August 5, 2025Open Access

Comparative analysis of central and peripheral pulmonary embolism: Clinical profile, imaging findings, and outcomes in a tertiary care center

AKAkshay Narendra KotasthaneDr. D. Y. Patil Medical College, Hospital and Research Centre CSChigullapalli SrideviDr. D. Y. Patil Medical College, Hospital and Research Centre SMSusheel Kumar MalaniDr. D. Y. Patil Medical College, Hospital and Research Centre

Key Points

Pulmonary embolism symptoms varied significantly between central and peripheral cases, highlighting clinical importance.
Peripheral pulmonary embolism was notably associated with leg swelling, tachycardia, and elevated troponin I levels.
Ninety-four patients diagnosed with PE were analyzed, revealing common symptoms like dyspnea and tachycardia.
Appropriate diagnosis requires clinical vigilance and individualized risk assessment for both central and peripheral PE.

Abstract

ABSTRACT Background: Pulmonary thromboembolism is a life-threatening condition with varying clinical presentations and prognostic implications based on the anatomical location of the embolus. This study aimed to compare the clinical, laboratory, and imaging profiles of central and peripheral pulmonary embolism (PE) diagnosed on computed tomography pulmonary angiography (CTPA). Materials and Methods: This retrospective observational study was conducted in the Department of Cardiology at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, from January 2023 to June 2024. Ninety-four adult patients with confirmed PE on CTPA were included and categorized into central PE ( n = 49) and peripheral PE ( n = 45) based on thrombus location. Clinical symptoms, risk factors, electrocardiogram (ECG) findings, echocardiographic parameters, and laboratory data, including D-dimer and Troponin I, were analyzed. Statistical comparisons were made using Chi-square and t -tests, with P < 0.05 considered significant. Results: The mean age of participants was 52.78 ± 17.98 years, with a male predominance (70.2%). Dyspnea (97.9%) and tachycardia (90.4%) were the most common symptoms. Deep vein thrombosis (DVT) was present in 43.6%, and right ventricle dysfunction in 36.2%. ST-segment changes were the most frequent ECG abnormality (31.9%). A significantly higher proportion of peripheral PE was observed in patients with leg swelling ( P = 0.002), tachycardia ( P = 0.003), SpO 2 between 80% and 90% ( P = 0.002), DVT ( P < 0.001), and positive Troponin I ( P = 0.010). D-dimer levels did not differ significantly between groups ( P = 0.861). Conclusion: The present study findings highlight that both central and peripheral PE can present with significant clinical symptoms and laboratory abnormalities, with peripheral PE notably associated with leg swelling, tachycardia, desaturation, DVT, and elevated troponin I levels. Peripheral PE, traditionally considered less severe, was found to be associated with significant symptoms, DVT, and elevated cardiac biomarkers. Clinical vigilance, early use of CTPA, and individualized risk stratification are critical for the diagnosis of both central and peripheral PE.

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