungs, termed "de novo" pulmonary embolism (DNPE). Severe chest trauma has been identified as a potential risk factor for DNPE due to localized inflammation, occult vascular injury, and low-flow states (venous stasis). The primary outcome was to examine the association between DNPE and chest trauma, while the secondary outcome was to characterize patients in the DNPE group.

METHODS

We conducted a retrospective cohort study of patients with trauma aged ≥ 15 years admitted to Songklanagarind Hospital, a level 1 trauma center, from 2013 to 2023. All patients diagnosed with post-traumatic PE were reviewed for clinical parameters, imaging findings, and treatments. Patients without ultrasonographic evaluation for DVT were excluded.

RESULTS

Among 43,908 patients with trauma, PE was diagnosed in 78 (0.18%). After excluding four patients without DVT assessment, 74 patients remained. Of these, 49 (66%) were diagnosed with DNPE and 25 (34%) with PE + DVT. Compared with patients with PE + DVT (32%), patients with DNPE (38.8%) showed no significant difference in the incidence of chest trauma (p = 0.567). The location of PE significantly differed (p = 0.005) between the groups, with DNPE showing more peripheral involvement (79.6%) and PE + DVT showing more central emboli (52%). No patient in the DNPE group underwent pulmonary thromboembolectomy.

CONCLUSION

DNPE is more common among patients with trauma, but its association with chest trauma was not statistically significant. DNPE may result from undetected pelvic DVT or other mechanisms requiring further investigation.