The origin of fatal pulmonary emboli: a postmortem analysis of 500 deaths from pulmonary embolism in trauma, surgical, and medical patients

BACKGROUND: The traditional theory that pulmonary emboli (PE) originate from the lower extremity has been challenged. METHODS: All autopsies performed in Los Angeles County between 2002 and 2010 where PE was the cause of death were reviewed. RESULTS: Of the 491 PE deaths identified, 36% were surgical and 64% medical. Venous dissection for clots was performed in 380 patients; the PE source was the lower extremity (70.8%), pelvic veins (4.2 %), and upper extremity (1.1%). No source was identified in 22.6% of patients. Body mass index (adjusted odds ratio [AOR] 1.044, 95% confidence interval [CI] 1.011 to 1.078, p = .009) and age (AOR 1.018, 95% CI 1.001 to 1.036, p = .042) were independent predictors for identifying a PE source. Chronic obstructive pulmonary disease (AOR.173, 95% CI .046 to .646, p = .009) was predictive of not identifying a PE source. CONCLUSIONS: Most medical and surgical patients with fatal PE had a lower extremity source found, but a significant number had no source identified. Age and body mass index were positively associated with PE source identification. However, a diagnosis of chronic obstructive pulmonary disease was associated with no PE source identification. (C) 2015 Elsevier Inc. All rights reserved.