Large saddle embolus seen in the<unk>  artery (white arrows). Less than 5 to 10% of symptomatic<unk> s are fatal within the first hour of symptoms. There are several markers used for risk stratification and these are also independent predictors of adverse outcomes. These include hypotension, cardiogenic shock, syncope, evidence of right heart dysfunction, and elevated cardiac enzymes. Some ECG changes including S1Q3T3 also correlate with a worse short-term prognosis. There have been other patient-related factors such as COPD and chronic heart failure thought to also play a role in prognosis. Prognosis depends on the amount of lung that is affected and on the co-existence of other medical conditions; chronic<unk> tion to the lung can lead to<unk>  hypertension. After a massive<unk> , the embolus must be resolved somehow if the patient is to survive. In thrombotic<unk> , the blood clot may be broken down by fibrinolysis, or it may be organized and recanalized so that a new channel forms through the clot. Blood flow is restored most rapidly in the first day or two after a<unk> . Improvement slows thereafter and some deficits may be<unk> rmanent. There is controversy over whether small subsegmental<unk> s need treatment at all and some evidence exists that patients with subsegmental<unk> s may do well without treatment. Once anticoagulation is stopped, the risk of a fatal<unk>  is 0.5%<unk> r year. Mortality from untreated<unk> s was said to be 26%. This figure comes from a trial published in 1960 by Barrit and Jordan, which compared anticoagulation against placebo for the management of<unk> . Barritt and Jordan<unk> rformed their study in the Bristol Royal Infirmary in 1957. This study is the only placebo-controlled trial ever to examine the place of anticoagulants in the treatment of<unk> , the results of which were so convincing that the trial has never been repeated as to do so would be considered unethical. That said, the reported mortality rate of 26% in the placebo group is probably an overstatement, given that the technology of the day may have detected only severe<unk> s. Predicting mortality The<unk> SI and sPESI scoring tools can estimate mortality of patients. The Geneva prediction rules and Wells criteria are used to calculate a pre-test probability of patients to predict who has a<unk> . These scores are tools to be used with clinical judgment in deciding diagnostic testing and types of therapy. The<unk> SI algorithm comprises 11 routinely available clinical variables. It puts the subjects into one of five classes (I–V), with 30-day mortality ranging from 1.1% to 24.5%. Those in classes I and II are low-risk and those in classes III–V are high-risk.
Pulmonary embolism
Dilated cardiomyopathy
Pulmonary hemorrhage
Pneumonia
Pleural effusion
Costochondritis
Lung infarction
Myocardial stunning