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Sample records for assessing pulmonary embolisms

  1. Severity assessment of acute pulmonary embolism: evaluation using helical CT

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    Collomb, D.; Paramelle, P.J.; Calaque, O. [Department of Radiology, CHU Grenoble, BP 218, 38043, Grenoble Cedex (France); Bosson, J.L. [Department of Statistics and Vascular diseases, CHU Grenoble, BP 218, 38043, Grenoble Cedex (France); Vanzetto, G. [Department of Cardiology, CHU Grenoble, BP 218, 38043, Grenoble Cedex (France); Barnoud, D. [Department of Medical Intensive Care, CHU Grenoble, BP 218, BP 218, 38043, Grenoble Cedex (France); Pison, C. [Department of Pulmonary Medicine, CHU Grenoble, BP 218, 38043, Grenoble Cedex (France); Coulomb, M.; Ferretti, G.

    2003-07-01

    The objective was to evaluate the helical CT (HCT) criteria that could indicate severe pulmonary embolism (PE). In a retrospective study, 81 patients (mean age 62 years) with clinical suspicion of PE explored by HCT were studied. The patients were separated into three different groups according to clinical severity and treatment decisions: group SPE included patients with severe PE based on clinical data who were treated by fibrinolysis or embolectomy (n=20); group NSPE included patients with non-severe PE who received heparin (n=30); and group WPE included patients without PE (n=31). For each patient we calculated a vascular obstruction index based on the site of obstruction and the degree of occlusion in the pulmonary artery. We noted the HCT signs, i.e., cardiac and pulmonary artery dimensions, that could indicate acute cor pulmonale. According to multivariate analysis, factors significantly correlated with the severity of PE were: the vascular obstruction index (group SPE: 54%; group NSPE: 24%; p<0.001); the maximum minor axis of the left ventricle (group SPE: 30.2 mm; group NSPE: 40.4 mm; p<0.001); the diameter of the central pulmonary artery (group SPE: 32.4 mm; group NSPE: 28.3 mm; p<0.001); the maximum minor axis of the right ventricle (group SPE: 47.5 mm; group NSPE: 42.7 mm; p=0.029); the right ventricle/left ventricle minor axis ratio (group SPE: 1.63; group NSPE: 1.09; p<0.0001). Our data suggest that hemodynamic severity of PE can be assessed on HCT scans by measuring four main criteria: the vascular obstruction index; the minimum diameter of the left ventricle; the RV:LV ratio; and the diameter of the central pulmonary artery. (orig.)

  2. Pulmonary embolism; Lungenarterienembolie

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    Sudarski, Sonja; Henzler, Thomas [Heidelberg Univ., Universitaetsmedizin Mannheim (Germany). Inst. fuer Klinische Radiologie und Nuklearmedizin

    2016-09-15

    Pulmonary embolism (PE) requires a quick diagnostic algorithm, as the untreated disease has a high mortality and morbidity. Crucial for the diagnostic assessment chosen is the initial clinical likelihood of PE and the individual risk profile of the patient. The overall goal is to diagnose or rule out PE as quickly and safely as possible or to initiate timely treatment if necessary. CT angiography of the pulmonary arteries (CTPA) with multi-slice CT scanner systems presents the actual diagnostic reference standard. With CTPA further important diagnoses can be made, like presence of right ventricular dysfunction. There are different scan and contrast application protocols that can be applied in order to gain diagnostic examinations with sufficient contrast material enhancement in the pulmonary arteries while avoiding all kinds of artifacts. This review article is meant to be a practical guide to examine patients with suspected PE according to the actual guidelines.

  3. Thrombolytic therapy in pulmonary embolism.

    LENUS (Irish Health Repository)

    Nagi, D

    2010-01-01

    Massive pulmonary embolism carries a high mortality. Potential treatment includes anticoagulation, thrombolytic therapy and embolectomy. We report a case of deep vein thrombosis leading to progressive massive pulmonary embolism despite appropriate anticoagulation, where thrombolysis with IVC filter placement resulted in a successful outcome.

  4. Assessment of heat shock proteins and endothelial dysfunction in acute pulmonary embolism.

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    İn, Erdal; Deveci, Figen; Kaman, Dilara

    2016-06-01

    We determined the levels of some heat shock proteins (HSP27, HSP70, and HSP90), L-arginine, asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) levels in patients with acute pulmonary embolism. The present case-control study comprised a healthy control group (n = 57) and patients with acute pulmonary embolism (n = 84). HSPs, L-arginine, ADMA, and SDMA levels were measured in all of the cases. The mean age of the control group was 56.72 ± 8.44 years, and the mean age of the patients with acute pulmonary embolism was 60.20 ± 16.56 years (P = 0.104). Compared with controls, patients with acute pulmonary embolism had significantly higher mean serum HSP27, HSP90, and ADMA levels, whereas the mean serum L-arginine and SDMA levels were lower (P In patients with acute pulmonary embolism serum HSP27, HSP70, and ADMA levels were negatively correlated with partial pressures of arterial oxygen levels (r = -0.281, P = 0.01; r = -0.263, P = 0.016; and r = -0.275, P = 0.011, respectively) and arterial oxygen saturation (r = -0.225, P = 0.039; r = -0.400, P in acute pulmonary embolism.

  5. METABOLIC DISORDERS AND PULMONARY EMBOLISM

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    O. Ya. Vasiltseva

    2015-01-01

    Full Text Available The purpose of the study. To examine the contribution of diabetes and obesity in the development of pulmonary embolism on the based data of the Register of new hospital of pulmonary embolism (PE in hospitals inTomsk(2003–2012. Material and Methods. The medical history and records of autopsies of patients treated in hospitals in the city ofTomsk, 2003–2012, and anatomopathological and/or instrumental examination revealed pulmonary embolism have been subjected to studies. We used the classification of diabetes mellitus proposed by the WHO in1999 inour work, because the register including data (2003–2012. The degree of obesity was assessed according to WHO classification (1997. Statistical analysis of the results was carried out with the help of software for computer Statistica for Windows, version 8.0. The Shapiro–Wilk and Kolmogorov–Smirnov tests was used to determine the nature of the distribution of the data. The ho mogeneity of the population variance was assessed using Fisher's exact test andLeuventest. The Mann– Whitney test was used when comparing two independent samples to determine the significance of differences. The analysis was conducted by means of qualitative characteristics contingency tables using Pearson χ 2 . The odds ratio was calculated to assess the association between a specific outcome and the risk. Data are presented as M ± SD factor. The significance level of p for all procedures used by the statistical analysis was taken to be 0.05. It was considered statistically significant level of p < 0.05. The results of the study. In intermediate urbanized city ofWestern Siberia,Tomsk, established register of hospital pulmonary embolism (2003–2012. The register included 751patients whose in vivo and / or postmortem revealed pulmonary embolism (PE. The data histories and autopsy reports was analyze. The type 2diabetes was diagnosed in 205 patients. The type 2 diabetes moderate had 29%. Diabetes severe suffer 82

  6. Multidetector computed tomography pulmonary angiography in childhood acute pulmonary embolism

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    Tang, Chun Xiang; Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Schoepf, U.J. [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Department of Pediatrics, Charleston, SC (United States); Chowdhury, Shahryar M. [Medical University of South Carolina, Department of Pediatrics, Charleston, SC (United States); Fox, Mary A. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2015-09-15

    Pulmonary embolism is a life-threatening condition affecting people of all ages. Multidetector row CT pulmonary angiography has improved the imaging of pulmonary embolism in both adults and children and is now regarded as the routine modality for detection of pulmonary embolism. Advanced CT pulmonary angiography techniques developed in recent years, such as dual-energy CT, have been applied as a one-stop modality for pulmonary embolism diagnosis in children, as they can simultaneously provide anatomical and functional information. We discuss CT pulmonary angiography techniques, common and uncommon findings of pulmonary embolism in both conventional and dual-energy CT pulmonary angiography, and radiation dose considerations. (orig.)

  7. Computed tomography of acute pulmonary embolism: state-of-the-art

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    Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Meinel, Felix G.; McQuiston, Andrew D.; Ravenel, James G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U.J. [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2015-09-15

    Multidetector computed tomography (CT) plays an important role in the detection, risk stratification and prognosis evaluation of acute pulmonary embolism. This review will discuss the technical improvements for imaging peripheral pulmonary arteries, the methods of assessing pulmonary embolism severity based on CT findings, a multidetector CT technique for pulmonary embolism detection, and lastly, how to avoid overutilization of CT pulmonary angiography and overdiagnosis of pulmonary embolism. (orig.)

  8. Radionuclide Diagnosis of Pulmonary Embolism

    DEFF Research Database (Denmark)

    Hess, Søren; Madsen, Poul Henning

    2016-01-01

    Diagnostic imaging plays an integral role in the diagnostic workup of suspected pulmonary embolism, and several modalities have been employed over the years. In recent years, the choice has been narrowed to either computer tomographic or radionuclide based methods, i.e. computer tomographic angio...

  9. Pulmonary embolism and impending paradoxical embolism: a case report

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    ZHONG You; HE Qing; WANG Xin-yue; CHEN Huan; LI Jing; ZHEN Wen-jun; TONG Hong-feng; WANG Huai-bin; CHEN Qi-hang

    2008-01-01

    @@ Adefinitive diagnosis of paradoxical embolism is based on the evidence that a thrombus crosses through the right-to-left shunting. We report a case of impending paradoxical embolism in a patient with pulmonary embolism diagnosed by echocardiography and proved by operation later.

  10. Formative assessment and design of a complex clinical decision support tool for pulmonary embolism.

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    Khan, Sundas; McCullagh, Lauren; Press, Anne; Kharche, Manish; Schachter, Andy; Pardo, Salvatore; McGinn, Thomas

    2016-02-01

    Electronic health record (EHR)-based clinical decision support (CDS) tools are rolled out with the urgency to meet federal requirements without time for usability testing and refinement of the user interface. As part of a larger project to design, develop and integrate a pulmonary embolism CDS tool for emergency physicians, we conducted a formative assessment to determine providers' level of interest and input on designs and content. This was a study to conduct a formative assessment of emergency medicine (EM) physicians that included focus groups and key informant interviews. The focus of this study was twofold, to determine the general attitude towards CDS tool integration and the ideal integration point into the clinical workflow. To accomplish this, we first approached EM physicians in a focus group, then, during key informant interviews, we presented workflow designs and gave a scenario to help the providers visualise how the CDS tool works. Participants were asked questions regarding the trigger location, trigger words, integration into their workflow, perceived utility and heuristic of the tool. Results from the participants' survey responses to trigger location, perceived utility and efficiency, indicated that the providers felt the tool would be more of a hindrance than an aid. However, some providers commented that they had not had exposure to CDS tools but had used online calculators, and thought the tools would be helpful at the point-of-care if integrated into the EHR. Furthermore, there was a preference for an order entry wireframe. This study highlights several factors to consider when designing CDS tools: (1) formative assessment of EHR functionality and clinical environment workflow, (2) focus groups and key informative interviews to incorporate providers' perceptions of CDS and workflow integration and/or (3) the demonstration of proposed workflows through wireframes to help providers visualise design concepts.

  11. Contrast Circulation Time to Assess Right Ventricular Dysfunction in Pulmonary Embolism: A Retrospective Pilot Study

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    Platon, Alexandra; Poletti, Pierre-Alexandre; Perrier, Arnaud; Bendjelid, Karim

    2016-01-01

    Objective To optimize enhancement of pulmonary arteries and facilitate diagnosis of pulmonary embolism (PE), modern computed tomography angiography (CTA) contains a contrast bolus tracking system. We explored the diagnostic accuracy of the time-intensity curves given by this automated system to identify right ventricular dysfunction (RVD) in acute PE. Methods 114 CTAs with a diagnosis of PE were reviewed. RVD was defined as right-to-left ventricular diameter ratio of 1 or greater. Four parameters on time-intensity curves were identified. Parameters between CTAs with and those without RVD were compared with the Wilcoxon rank-sum test. The ability of the four parameters to discriminate patients with RVD was explored by compiling the area under the operating curves (AUC). Results The time needed by the contrast media to reach the pulmonary artery [8 seconds (IQR: 7–9) versus 7 seconds (IQR: 6–8), p<0.01], the time needed to reach 40 Hounsfield units (HU) [11 seconds (IQR: 8.5–14) versus 9.5 seconds (IQR: 8–10.5), p<0.01], and the contrast intensity reached after 10 seconds [19 HU (IQR: 4–67) versus 53 HU (IQR: 32–80), p<0.05] were all statistically different between CTA with and CTA without RVD. Those three parameters changed gradually across severity categories of RVD (p<0.05 for trend). Their AUC to identify RVD ranged from 0.63 to 0.66. The slope of contrast intensity over time was not informative: [31 HU/s (IQR: 20–57) in CTA with, compared to 36 HU/s (IQR: 22.5–53) in CTA without RVD, p = 0.60]. Conclusion Several parameters of the time-intensity curve obtained by the bolus tracking system are associated with RVD assessed on CTA images. Of those, the time needed to reach a predefined threshold seems to be the easiest to obtain in any CTA without additional processing time or contrast injection. However, the performance of those parameters is globally low. PMID:27551831

  12. Role of tenecteplase in pulmonary embolism.

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    Shrivastava, Sameer; Sachdeva, Ankush; Paul, Biswajit

    2009-01-01

    Patients presenting with pulmonary embolism (PE) have a wide spectrum of clinical severity. Although, some patients may present with frank hemodynamic collapse and cardiac arrest, others may present with asymptomatic PE that is discovered incidentally during work up of another condition. Fibrinolytic therapy is an option in the treatment of patients with PE. A rational approach to decide whether to indicate fibrinolytic therapy is based on assessment of benefits that each patient will derive from fibrinolytic therapy weighed against risk of major bleeding and intracranial hemmorage. There is a clear benefit/risk ratio for fibrinolytic therapy in patients with PE who present with cardiac arrest and in those who are hemodynamically unstable from a massive pulmonary embolism. With proper risk assessment selected patients with stable hemodynamics and right ventricular dysfunction may also benefit from fibrinolytic therapy. This article sets out to review the literature on tenecteplase in treatment of patients with PE.

  13. Fat embolism syndrome and pulmonary microvascular cytology.

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    Castella, X; Vallés, J; Cabezuelo, M A; Fernandez, R; Artigas, A

    1992-06-01

    Pulmonary microvascular cytology consists of analysis of capillary blood sampled while a Swan-Ganz catheter is in the wedge position. This technique has proved to be useful in the diagnosis of lymphangitic spread of carcinoma in the lungs and there are case reports of their use in amniotic fluid embolism. Its usefulness in diagnosing fat embolism syndrome has been shown only rarely. We report a new case in which pulmonary microvascular cytologic study allowed a definite diagnosis of fat embolism syndrome. We suggest obtaining routinely samples of capillary blood when a pulmonary catheter is in place and fat embolism is suspected on a clinical basis.

  14. Dual energy CT pulmonary blood volume assessment in acute pulmonary embolism - correlation with D-dimer level, right heart strain and clinical outcome

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    Bauer, Ralf W.; Frellesen, Claudia; Schell, Boris; Lehnert, Thomas; Jacobi, Volkmar; Vogl, Thomas J.; Kerl, J.M. [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Renker, Matthias [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Medical University of South Carolina, Heart and Vascular Center, Ashley River Tower, Charleston, SC (United States); Ackermann, Hanns [Clinic of the Goethe University, Department of Biostatistics and Mathematical Modelling, Frankfurt (Germany); Schoepf, U.J. [Medical University of South Carolina, Heart and Vascular Center, Ashley River Tower, Charleston, SC (United States)

    2011-09-15

    To investigate the role of perfusion defect (PD) size on dual energy CT pulmonary blood volume assessment as predictor of right heart strain and patient outcome and its correlation with d-dimer levels in acute pulmonary embolism (PE). 53 patients with acute PE who underwent DECT pulmonary angiography were retrospectively analyzed. Pulmonary PD size caused by PE was measured on DE iodine maps and quantified absolutely (VolPD) and relatively to the total lung volume (RelPD). Signs of right heart strain (RHS) on CT were determined. Information on d-dimer levels and readmission for recurrent onset of PE and death was collected. D-dimer level was mildly (r = 0.43-0.47) correlated with PD size. Patients with RHS had significantly higher VolPD (215 vs. 73 ml) and RelPD (9.9 vs. 2.9%) than patients without RHS (p < 0.003). There were 2 deaths and 1 readmission due of PE in 18 patients with >5% RelPD, while no such events were found for patients with <5% RelPD. Pulmonary blood volume on DECT in acute PE correlates with RHS and appears to be a predictor of patient outcome in this pilot study. (orig.)

  15. Diagnosis and Management of Pulmonary Embolism in Pregnancy

    Directory of Open Access Journals (Sweden)

    Sarah Broder

    1996-01-01

    Full Text Available Pulmonary embolism in pregnancy is a significant and under-recognized problem. In British Columbia, where there are 46,000 pregnancies per year, it is estimated that there are approximately 160 pulmonary embolisms per year and one maternal death every two years secondary to pulmonary embolism. A complete assessment for suspected pulmonary embolus can be performed without putting the fetus at significant risk from radiation exposure. An algorithm is provided for the workup of pulmonary embolus during pregnancy. Heparin is the drug of choice for anticoagulating pregnant women, initially managing the situation with intravenous heparin and then switching to the subcutaneous route given in a bid or tid regimen, aiming to keep the activated partial thromboplastin time 1.5 to 2 times the control. The risks to both the fetus and the mother from anticoagulation during pregnancy are reviewed.

  16. Pulmonary Cement Embolism following Percutaneous Vertebroplasty

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    Ümran Toru

    2014-01-01

    Full Text Available Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.

  17. Validity and clinical utility of the simplified Wells rule for assessing clinical probability for the exclusion of pulmonary embolism

    NARCIS (Netherlands)

    Douma, R.A.; Gibson, N.S.; Gerdes, V.E.A.; Buller, H.R.; Wells, P.S.; Perrier, A.; Le Gal, G.

    2009-01-01

    The recently introduced simplified Wells rule for the exclusion of pulmonary embolism (PE) assigns only one point to the seven variables of the original Wells rule. This study was performed to independently validate the simplified Wells rule for the exclusion of PE. We retrospectively calculated the

  18. Pulmonary Embolism with Vertebral Augmentation Procedures

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    Swetha Bopparaju

    2013-01-01

    Full Text Available With the prevalence of an aging American population on the rise, osteoporotic vertebral fractures are becoming a common occurrence, resulting in an increase in vertebral augmentation procedures and associated complications such as cement leakage, vertebral compressions, and pulmonary embolism. We describe a patient who presented with respiratory distress three years following kyphoplasty of the lumbar vertebra. Computed tomography (CT angiogram of the chest confirmed the presence of polymethylmethacrylate (PMMA cement in the lung fields and pulmonary vessels. We conducted a systematic review of the published literature identifying effective management strategies for the treatment of vertebroplasty-associated pulmonary embolism.

  19. Dermatomyositis masquerading as pulmonary embolism

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    Mroz RM

    2009-12-01

    Full Text Available Abstract A 61-year-old Caucasian was admitted to Department of Chest Diseases and Tuberculosis, Medical University of Bialystok, Poland for progressive muscle weakness and weight loss. Eighteen months prior to admission, the patient had been diagnosed with pulmonary embolism. At that point he was started on Enoxaparin QD. Past medical history was unremarkable. In the interim, the patient developed fever, myalgia and progressive dyspnea. Physical examination on admission revealed a rash on his upper torso and back, and the extensor surfaces of all four extremities. Laboratory values included CPK 8229, MB fraction 219, LDH 981. Chest X-ray and CT scan revealed bilateral patchy consolidations and ground-glass opacities. EMG was consistent with myositis. The patient was started on solumedrol 40 mg i.v., b.i.d., and then switched to prednisone 40 mg b.i.d. His symptoms and muscle strength improved remarkably. The patient was discharged with prednisone with an outpatient follow up.

  20. Electrical impedance tomography for assessing ventilation/perfusion mismatch for pulmonary embolism detection without interruptions in respiration.

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    Nguyen, Doan Trang; Thiagalingam, Aravinda; Bhaskaran, Abhishek; Barry, Michael A; Pouliopoulos, Jim; Jin, Craig; McEwan, Alistair L

    2014-01-01

    Recent studies have shown high correlation between pulmonary perfusion mapping with impedance contrast enhanced Electrical Impedance Tomography (EIT) and standard perfusion imaging methods such as Computed Tomography (CT) and Single Photon Emission Computerized Tomography (SPECT). EIT has many advantages over standard imaging methods as it is highly portable and non-invasive. Contrast enhanced EIT uses hypertonic saline bolus instead of nephrotoxic contrast medium that are utilized by CT and nuclear Ventilation/Perfusion (V/Q) scans. However, current implementation of contrast enhanced EIT requires induction of an apnea period for perfusion measurement, rendering it disadvantageous compared with current gold standard imaging modalities. In the present paper, we propose the use of a wavelet denoising algorithm to separate perfusion signal from ventilation signal such that no interruption in patient's ventilation would be required. Furthermore, right lung to left lung perfusion ratio and ventilation ratio are proposed to assess the mismatch between ventilation and perfusion for detection of Pulmonary Embolism (PE). The proposed methodology was validated on an ovine model (n=3, 83.7±7.7 kg) with artificially induced PE in the right lung. The results showed a difference in right lung to left lung perfusion ratio between baseline and diseased states in all cases with all paired t-tests between baseline and PE yielding p <; 0.01, while the right lung to left lung ventilation ratio remained unchanged in two out of three experiments. Statistics were pooled from multiple repetitions of measurements per experiment.

  1. Pulmonary embolism in cancer patients

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    S P Sawant

    2012-01-01

    Full Text Available Aims and Objectives: Pulmonary embolism (PE is rare in the Indian population and is under-reported in patients with malignancy. We studied the clinical profile and outcome of patients with PE and cancer in the Indian population. Materials and Methods: Data of cancer patients with PE, admitted in a tertiary cancer centre, was analyzed. The prevalence of PE was calculated as the number of patients with PE per 10,000 hospital admissions. The demographic data, details of cancer, co-morbidities, details of PE, and treatment given for PE and their outcomes were recorded and analyzed. Results: There were 56,425 hospital admissions in the study period. The prevalence of PE was 6.4 per 10,000 hospital admissions .Thirty-six cancer patients were diagnosed to have PE. In females, gynecological malignancies (36.84% and in males gastrointestinal, head and neck cancers, and hematological malignancies were the most common sites (17.7% each. PE was associated with DVT in 41.7%. Dyspnea was the most common presenting symptom. Five patients (13.88% were asymptomatic and were incidentally detected to have PE . The most common echocardiographic finding was right ventricular dysfunction (55.55%. Mortality among the treated patients was 22% (7 / 31 and in untreated patients it was 80% (4 / 5. The factors that had an impact on a three-month survival were, the presence of massive PE (P = 0.019 and the presence of RV dysfunction at presentation (P = 0.005. Conclusion: The prevalence of PE and mortality due to PE is high in cancer patients. Risk stratification for venous thromboembolism (VTE should be done in all cancer patients and thromboprophylaxis should be optimally used.

  2. Neural Hypernetwork Approach for Pulmonary Embolism diagnosis

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    Rucco, Matteo; Merelli, Emanuela; Johnson, Jeffrey H; Falsetti, Lorenzo; Nitti, Cinzia; Salvi, Aldo

    2014-01-01

    This work introduces an integrative approach based on Q-analysis with machine learning. The new approach, called Neural Hypernetwork, has been applied to a case study of pulmonary embolism diagnosis. The objective of the application of neural hyper-network to pulmonary embolism (PE) is to improve diagnose for reducing the number of CT-angiography needed. Hypernetworks, based on topological simplicial complex, generalize the concept of two-relation to many-body relation. Furthermore, Hypernetworks provide a significant generalization of network theory, enabling the integration of relational structure, logic and analytic dynamics. Another important results is that Q-analysis stays close to the data, while other approaches manipulate data, projecting them into metric spaces or applying some filtering functions to highlight the intrinsic relations. A pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches, frequently fatal. Our study uses data on 28 diagnostic features of 1,427...

  3. Monitoring for suspected pulmonary embolism.

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    Capan, L M; Miller, S M

    2001-12-01

    It is fortunate that serious embolic phenomena are uncommon because, with the exception of neurosurgery in the sitting position and cardiac surgery, thoracic echocardiography and the precordial Doppler device, the most sensitive indicators of embolism, are seldom used. Vigilance is required of the anesthesiologist to recognize the rapid fall in end-tidal PCO2, the usual first indicator of a clinically significant PE. Any sudden deterioration in the patient's vital signs should include embolism in the differential diagnosis, particularly during procedures that carry a high risk of the complication.

  4. OBESITY AS A RISK FACTOR FOR PULMONARY EMBOLISM

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    O. Ya. Vasiltseva

    2014-01-01

    Full Text Available The aim of the study. Based on the data of the Register of new cases of hospital pulmonary embolism (PE in hospitals in Tomsk (2003–2012, to explore the contribution of obesity to the development of venous thromboembolism.Material and Methods. Study were subjected to medical history and records of autopsies of patients treated in hospitals in Tomsk in 2003–2012, who at patologoanatomic and/or instrumental study revealed pulmonary embolism. The degree of obesity was assessed according to WHO criteria (1997. Statistical processing of the results was carried out using the software package for PC Statistica 8.0 for Windows. To test the normality of the distribution of quantitative traits using the Shapiro–Wilk test and the Kolmogorov–Smirnov with the adjusted Lillieforsa. Check the equality of the population variance was performed using Fisher's exact test and Cochran. Was considered statistically significant level of p < 0.05.The results of the study. In Western Siberia, Tomsk, a register of hospital pulmonary embolism (2003–2012. In the register included 720 patients with in vivo and/or post mortem revealed pulmonary embolism (PE. Analyzed data from medical records and autopsy reports. Revealed statistically significant differences in BMI (p = 0.033 and the presence of obesity (p = 0.002 in patients with pulmonary embolism, holding medical and surgical beds. As of medical, surgical and among patients with thromboembolism, obesity is significantly more common in women than men (p = 0.050 and p = 0.041 respectively. According to the study, obesity grade 1 or 2 alone (at the isolated presence of the patient is not significantly increased the odds of a massive thromboembolism. However, grade 3 obesity increased the odds of a massive pulmonary embolism by more than 2.7 times (OR = 2.708, CI: 1,461–5,020.

  5. Anatomic distribution of embolus at CT pulmonary angiography in patients suspected acute pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    朱力

    2013-01-01

    Objective To summarize and analyze the morphology and distribution of embolus in patients suspected acute pulmonary embolism. Methods The CT pulmonary angiography(CTPA) imagings of 279 patients suspected acute pulmonary embolism were analyzed retrospectively in

  6. Breathomics as a diagnostic tool for pulmonary embolism

    NARCIS (Netherlands)

    Fens, N.; Douma, Renee; Sterk, P.J.; Kamphuisen, P.W.

    2011-01-01

    Rationale The majority of patients suspected of pulmonary embolism (PE) undergoes imaging tests, but PE will only be confirmed in a minority of patients. Consequently, there is a need for non-invasive, safe assessment aimed to accurately exclude PE. Exhaled breath molecular profiling by electronic n

  7. Perfusion visualization and analysis for pulmonary embolism

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    Vaz, Michael S.; Kiraly, Atilla P.; Naidich, David P.; Novak, Carol L.

    2005-04-01

    Given the nature of pulmonary embolism (PE), timely and accurate diagnosis is critical. Contrast enhanced high-resolution CT images allow physicians to accurately identify segmental and sub-segmental emboli. However, it is also important to assess the effect of such emboli on the blood flow in the lungs. Expanding upon previous research, we propose a method for 3D visualization of lung perfusion. The proposed method allows users to examine perfusion throughout the entire lung volume at a single glance, with areas of diminished perfusion highlighted so that they are visible independent of the viewing location. This may be particularly valuable for better accuracy in assessing the extent of hemodynamic alterations resulting from pulmonary emboli. The method also facilitates user interaction and may help identify small peripheral sub-segmental emboli otherwise overlooked. 19 patients referred for possible PE were evaluated by CT following the administration of IV contrast media. An experienced thoracic radiologist assessed the 19 datasets with 17 diagnosed as being positive for PE with multiple emboli. Since anomalies in lung perfusion due to PE can alter the distribution of parenchymal densities, we analyzed features collected from histograms of the computed perfusion maps and demonstrate their potential usefulness as a preliminary test to suggest the presence of PE. These histogram features also offer the possibility of distinguishing distinct patterns associated with chronic PE and may even be useful for further characterization of changes in perfusion or overall density resulting from associated conditions such as pneumonia or diffuse lung disease.

  8. Endovascular embolization of pulmonary arteriovenous malformations

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    LIU Feng-yong; WANG Mao-qiang; FAN Qing-sheng; DUAN Feng; WANG Zhi-jun; SONG Peng

    2010-01-01

    Background The major consequence of pulmonary arteriovenous malformations (PAVMs) is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc. Methods Patients (n=23) with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases.Results Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from (78.04±8.22)% to (95.13±3.67)% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization (fe=9.101, P <0.001). Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who

  9. Cardiac arrest caused by multiple recurrent pulmonary embolism

    DEFF Research Database (Denmark)

    Hannig, Kjartan Eskjaer; Husted, Steen Elkjaer; Grove, Erik Lerkevang

    2011-01-01

    Pulmonary embolism is a common condition with a high mortality. We describe a previously healthy 68-year-old male who suffered three pulmonary embolisms during a short period of time, including two embolisms while on anticoagulant treatment. This paper illustrates three important points. (1...

  10. Clinical characteristics of pulmonary embolism with concomitant pneumonia.

    Science.gov (United States)

    Cha, Seung-Ick; Choi, Keum-Ju; Shin, Kyung-Min; Lim, Jae-Kwang; Yoo, Seung-Soo; Lee, Jaehee; Lee, Shin-Yup; Kim, Chang-Ho; Park, Jae-Yong

    2016-04-01

    Although pneumonia is associated with an increased risk of venous thromboembolism, patients with pulmonary embolism and concomitant pneumonia are uncommon. The aim of the present study was to investigate the clinical features of pulmonary embolism with coexisting pneumonia. We retrospectively compared clinical, radiologic and laboratory parameters between patients with pulmonary embolism and concomitant pneumonia (pneumonia group) and those with unprovoked pulmonary embolism (unprovoked group), and then between the pneumonia group and those with pulmonary infarction (infarction group). Of 794 patients with pulmonary embolism, 36 (5%) had coexisting pneumonia and six (1%) had no provoking factor other than pneumonia. Stroke was significantly more common in the pneumonia group, than either the unprovoked group or the infarction group. In the pneumonia group, fever was significantly more common and serum C-reactive protein levels were significantly higher. By contrast, central pulmonary embolism and right ventricular dilation on computed tomography were significantly less frequent in the pneumonia group. In addition, an adverse outcome due to pulmonary embolism was less common in the pneumonia group than in either of the other two groups. The coexistence of pulmonary embolism and pneumonia is rarely encountered in clinical practice, especially without the presence of other factors that could provoke venous thromboembolism and is commonly associated with stroke. It is characterized by lower incidences of central pulmonary embolism and right ventricular dilation and by a lower rate of adverse outcomes due to pulmonary embolism itself.

  11. MRI of pulmonary embolism; MRT der akuten Lungenembolie

    Energy Technology Data Exchange (ETDEWEB)

    Fink, C.; Schoenberg, S.O. [Universitaetsklinikum Mannheim, Medizinische Fakultaet Mannheim der Universitaet Heidelberg, Institut fuer Klinische Radiologie, Mannheim (Germany); Thieme, S.; Clevert, D.; Reiser, M.F. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany); Ley, S. [Deutsches Krebsforschungszentrum Heidelberg, Abteilung Radiologie, Heidelberg (Germany); Universitaetsklinikum Heidelberg, Abteilung Paediatrische Radiologie, Heidelberg (Germany); Kauczor, H.U. [Deutsches Krebsforschungszentrum Heidelberg, Abteilung Radiologie, Heidelberg (Germany)

    2007-08-15

    Recent technical developments have substantially improved the potential of MRI for the diagnosis of pulmonary embolism. On the MR scanner side this includes the development of short magnets and dedicated whole-body MRI systems, which allow a comprehensive evaluation of pulmonary embolism and deep venous thrombosis in a single exam. The introduction of parallel imaging has substantially improved the spatial and temporal resolution of pulmonary MR angiography. By combining time-resolved pulmonary perfusion MRI with high-resolution pulmonary MRA a sensitivity and specificity of over 90% is achievable, which is comparable to the accuracy of CTA. Thus, for certain patient groups, such as patients with contraindications to iodinated contrast media and young women with a low clinical probability for pulmonary embolism, MRI can be considered as a first-line imaging tool for the assessment of pulmonary embolism. (orig.) [German] Technische Weiterentwicklungen der MRT haben deren Moeglichkeiten fuer die Diagnostik der Lungenembolie erheblich verbessert. Hierzu zaehlen auf Geraeteseite kuerzere Magneten sowie dedizierte Ganzkoerper-MRT-Systeme, die einerseits den Patientenzugang beguenstigen und andererseits eine Abklaerung einer potenziell zugrunde liegenden Venenthrombose in einer Untersuchung ermoeglichen. Auf Seite der Sequenztechnik hat die Einfuehrung der parallelen Bildgebung die raeumliche und zeitliche Aufloesung der MR-Angiographie (MRA) der Lunge deutlich verbessert. Durch eine Kombination zeitaufgeloester Messungen der Lungenperfusion und einer raeumlich hochaufgeloesten MRA kann fuer die Diagnostik der Lungenembolie eine Sensitivitaet und Spezifitaet von ueber 90% erzielt werden, was vergleichbar der Genauigkeit der CT-Angiographie (CTA) ist. Daher kann die MRT fuer bestimmte Personen, wie z. B. Patienten mit Kontraindikationen gegen jodhaltige Roentgenkontrastmittel (z. B. Hyperthyreose) oder juengere Frauen mit einer geringen klinischen Wahrscheinlichkeit fuer

  12. Pulmonary MRA: Differentiation of pulmonary embolism from truncation artefact

    Energy Technology Data Exchange (ETDEWEB)

    Bannas, Peter [University of Wisconsin-Madison, Department of Radiology, Madison, WI (United States); University Hospital Hamburg-Eppendorf, Department of Radiology, Hamburg (Germany); Schiebler, Mark L.; Motosugi, Utaroh; Francois, Christopher J. [University of Wisconsin-Madison, Department of Radiology, Madison, WI (United States); Reeder, Scott B. [University of Wisconsin-Madison, Department of Radiology, Madison, WI (United States); University of Wisconsin-Madison, Department of Biomedical Engineering, Madison, WI (United States); University of Wisconsin-Madison, Department of Medical Physics, Madison, WI (United States); University of Wisconsin-Madison, Department of Medicine, Madison, WI (United States); Nagle, Scott K. [University of Wisconsin-Madison, Department of Radiology, Madison, WI (United States); University of Wisconsin-Madison, Department of Medical Physics, Madison, WI (United States); University of Wisconsin-Madison, Department of Pediatrics, Madison, WI (United States)

    2014-08-15

    Truncation artefact (Gibbs ringing) causes central signal drop within vessels in pulmonary magnetic resonance angiography (MRA) that can be mistaken for emboli, reducing diagnostic accuracy for pulmonary embolism (PE). We propose a quantitative approach to differentiate truncation artefact from PE. Twenty-eight patients who underwent pulmonary computed tomography angiography (CTA) for suspected PE were recruited for pulmonary MRA. Signal intensity drops within pulmonary arteries that persisted on both arterial-phase and delayed-phase MRA were identified. The percent signal loss between the vessel lumen and central drop was measured. CTA served as the reference standard for presence of pulmonary emboli. A total of 65 signal intensity drops were identified on MRA. Of these, 48 (74 %) were artefacts and 17 (26 %) were PE, as confirmed by CTA. Truncation artefacts had a significantly lower median signal drop than PE on both arterial-phase (26 % [range 12-58 %] vs. 85 % [range 53-91 %]) and delayed-phase MRA (26 % [range 11-55 %] vs. 77 % [range 47-89 %]), p < 0.0001 for both. Receiver operating characteristic (ROC) analyses revealed a threshold value of 51 % (arterial phase) and 47 % signal drop (delayed phase) to differentiate between truncation artefact and PE with 100 % sensitivity and greater than 90 % specificity. Quantitative signal drop is an objective tool to help differentiate truncation artefact and pulmonary embolism in pulmonary MRA. (orig.)

  13. Right Heart Thrombi Accompained with Pulmonary Embolism

    Directory of Open Access Journals (Sweden)

    Mustafa Çörtük

    2015-10-01

    Full Text Available Aim: Right sided heart thrombus (RSHT is rarely seen. It is generally detected during transthoracic echocardiographic (TTE examination or multislice thoracic computed tomographic scanning for pulmonary embolism (PE. Although RSHT and PE secondary to this situation is rare, mortality during the course of process is very high. We aim to aproach right cardiac trombus and determine the results of treatment. Method: In this study 25 patients hospital records were investigated retrospectively. The data obtained consisted of diagnostic methods, presence of shock state, treatments applied and results were assessed. Results: Th present study revealed that the 32% of patients had been admitted to hospital in shock state, hospital mortality rate was 24%, and this mortality rate was not affected by different treatment choices. Conclusion: The exact incidence of RSHT is unknown. It is reported that the probability of seeing a case suffering from RSHT during echocardiographic examination performed to diagnose the PE is 9%. RSHT may cause PE anytime and requires urgent treatment. In our study, we determined that the hospital mortaliy did not change with the type of given treatment and overall mortality was determined as 24%. There are no sufficient studies searching large series on RSHT in literature. Therefore, there is no agreement on treatment tecniques.

  14. Paradoxical embolism, deep vein thrombosis, pulmonary embolism in a patient with patent foramen ovale: a case report

    Directory of Open Access Journals (Sweden)

    Guo Shan

    2007-09-01

    Full Text Available Abstract Introduction Coexistence of pulmonary embolism and systemic arterial embolism suggest the diagnosis of paradoxical embolism which suggests the presence of intracardiac defects such as patent foramen ovale (PFO. Case presentation A 42 year old man was found to have a paradoxical embolism in the systemic arterial circulation, in the setting of pulmonary embolism and deep vein thrombosis (DVT in the lower extremities. Conclusion Paradoxical embolism and intracardiac shunt should be immediately considered in a patient with pulmonary embolism and systemic arterial embolism. Diagnostic modalities included arteriogram and saline contrast echocardiography. Closure of intracardiac shunt is needed for patients who are at risk for recurrent embolic events.

  15. SPECT/CT and pulmonary embolism

    DEFF Research Database (Denmark)

    Mortensen, Jann; Borgwardt, Henrik Gutte

    2014-01-01

    Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar...... technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had...... the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume...

  16. Incidence of Pleural Effusion in Patients with Pulmonary Embolism

    Institute of Scientific and Technical Information of China (English)

    Min Liu; Ai Cui; Zhen-Guo Zhai; Xiao-Juan Guo; Man Li; Lei-Lei Teng; Li-Li Xu

    2015-01-01

    Background:No data on the incidence of pleural effusion (PE) in Chinese patients with pulmonary embolism are available to date.The aim of the current study was to investigate the frequency of PE in a Chinese population of patients with pulmonary embolism.Methods:This was a retrospective observational single-center study.All data of computed tomography pulmonary angiography (CTPA)performed over 6-year period on adult patients with clinically suspected pulmonary embolism were analyzed.Results:From January 2008 until December 2013,PE was identified in 423 of 3141 patients (13.5%) with clinically suspected pulmonary embolism who underwent CTPA.The incidence of PE in patients with pulmonary embolism (19.9%) was significantly higher than in those without embolism (9.4%) (P < 0.001).Majority of PEs in pulmonary embolism patients were small to moderate and were unilateral.The locations of emboli and the numbers of arteries involved,CT pulmonary obstruction index,and parenchymal abnormalities at CT were not associated with the development of PE.Conclusions:PEs are present in about one fifth of a Chinese population of patients with pulmonary embolism,which are usually small,unilateral,and unsuitable for diagnostic thoracentesis.

  17. Using Topological Data Analysis for diagnosis pulmonary embolism

    CERN Document Server

    Rucco, Matteo; Herman, Damir; Petrossian, Tanya; Merelli, Emanuela; Nitti, Cinzia; Salvi, Aldo

    2014-01-01

    Pulmonary Embolism (PE) is a common and potentially lethal condition. Most patients die within the first few hours from the event. Despite diagnostic advances, delays and underdiagnosis in PE are common.To increase the diagnostic performance in PE, current diagnostic work-up of patients with suspected acute pulmonary embolism usually starts with the assessment of clinical pretest probability using plasma d-Dimer measurement and clinical prediction rules. The most validated and widely used clinical decision rules are the Wells and Geneva Revised scores. We aimed to develop a new clinical prediction rule (CPR) for PE based on topological data analysis and artificial neural network. Filter or wrapper methods for features reduction cannot be applied to our dataset: the application of these algorithms can only be performed on datasets without missing data. Instead, we applied Topological data analysis (TDA) to overcome the hurdle of processing datasets with null values missing data. A topological network was devel...

  18. Diagnosis, management and prognosis of symptomatic and incidental pulmonary embolism

    NARCIS (Netherlands)

    Exter, den P.L.

    2016-01-01

    This thesis describes studies that aimed to evaluate and improve the diagnostic work-up and management of pulmonary embolism. Age-adjusted D-dimer testing was found to be an effective and safe strategy to reduce the need for CT-imaging in elderly patients with clinically suspected pulmonary embolism

  19. Pulmonary cement embolization after vertebroplasty, an uncommon presentation of pulmonary embolism: A case report and literature review

    Science.gov (United States)

    Sinha, Nishant; Padegal, Vivek; Satyanarayana, Satish; Santosh, Hassan Krishnamurthy

    2015-01-01

    Pulmonary Cement Embolization (PCE) is a rare complication of vertebroplasty surgery. There is no clear guideline for management of this entity. There is no definite protocol for anticoagulation in PCE. This is a case report of our patient who was diagnosed to have Pulmonary Cement Embolization, which was quite significant involving both lungs. She was successfully managed without long term anticoagulation. PMID:26664167

  20. Added value of lung perfused blood volume images using dual-energy CT for assessment of acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Munemasa, E-mail: radokada@yamaguchi-u.ac.jp [Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Kunihiro, Yoshie [Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Nakashima, Yoshiteru [Department of Radiology, Yamaguchi Grand Medical Center, Oosaki 77, Hofu, Yamaguchi 747-8511 (Japan); Nomura, Takafumi [Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Kudomi, Shohei; Yonezawa, Teppei [Department of Radiology, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan); Suga, Kazuyoshi [Department of Radiology, St. Hills Hospital, Imamurakita 3-7-18, Ube, Yamaguchi 755-0155 (Japan); Matsunaga, Naofumi [Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505 (Japan)

    2015-01-15

    Purpose: To investigate the added value of lung perfused blood volume (LPBV) using dual-energy CT for the evaluation of intrapulmonary clot (IPC) in patients suspected of having acute pulmonary embolism (PE). Materials and methods: Institutional review board approval was obtained for this retrospective study. Eighty-three patients suspected of having PE who underwent CT pulmonary angiography (CTPA) using a dual-energy technique were enrolled in this study. Two radiologists who were blinded retrospectively and independently reviewed CTPA images alone and the combined images with color-coded LPBV over a 4-week interval, and two separate sessions were performed with a one-month interval. Inter- and intraobserver variability and diagnostic accuracy were evaluated for each reviewer with receiver operating characteristic (ROC) curve analysis. Results: Values for inter- and intraobserver agreement, respectively, were better for CTPA combined with LPBV (ICC = 0.847 and 0.937) than CTPA alone (ICC = 0.748 and 0.861). For both readers, diagnostic accuracy (area under the ROC curve [A{sub z}]) were also superior, when CTPA alone (A{sub z} = 0.888 [reader 1] and 0.912 [reader 2]) was compared with that after the combination with LPBV images (A{sub z} = 0.966 [reader 1] and 0.959 [reader 2]) (p < 0.001). However, A{sub z} values of both images might not have significant difference in statistics, because A{sub z} value of CTPA alone was high and 95% confidence intervals overlapped in both images. Conclusion: Addition of dual-energy perfusion CT to CTPA improves detection of peripheral IPCs with better interobserver agreement.

  1. Pulmonary embolism and pulmonary infarction; Lungenembolie und Lungeninfarkt - pathologische Anatomie

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, K.M.; Mueller, A.M. [Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum (Germany). Inst. fuer Pathologie]|[Bochum Univ. (Germany). Universitaetsklinikum

    1998-03-01

    Radiological and nuclear medical evaluation of pulmonary embolisms and their consequences is often problematic, since parenchymal alterations in the form of possible pulmonary infarctions occur in only 10-15% after vessel obliteration. Small embolisms rather frequently cause hemorrhagic pulmonary infarctions, which can clinically be demonstrated by radiological and nuclear medical methods, after obliteration of the pre-capillary arterio-arterial anastomoses type I. In pre-existing chronic lung diseases with often markedly developed bronchial artery systems and additional anastomoses hemorrhagic pulmonary infarctions are extremely rare. Thus, today, radiological and nuclear medical studies, such as spiral computer scanning, have to rely largely on the results of thrombembolic vessel obstruction and transitory perfusion deficits and less on parenchymal infiltration patterns. (orig./MG) [Deutsch] Die radiologischen und nuklearmedizinischen Begutachtungen von Lungenembolien und deren Folgen sind oft problematisch, weil Parenchymveraenderungen in Form moeglicher Lungeninfarkte in nur 10-15% nach der Gefaessverlegung entstehen. Kleine Embolien fuehren haeufiger zu haemorrhagischen Lungeninfarkten, die mit radiologischen und nukelarmedizinischen Verfahren fassbar werden. Bei vorbestehenden chronischen Lungenerkrankungen mit meist verstaerkt ausgebautem Bronchialartheriensystem und zusaetzlichen Anatomosen sind haemorrhagische Lungeninfarkte besonders selten. Die radiologische und nuklearmedizinische Diagnostik muss sich daher heute nach vielversprechenden Studien, z.B. unter Einsatz der Spiralcomputertomographie, wesentlich auf die Befunde der thrombembolischen Gefaessobstruktion und transitorische Perfusionsausfaelle und weniger auf parenchymatoese Infiltratmuster stuetzen. (orig./MG)

  2. Severity assessment of pulmonary embolism using dual energy CT - correlation of a pulmonary perfusion defect score with clinical and morphological parameters of blood oxygenation and right ventricular failure

    Energy Technology Data Exchange (ETDEWEB)

    Thieme, Sven F. [Ludwig-Maximilians-Universitaet, Department of Clinical Radiology, Muenchen (Germany); Institut fuer Klinische Radiologie der LMU Muenchen, Muenchen (Germany); Ashoori, Nima; Bamberg, Fabian; Sommer, Wieland H.; Johnson, Thorsten R.C.; Maxien, Daniel; Helck, Andreas D.; Reiser, Maximilian F.; Nikolaou, Konstantin [Ludwig-Maximilians-Universitaet, Department of Clinical Radiology, Muenchen (Germany); Leuchte, Hanno; Becker, Alexander [Ludwig-Maximilians-Universitaet, Department of Medicine I, Muenchen (Germany); Behr, Juergen [Ludwig-Maximilians-Universitaet, Department of Medicine I, Muenchen (Germany); Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH Ruhr-Universitaet Bochum, Department of Medicine III, Bochum (Germany)

    2012-02-15

    To correlate a Dual Energy (DE)-based visual perfusion defect scoring system with established CT-based and clinical parameters of pulmonary embolism (PE) severity. In 63 PE patients, DE perfusion maps were visually scored for perfusion defects (P-score). Vascular obstruction was quantified using the Mastora score. Both scores were correlated with short-axis diameters of the right and left ventricle, their ratio (RV/LV ratio), width of the pulmonary trunk, a number of clinical parameters and each other. Univariate and multivariate analyses were performed. Times to generate both scores were recorded. After univariate and multivariate analysis, a significant (p < 0.05) correlation with the P-score was shown for the Mastora score (r = 0.65), RV/LV ratio (r = 0.47), width of the pulmonary trunk (r = 0.26), troponin I (r = 0.43) and PaO{sub 2} (r = -0.50). For the left ventricular diameter, only univariate analysis showed a significant correlation. Mastora score correlated significantly with RV/LV ratio (r = 0.36), width of the pulmonary trunk (r = 0.27), PaO{sub 2} (r = -0.41) and troponin I (r = 0.37). Mean time for generating the P-score was significantly shorter than for the Mastora score. A DE-based P-score correlates with a number of parameters of PE severity. It might be easier and faster to perform than some traditional CT scoring methods for vascular obstruction. (orig.)

  3. Cancer patients and characteristics of pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Hasenberg, U.; Paul, T. [Department of Radiology, University Hospital Essen (Germany); Feuersenger, A. [Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen (Germany); Goyen, M. [Department of Radiology, University Medical Center Hamburg-Eppendorf (Germany); Kroeger, K. [Department of Angiology, University Hospital Essen (Germany)], E-mail: knut.kroeger@uk-essen.de

    2009-03-15

    Objective: To check the hypothesis that cancer patients suffer from extended pulmonary embolism (PE) more frequently than patients without cancer we analysed PEs proved by computed tomography (CT)-imaging. Patients and methods: One hundred and fifty consecutive CT scans at the University Hospital of Essen from March 2002 until December 2004 which proved a definite case of pulmonary embolism were retrospectively reviewed (79 men, 71 women; mean age 57 {+-} 15 years). Underlying disease and blood parameters were included (haemoglobin, haematocrit, fibrinogen and total protein, if determined within 48 h before the CT scans). Results: Patients with malignant disease were older (59 {+-} 12 years vs. 54 {+-} 19 years, p = 0.05) and tend to have a higher rate of central PEs (52% vs. 34%, p = 0.08) than patients without malignancies. The odds of a central PE in cancer patients was about twice as high as in patients without a malignant disease (Odds ratio: 2.08, 95%-confidence interval: 1.06-4.10; age-adjusted Odds ratio 1.88, 95%-confidence interval: 0.92-3.84). Additional adjustment for the clinical information dyspnoea, inhospital patient and clinically expected PE did not deteriorate the odds. Thrombus density determined in patients with central PE only shows a trend towards a lower density in patients with malignant disease (52 {+-} 13 HE vs. 45 {+-} 15 HE, p = 0.13). There is no statistical evidence that thrombus density is related to one of the blood parameters or even blood density measured in the pulmonary artery. Conclusion: Although this is a retrospective study including a small number of patients it shows that cancer patients are at a higher risk for central PE than patients without cancer. Characteristics of the intrapulmonal thrombus in cancer and non-cancer patients seem to be different.

  4. SPECT/CT and pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Mortensen, Jann [Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark); The Faroese National Hospital, Department of Medicine, Torshavn (Faroe Islands); Gutte, Henrik [Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark); Herlev Hospital, Copenhagen University Hospital, Department of Radiology, Copenhagen (Denmark); University of Copenhagen, Cluster for Molecular Imaging, Faculty of Health Sciences, Copenhagen (Denmark)

    2014-05-15

    Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume coverage per rotation and faster rotation. Furthermore, the dual energy CT technique is a promising modality that can provide functional imaging in combination with anatomical information. Newer high-end CT scanners and SPECT systems are able to visualize smaller subsegmental emboli. However, consensus is lacking regarding the clinical impact and treatment. In the present review, SPECT and SPECT in combination with low-dose CT, CTPA and dual energy CT are discussed in the context of diagnosing PE. (orig.)

  5. Isolated Pulmonary Embolism following Shoulder Arthroscopy

    Directory of Open Access Journals (Sweden)

    Nicole H. Goldhaber

    2014-01-01

    Full Text Available Pulmonary embolism (PE following shoulder arthroscopy is a rare complication. We present a unique case report of a 43-year-old right-hand dominant female who developed a PE 41 days postoperatively with no associated upper or lower extremity DVT. The patient had minimal preoperative and intraoperative risk factors. Additionally, she had no thromboembolic symptoms postoperatively until 41 days following surgery when she developed sudden right-hand swelling, labored breathing, and abdominal pain. A stat pulmonary computed tomography (CT angiogram of the chest revealed an acute PE in the right lower lobe, and subsequent extremity ultrasounds showed no upper or lower extremity deep vein thrombosis. After a thorough review of the literature, we present the first documented isolated PE following shoulder arthroscopy. Although rare, sudden development of an isolated PE is possible, and symptoms such as sudden hand swelling, trouble breathing, and systemic symptoms should be evaluated aggressively with a pulmonary CT angiogram given the fact that an extremity ultrasound may be negative for deep vein thrombosis.

  6. Computed tomography for pulmonary embolism - Assessment of a 1-year cohort and estimated cancer risk associated with diagnostic irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Niemann, T. [Dept. of Radiology and Nuclear Medicine, Univ. Hospital, Basel (Switzerland); Dept. of Thoracic Imaging, Univ. Lille Nord de France, Hospital Calmette, Lille (France)], e-mail: tilo.niemann@usb.ch; Zbinden, I.; Bremerich, J.; Bongartz, G. [Dept. of Radiology and Nuclear Medicine, Univ. Hospital, Basel (Switzerland); Roser, H. W. [Dept. of Radiology and Nuclear Medicine, Univ. Hospital, Radiological Physics, Basel (Switzerland); Remy-Jardin, M. [Dept. of Thoracic Imaging, Univ. Lille Nord de France, Hospital Calmette, Lille (France)

    2013-09-15

    Background: The principal concern of any radiation exposure in computed tomography (CT) is the induction of stochastic risks of developing a radiation-induced cancer. The results given in this manuscript will allow to (re-)calculate yield of chest CT. Purpose: To demonstrate a method to evaluate the lifetime attributable risk (LAR) of cancer incidence/mortality due to a single diagnostic investigation in a 1-year cohort of consecutive chest CT for suspected pulmonary embolism (PE). Material and Methods: A 1-year cohort of consecutive chest CT for suspected PE using a standard scan protocol was analyzed retrospectively (691 patients, 352 men, 339 women). Normalized patient-specific estimations of the radiation doses received by individual organs were correlated with age- and sex-specific mean predicted cancer incidence and age- and sex-specific predicted cancer mortality based on the BEIR VII results. Additional correlation was provided for natural occurring risks. Results: LAR of cancer incidence/mortality following one chest CT was calculated for cancer of the stomach, colon, liver, lung, breast, uterus, ovaries, bladder, thyroid, and for leukemia. LAR remains very low for all age and sex categories, being highest for cancer of the lungs and breasts in 20-year-old women (0.61% and 0.4%, respectively). Summation of all cancer sites analyzed raised the cumulative relative LAR up to 2.76% in 20-year-old women. Conclusion: Using the method presented in this work, LAR of cancer incidence and cancer mortality for a single chest CT for PE seems very low for all age groups and both sexes, but being highest for young patients. Hence the risk for radiation-induced organ cancers must be outweighed with the potential benefit or a treatment and the potential risks of a missed and therefore untreated PE.

  7. CT Pulmonary Angiography and Suspected Acute Pulmonary Embolism

    Energy Technology Data Exchange (ETDEWEB)

    Enden, T.; Kloew, N.E. [Ullevaal Univ. Hospital, Oslo (Norway). Dept. of Cardiovascular Radiology

    2003-05-01

    Purpose: To evaluate the use and quality of CT pulmonary angiography in our department, and to relate the findings to clinical parameters and diagnoses. Material and Methods: A retrospective study of 324 consecutive patients referred to CT pulmonary angiography with clinically suspected pulmonary embolism (PE). From the medical records we registered clinical parameters, blood gases, D-dimer, risk factors and the results of other relevant imaging studies. Results: 55 patients (17%) had PE detected on CT. 39 had bilateral PE, and 8 patients had isolated peripheral PE. 87% of the examinations showing PE had satisfactory filling of contrast material including the segmental pulmonary arteries, and 60% of the subsegmental arteries. D-dimer test was performed in 209 patients, 85% were positive. A negative D-dimer ruled out PE detected at CT. Dyspnea and concurrent symptoms or detection of deep vein thrombosis (DVT), contraceptive pills and former venous thromboembolism (VTE) were associated with PE. The presence of only one clinical parameter indicated a negative PE diagnosis (p < 0.017), whereas two or more suggested a positive PE diagnosis (p < 0.002). CT also detected various ancillary findings such as consolidation, pleural effusion, nodule or tumor in nearly half of the patients; however, there was no association with the PE diagnosis. Conclusion: The quality of CT pulmonary angiography was satisfactory as a first-line imaging of PE. CT also showed additional pathology of importance in the chest. Our study confirmed that a negative D-dimer ruled out clinically suspected VTE.

  8. S WAVE IN PULMONARY EMBOLISM, A NEW ECG SIGN TO AID THROMBOLYSIS

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    Thomas John

    2012-11-01

    Full Text Available Acute pulmonary embolism is a devastating disease that often leads to mortality . Previous investigators have found that thrombolysis reduces mortality in men but not significantly in women with pulmonary embolism. Many of the previous studies are with tenecteplase and alteplase. Here, we describe intra - venous thrombolysis with streptokinase in seven patients with pulmonary embolism who survived including two women. Further, we have one patient who had a new onset of S wave in lead I which subsequently disappeared after embolectomy. We also comment on the usefulness of shock sign in 2 deciding on thrombolysis .We propose a new sign for noninvasive assessment of need for thrombolysis in pulmonary embolism. New onset S wave in Lead I in pulmonary embolism can be used as a new sign for deciding the need for thrombolysis. When added to the shock sign it can be used in the emergency deparment to decide the need for thrombolysis. Further, there are no clear end points as to when to stop thrombolysis. In all 4 patients we switched to heparin when spontaneous bleeding or oozing started. In all 4 patients subsequent CT scans showed that the patient has mild to moderate resolution of the pulmonary embolism and patients remained stable and have been discharged and are under regular follow up. Hence we propose that bleeding can be used as an end point for thrombolysis in acute pulmonary embolism. We also describe a patient who had new onset S wave that disappeared after successful pulmonary embolectomy. Probably, the S wave is a marker of main pulmonary artery branch occlusions.

  9. Tenecteplase to treat pulmonary embolism in the emergency department.

    Science.gov (United States)

    Kline, Jeffrey A; Hernandez-Nino, Jackeline; Jones, Alan E

    2007-04-01

    Tenecteplase, a mutant form of alteplase, possesses pharmacological properties that might favor its use for emergent fibrinolysis of acute pulmonary embolism. Contemporaneous search of the World's literature reveals 14 humans with acute pulmonary embolism treated with tenecteplase. Here, we summarize those cases and report the presentation features, dosing details and outcomes of eight additional patients with acute pulmonary embolism treated with tenecteplase in an academic emergency department. None of our eight patients had a significant hemorrhagic event after tenecteplase, and the outcomes of all eight appear to be acceptable. Taken together, we submit that the present case report and prior case reports are sufficient to comprise a phase I study of the safety and efficacy of tenecteplase to treat acute pulmonary embolism.

  10. Negative spiral CT in acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Nilsson, T.; Olausson, A. [Karolinska Hospital, Stockholm (Sweden). Dept. of Thoracic Radiology; Johnsson, H. [Karolinska Hospital, Stockholm (Sweden). Dept. of Internal Medicine; Nyman, U. [County Hospital, Trelleborg (Sweden). Dept. of Radiology; Aspelin, P. [Huddinge Univ. Hospital (Sweden). Dept. of Radiology

    2002-09-01

    Purpose: To retrospectively evaluate the clinical outcome of non-anticoagulated patients with clinically suspected acute pulmonary embolism (PE) and no symptoms or signs of deep venous thrombosis (DVT) following a negative contrast medium-enhanced spiral CT of the pulmonary arteries (s-CTPA). Material and Methods: During a 24-month period, 739 of 751 patients underwent s-CTPA with acceptable diagnostic quality for clinically suspected acute PE. All patients who had a CT study not positive for PE were followed up with a questionnaire, a telephone interview and review of all medical reports, including autopsies and death certificates for any episodes of venous thromboembolism (VTE) during a 3-month period. Results: PE was diagnosed in 158 patients. Of the remaining 581 patients with a negative s-CTPA, 45 patients were lost to follow-up. 88 patients were excluded because of anticoagulation treatment (cardiac disorder n=32, chronic VTE or acute symptomatic DVT n=31, PE diagnosed at pulmonary angiography n=1, thrombus prophylaxis during diagnostic work-up or other reasons than VTE n=24) and 7 patients undergoing lower extremity venous studies because of symptoms of DVT (all negative). Thus, 441 patients with a negative s-CTPA and no DVT symptoms, venous studies or anticoagulant treatment constituted the follow-up cohort. Four of these patients had proven VTE (all PE) during the 3-month follow-up period. Two of the PE episodes contributed to the patient's death. Conclusion: Patients with clinically suspected acute PE, no symptoms or signs of DVT and a negative single slice s-CTPA using 3-5 mm collimation, may safely be left without anticoagulation treatment unless they are critically ill, have a limited cardiopulmonary reserve and/or if a high clinical suspicion remains.

  11. Tenecteplase in the treatment of acute pulmonary thrombo-embolism.

    Science.gov (United States)

    Bhuvaneswaran, J S; Premchand, Rajendra Kumar; Iyengar, S S; Rajeev Khare; Chabra, C B; Padmanabhan, T N C; Sharma, S K; Jain, Alkesh; Pandian, S A; Rajdev, S; Modi, N; Kumar, V

    2011-05-01

    This is a retrospective study documenting the use of tenecteplase in 41 cases of suspected or confirmed pulmonary embolism receiving in-hospital tenecteplase as per weight-adjusted dosing in addition to standard heparin and oral anticoagulant therapy. The presenting symptoms of dyspnoea, chest pain, hemoptysis and syncope were found in 40 (97.56%), 19 (46.34%), 6 (14.63%) and 9 (21.95%) patients, respectively. There was one case of mortality who was a 26 yrs old female of postpartum pulmonary thrombo-embolism with severe hypotension, cyanosis, bilateral crepitations in lungs and pulmonary hypertension. In the 40 survived patients, there was alleviation of dyspnoea and hemoptysis in all patients. Significant reduction in tachycardia (P tenecteplase therapy. Resolution of pulmonary embolism on CT pulmonary angiography was documented in only two patients. No bleeding events or any other adverse events were reported during this study. The present study suggests favourable efficacy of tenecteplase in patients with suspected or confirmed acute pulmonary embolism. Although no major adverse events were noted, a large prospective study on the use of tenecteplase in pulmonary embolism is suggested.

  12. CT imaging in acute pulmonary embolism: diagnostic strategies

    Energy Technology Data Exchange (ETDEWEB)

    Wildberger, Joachim E.; Mahnken, Andreas H.; Das, Marco; Guenther, Rolf W. [University of Technology (RWTH), Department of Diagnostic Radiology, University Hospital, Aachen (Germany); Kuettner, Axel [Eberhard Karls University, Department of Diagnostic Radiology, Tuebingen (Germany); Lell, Michael [Friedrich Alexander University, Department of Diagnostic Radiology, Erlangen (Germany)

    2005-05-01

    Computed tomography pulmonary angiography (CTA) has increasingly become accepted as a widely available, safe, cost-effective, and accurate method for a quick and comprehensive diagnosis of acute pulmonary embolism (PE). Pulmonary catheter angiography is still considered the gold standard and final imaging method in many diagnostic algorithms. However, spiral CTA has become established as the first imaging test in clinical routine due to its high negative predictive value for clinically relevant PE. Despite the direct visualization of clot material, depiction of cardiac and pulmonary function in combination with the quantification of pulmonary obstruction helps to grade the severity of PE for further risk stratification and to monitor the effect of thrombolytic therapy. Because PE and deep venous thrombosis are two different aspects of the same disease, additional indirect CT venography may be a valuable addition to the initial diagnostic algorithm - if this was positive for PE - and demonstration of the extent and localization of deep venous thrombosis has an impact on clinical management. Additional and alternate diagnoses add to the usefulness of this method. Using advanced multislice spiral CT technology, some practitioners have advocated CTA as the sole imaging tool for routine clinical assessment in suspected acute PE. This will simplify standards of practice in the near future. (orig.)

  13. Septic Pulmonary Embolism Induced by Dental Infection

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    Watanabe,Yoichi

    2013-08-01

    Full Text Available Dental infection can be an important source for septic pulmonary embolism (SPE, but only a few cases of SPE accompanying dental infection have been reported. The aim of this study was to characterize the clinical features of SPE induced by dental infection. Patients who fulfilled the diagnostic criteria described in the text were recruited in a retrospective fashion. All 9 patients were men, with a median age of 59 years (range:47 to 74 years. Eight patients had chest pain (88.9%, 5 had a preceding toothache (55.6% and 3 had preceding gingival swelling (33.3%. Blood cultures obtained from 7 patients were negative. Periodontitis was found in all of the cases, periapical periodontitis in 5 cases, and gingival abscess in 3 cases. The median duration of hospitalization was 15 days, and symptoms were mild in some cases. In addition to antimicrobial therapy, tooth extraction was performed in 3 cases, tooth scaling in 6. SPE induced by dental infection has prominent clinical characteristics such as male preponderance, chest pain, preceding toothache, and mild clinical course.

  14. Comparison of the Wells score with the revised Geneva score for assessing suspected pulmonary embolism: a systematic review and meta-analysis.

    Science.gov (United States)

    Shen, Jun-Hua; Chen, Hong-Lin; Chen, Jian-Rong; Xing, Jia-Li; Gu, Peng; Zhu, Bao-Feng

    2016-04-01

    The Wells score and the revised Geneva score are two most commonly used clinical rules for excluding pulmonary embolism (PE). In this study, we aimed to assess the diagnostic accuracy of these two rules; we also compared the diagnostic accuracy between them. We searched PubMed and Web of science up to April 2015. Studies assessed Wells score and revised Geneva score for diagnosis suspected PE were included. The summary area under the curve (AUC) and the 95 % confidence interval (CI) were calculated. Eleven studies were included in this meta-analysis. For Wells score, the sensitivity ranged from 63.8 to 79.3 %, and the specificity ranged from 48.8 to 90.0 %. The overall weighted AUC was 0.778 (95 % CI 0.740-0.818; Z = 9.88, P Geneva score, the sensitivity ranged from 55.3 to 73.6 %. The overall weighted AUC was 0.693 (95 % CI 0.653-0.736; Z = 11.96, P Geneva score for predicting PE in suspected patients. Meta-regression showed diagnostic accuracy of these two rules was not related with PE prevalence. Sensitivity analysis by only included prospective studies showed the results were robust. Our results showed the Wells score was more effective than the revised Geneva score in discriminate PE in suspected patients.

  15. Pulmonary embolism in pregnancy: comparison of pulmonary CT angiography and lung scintigraphy.

    LENUS (Irish Health Repository)

    Ridge, Carole A

    2012-02-01

    OBJECTIVE: The purpose of this study was to retrospectively compare the diagnostic adequacy of lung scintigraphy with that of pulmonary CT angiography (CTA) in the care of pregnant patients with suspected pulmonary embolism. MATERIALS AND METHODS: Patient characteristics, radiology report content, additional imaging performed, final diagnosis, and diagnostic adequacy were recorded for pregnant patients consecutively referred for lung scintigraphy or pulmonary CTA according to physician preference. Measurements of pulmonary arterial enhancement were performed on all pulmonary CTA images of pregnant patients. Lung scintigraphy and pulmonary CTA studies deemed inadequate for diagnosis at the time of image acquisition were further assessed, and the cause of diagnostic inadequacy was determined. The relative contribution of the inferior vena cava to the right side of the heart was measured on nondiagnostic CTA images and compared with that on CTA images of age-matched nonpregnant women, who were the controls. RESULTS: Twenty-eight pulmonary CTA examinations were performed on 25 pregnant patients, and 25 lung scintigraphic studies were performed on 25 pregnant patients. Lung scintigraphy was more frequently adequate for diagnosis than was pulmonary CTA (4% vs 35.7%) (p = 0.0058). Pulmonary CTA had a higher diagnostic inadequacy rate among pregnant than nonpregnant women (35.7% vs 2.1%) (p < 0.001). Transient interruption of contrast material by unopacified blood from the inferior vena cava was identified in eight of 10 nondiagnostic pulmonary CTA studies. CONCLUSION: We found that lung scintigraphy was more reliable than pulmonary CTA in pregnant patients. Transient interruption of contrast material by unopacified blood from the inferior vena cava is a common finding at pulmonary CTA of pregnant patients.

  16. Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

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    Deng-Wei Chou

    Full Text Available OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%. The most common computed tomographic findings included a feeding vessel sign (90%, peripheral nodules without cavities (80% or with cavities (65%, and peripheral wedge-shaped opacities (75%. The most common primary source of infection was liver abscess (40%, followed by pneumonia (25%. The two most frequent causative pathogens were Klebsiella pneumoniae (50% and Staphylococcus aureus (35%. Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.

  17. Prevalence of death due to pulmonary embolism after trauma

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    Echeverria Rodrigo

    2010-01-01

    Full Text Available Background: Pulmonary thromboembolism is an important cause of death affecting thousands of people worldwide. The current study aims to evaluate the prevalence of death due to pulmonary embolism after trauma. Materials and Methods: The diagnoses of the causa mortis of all patients treated in the Accident and Emergency Department of Hospital de Base in Sγo Josι do Rio Preto, in the period from July 2004 to June 2005, were identified from autopsy reports to check whether pulmonary thromboembolism was involved. Result: A total of 109 deaths due to trauma were detected in this period with pulmonary embolism occurring in 3 (2.75% patients. Conclusion: Pulmonary thromboembolism is an important cause of mortality in trauma patients and so prophylactic measures should be taken during the treatment of these patients.

  18. Rising incidence of pulmonary embolism in modern China

    Institute of Scientific and Technical Information of China (English)

    Tsung O.Cheng

    2006-01-01

    @@ To the Editor: Pulmonary embolism (PE) used to be thought to be rare in China.1 Traditional teaching by such authorities as Snapper, who was highly regarded in old China as one of the most astute diagnosticians, was that PE was uncommon in China.2 As a matter of fact, he did not even mention it in his book "Chinese lessons to western medicine",3 published in 1941. The rarity of pulmonary embolism was even more remarkable when one considered the widespread use of birth control pills among the Chinese women of child-bearing age.1

  19. Pulmonary embolism following celiac plexus block and neurolysis

    Science.gov (United States)

    Raizada, Miles S.; Kelly, Seth M.

    2016-01-01

    Treatment of acute pain in chronic disease requires the physician to choose from an arsenal of pain management techniques tailored to the individual patient. Celiac plexus block and neurolysis are commonly employed for the management of chronic abdominal pain, especially in debilitating conditions such as cancer or chronic pancreatitis. The procedure is safe, well tolerated, and produces few complications. We present a case of pulmonary embolism following a celiac plexus block and neurolysis procedure. Further study is required to determine if celiac plexus ablation, alone or in combination with other risk factors, may contribute to increased risk for pulmonary embolism in patients seeking treatment for chronic upper abdominal pain conditions. PMID:27365890

  20. Thrombolytic Therapy by Tissue Plasminogen Activator for Pulmonary Embolism.

    Science.gov (United States)

    Islam, Md Shahidul

    2017-01-01

    Clinicians need to make decisions about the use of thrombolytic (fibrinolytic) therapy for pulmonary embolism (PE) after carefully considering the risks of major complications from bleeding, and the benefits of treatment, for each individual patient. They should probably not use systemic thrombolysis for PE patients with normal blood pressure. Treatment by human recombinant tissue plasminogen activator (rt-PA), alteplase, saves the lives of high-risk PE patients, that is, those with hypotension or in shock. Even in the absence of strong evidence, clinicians need to choose the most appropriate regimen for administering alteplase for individual patients, based on assessment of the urgency of the situation, risks for major complications from bleeding, and patient's body weight. In addition, invasive strategies should be considered when absolute contraindications for thrombolytic therapy exist, serious complications arise, or thrombolytic therapy fails.

  1. Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach.

    Science.gov (United States)

    Lavorini, Federico; Di Bello, Vitantonio; De Rimini, Maria Luisa; Lucignani, Giovanni; Marconi, Letizia; Palareti, Gualtiero; Pesavento, Raffaele; Prisco, Domenico; Santini, Massimo; Sverzellati, Nicola; Palla, Antonio; Pistolesi, Massimo

    2013-12-19

    The diagnosis of pulmonary embolism (PE) is frequently considered in patients presenting to the emergency department or when hospitalized. Although early treatment is highly effective, PE is underdiagnosed and, therefore, the disease remains a major health problem. Since symptoms and signs are non specific and the consequences of anticoagulant treatment are considerable, objective tests to either establish or refute the diagnosis have become a standard of care. Diagnostic strategy should be based on clinical evaluation of the probability of PE. The accuracy of diagnostic tests for PE are high when the results are concordant with the clinical assessment. Additional testing is necessary when the test results are inconsistent with clinical probability. The present review article represents the consensus-based recommendations of the Interdisciplinary Association for Research in Lung Disease (AIMAR) multidisciplinary Task Force for diagnosis and treatment of PE. The aim of this review is to provide clinicians a practical diagnostic and therapeutic management approach using evidence from the literature.

  2. Retrospective Clinical Analysis of 38 Cases of Pulmonary Embolism

    Institute of Scientific and Technical Information of China (English)

    Ruiyun Liang; Wei Zhang; Wei Wu; Shanping Jiang; Zhiqiang Lü

    2007-01-01

    To investigate the clinical feature of acute pulmonary embolism.Methods Retrospective clinical analysis was performed according to the data of 38 cases of pulmonary embolism.Results There were ground diseases and predisposing factors in 36 cases of pulmonary embolism among 38 cases,the ratio was 94.7 %,among the total predisposing factors,tumor,cardiovascular disease,venous thrombosis of lower extremity,smoking and long-term bed were common.There was no specificity in clinical feature,physical sign and rout chest X ray,electrocardiography,and their appearances were diversified.There were specificity and sensitivity in echocardiogram (UCG) and D-dimer to some extent.But,the final diagnosis must depend on some special examinations,such as selective pulmonary arteriography,CTPA,MRA and so on.Conclusions The special examinations must be done to make a definite diagnosis to confirm pulmonary embolism when the high risk factors and ground diseases are existing.It is necessary to some cases when the clinical feature can not be explained by other diseases.

  3. Symptomatic pulmonary lipiodol embolism after transarterial chemoembolization for hepatic malignant tumor: clinical presentation and chest imaging findings

    Institute of Scientific and Technical Information of China (English)

    Xu Haifeng; Yang Renjie; Wang Xiaodong; Zhu Xu; Chen Hui

    2014-01-01

    Background Pulmonary lipiodol embolism after transarterial chemoembolization (TACE) was rare and life-threatening,occasionally reported in previous literatures.We aimed to review the records of 11 patients with pulmonary oily embolism and analyze their characteristics of radiographic findings and risk factors.Methods Records of 478 consecutive patients who underwent 1 026 percutaneous TACE procedures were retrospectively analyzed.Eleven cases with respiratory symptoms were identified as having symptomatic pulmonary lipiodol embolism after TACE.Data of these patients,including clinical presentation,techniques of TACE,imaging features of tumor and chest imaging findings,were assessed.Results Eleven (2.3%) of 478 consecutive patients who underwent percutaneous TACE procedures had a pulmonary oily embolism after procedures.The mean size of target tumors embolized was (13.6±2.0) cm.All were hyper-vascular.The mean volume of lipiodol was (21.8±8.2) ml.Pulmonary oily embolisms were revealed within 12-48 hours after TACE.The most severe respiratory symptoms and imaging abnormalities of the eight patients who survived presented between 2 and 5 days after TACE,becoming normal between 12 and 35 days after TACE.Three patients died.Chest CT revealed retention of radiopaque lipiodol in lungs.Conclusions Pulmonary lipiodol embolism occurs easily in patients who have large hyper-vascular hepatic malignant tumor.The high-density lipiodol deposition in the lung field can be used as diagnostic feature.

  4. Low level of residual thrombotic obstruction following 6 months of anticoagulant treatment for acute pulmonary embolism

    NARCIS (Netherlands)

    Den Exter, P.L.; Van Es, J.; Kroft, L.J.M.; Erkens, P.G.M.; Douma, Renee; Jonkers, G.; Ten Cate, H.; Beenen, L.; Kamphuisen, P.W.; Huisman, M.V.

    2013-01-01

    Background: In patients with acute pulmonary embolism (PE), systematic assessment of residual thrombotic obstruction after long-term anticoagulation has been understudied. This information may be of clinical importance for diagnostic baseline imaging, in case of clinically suspected recurrent PE or

  5. Low-pressure pulmonary artery aneurysm presenting with pulmonary embolism: a case series

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    Papoulidis Pavlos

    2011-04-01

    Full Text Available Abstract Introduction Pulmonary artery aneurysm is an uncommon disorder with severe complications. The diagnosis is often difficult, since the clinical manifestations are non-specific and the treatment is controversial, as the natural history of the disease is not completely understood. Case presentation We describe the cases of two patients with pulmonary artery aneurysms. The first patient was a 68-year-old Caucasian man with an idiopathic low-pressure pulmonary artery aneurysm together with a pulmonary embolism. The patient preferred a conservative approach and was stable at the 10-month follow-up visit after being placed on anti-coagulant treatment. The second patient was a 66-year-old Caucasian woman with a low-pressure pulmonary artery aneurysm also presented together with a pulmonary embolism. The aneurysm was secondary to pulmonary valve stenosis. She received anti-coagulants and, after stabilization, underwent percutaneous balloon valvuloplasty. Conclusion Pulmonary embolism may be the initial presentation of a low-pressure pulmonary artery aneurysm. No underlying cause for pulmonary embolism was found in either of our patients, suggesting a causal association with low-pressure pulmonary artery aneurysm.

  6. Pulmonary embolism and stroke associated with mechanical thrombectomy

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    Paulo Bastianetto

    2014-04-01

    Full Text Available Mechanical thrombectomy offers the advantage of rapid removal of venous thrombi. It allows venous obstructions to be removed and requires shorter duration of infusion of thrombolytic agents. However, aspiration of thrombi can lead to complications, particularly pulmonary embolism and hemolysis. The validity of using vena cava filters during thrombectomy in order to avoid embolism has not yet been established. The authors report a case of massive pulmonary embolism associated with ischemic stroke in a patient with a hitherto undiagnosed patent foramen ovale. The patient developed respiratory failure and neurological deficit after thrombectomy. This case raise questions about the value of the thrombectomy for the treatment of proximal vein thrombosis due to the risks of this procedure. The authors also discuss the need for vena cava filters and ruling out a patent foramen ovale in patients undergoing thrombectomy.

  7. Pulmonary Embolism Mimicking Community Acquired Pneumonia: A Case Report

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    Ibrahim Koc

    2016-02-01

    Full Text Available Acute pulmonary trombo embolism is a form of venous thromboembolism that is common and sometimes even may be fatal. Patients might present with variable clinical presentation and often have non-specific complaints which make the diagnosis challenging. Here we aimed to report a thirty years old male who was diagnosed with community acquired pneumonia but further investigations revealed pulmonary embolism. A thirty years old male presented to our clinic with right sided chest pain and shortness of breath. Chest radiograph revealed right sided consolidations and pleural effusion. His physical examination revealed high body temperature (38 C° and oxygen saturation on room air was 85 %. The patient did not respond to the antibiotherapy and oxygen supply. Computed tomography angiography of the chest revealed right sided pulmonary embolism with pneumonia. Blood and sputum cultures revealed no bacteria. Cardiovascular disease panel revealed heterozygous mutation in prothrombine G20210A and metilentetrahidrofolate reductase (MTHFR C677T. In conclusion pulmonary embolism may mimic community acquired pneumonia thus clinicians must be carefull during the diagnostic process.

  8. Phosphodiesterase 5 inhibitors (PDE5i) and pulmonary embolism

    NARCIS (Netherlands)

    Gerritsen, R.F.; Bijl, A.; Van Puijenbroek, E.P.

    2009-01-01

    Introduction: PDE5i-related arterial thromboembolism is described in literature. Published venous thrombotic events are limited to one case of pulmonary embolism (tadalafil) and of recurrent deep venous thrombosis (DVT) related to sildenafil. Aim of the study: Presentation of two cases of vardenafil

  9. Identification of patients with low-risk pulmonary embolism suitable for outpatient treatment using the pulmonary embolism severity index (PESI).

    LENUS (Irish Health Repository)

    McCabe, A

    2013-06-01

    There is increasing evidence that outpatient treatment of patients with low-risk stable pulmonary embolism (PE) is safe, effective and potentially reduces costs. It is not clear how many patients presenting to an Irish Emergency Department (ED) are potentially suitable for outpatient management.

  10. Clot resolution after 3 weeks of anticoagulant treatment for pulmonary embolism : comparison of computed tomography and perfusion scintigraphy

    NARCIS (Netherlands)

    van Es, J.; Douma, R. A.; Kamphuisen, P. W.; Gerdes, V. E. A.; Verhamme, P.; Wells, P. S.; Bounameaux, H.; Lensing, A. W. A.; Bueller, H. R.

    2013-01-01

    Introduction Little is known about the natural history of clot resolution in the initial weeks of anticoagulant therapy in patients with acute pulmonary embolism (PE). Clot resolution of acute PE was assessed with either computed tomography pulmonary angiography scan (CT-scan) or perfusion scintigra

  11. CT pulmonary angiography findings that predict 30-day mortality in patients with acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Bach, Andreas Gunter, E-mail: mail@andreas-bach.de [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Nansalmaa, Baasai; Kranz, Johanna [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Taute, Bettina-Maria [Department of Internal Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany); Wienke, Andreas [Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger-Str. 8, 06112 Halle (Germany); Schramm, Dominik; Surov, Alexey [Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Germany)

    2015-02-15

    Highlights: • In patients with acute pulmonary embolism contrast reflux in inferior vena cava is significantly stronger in non-survivors (odds ratio 3.29; p < 0.001). • This finding is independent from the following comorbidities: heart insufficiency and pulmonary hypertension. • Measurement of contrast reflux is a new and robust radiologic method for predicting 30-day mortality in patients with acute pulmonary embolism. • Measurement of contrast reflux is a better predictor of 30-day mortality after acute pulmonary embolism than any other existing radiologic predictor. This includes thrombus distribution, and morphometric measurements of right ventricular dysfunction. - Abstract: Purpose: Standard computed tomography pulmonary angiography (CTPA) can be used to diagnose acute pulmonary embolism. In addition, multiple findings at CTPA have been proposed as potential tools for risk stratification. Therefore, the aim of the present study is to examine the prognostic value of (I) thrombus distribution, (II) morphometric parameters of right ventricular dysfunction, and (III) contrast reflux in inferior vena cava on 30-day mortality. Material and methods: In a retrospective, single-center study from 06/2005 to 01/2010 365 consecutive patients were included. Inclusion criteria were: presence of acute pulmonary embolism, and availability of 30-day follow-up. A review of patient charts and images was performed. Results: There were no significant differences between the group of 326 survivors and 39 non-survivors in (I) thrombus distribution, and (II) morphometric measurements of right ventricular dysfunction. However, (III) contrast reflux in inferior vena cava was significantly stronger in non-survivors (odds ratio 3.29; p < 0.001). Results were independent from comorbidities like heart insufficiency and pulmonary hypertension. Conclusion: Measurement of contrast reflux is a new and robust method for predicting 30-day mortality in patients with acute pulmonary

  12. Radiographic findings in pulmonary hypertension from unresolved embolism

    Energy Technology Data Exchange (ETDEWEB)

    Woodruff, W.W. III; Hoeck, B.E.; Chitwood, W.R. Jr.; Lyerly, H.K.; Sabiston, D.C. Jr.; Chen, J.T.T.

    1985-04-01

    Pulmonary artery hypertension with chronic pulmonary embolism is an uncommon entity that is potentially treatable with pulmonary embolectomy. Although the classic radiographic features have been described, several recent investigators report a significant percentage of these patients with normal chest radiographs. In a series of 22 patients, no normal radiographs were seen. Findings included cardiomegaly (86.4%) with right-sided enlargement (68.4%), right descending pulmonary artery enlargement (54.5%), azygos vein enlargement (27.3%), mosaic oligemia (68.2%), chronic volume loss (27.3%), atelectasis and/or effusion (22.7%), and pleural thickening (13.6%). Good correlation with specific areas of diminished vascularity was seen on chest radiographs compared with pulmonary angiograms.

  13. Demonstration of pulmonary embolism with gadolinium-enhanced spiral CT

    Energy Technology Data Exchange (ETDEWEB)

    Coche, E.E.; Hammer, F.D.; Goffette, P.P. [Dept. of Radiology, St. Luc University Hospital, Brussels (Belgium)

    2001-11-01

    The authors report a case of successful detection of pulmonary embolism using gadolinium-enhanced spiral CT (Gadodiamide, 0.4 mmol/kg, 2 ml/s, delay 18 s) in a 77-year-old woman, with previous allergy to iodinated contrast medium, and renal failure, who presented with pulmonary arterial hypertension. Doppler ultrasound of the lower limbs was first performed and revealed a deep venous thrombosis of the right lower limb. To establish if venous thrombosis was the cause of pulmonary hypertension and to confirm that pulmonary endarterectomy was not indicated in this situation, several imaging modalities were performed. Lung scintigraphy and MRI were non-diagnostic. Gadolinium-enhanced spiral CT demonstrated a large thrombus located proximally and in a segmental artery of the right lower lobe. This case illustrates the potential usefulness of gadolinium as alternative contrast agent with spiral CT to diagnose pulmonary embolism and elucidate the cause of pulmonary arterial hypertension in a patient with some contraindications for iodinated contrast medium injection. (orig.)

  14. Pulmonary Air Embolism: An Infrequent Complication in the Radiology Suite

    Science.gov (United States)

    Lanfranco, Julio; Romero-Legro, Ivan; Freire, Amado X.; Nearing, Katherine; Ratnakant, Sanjay

    2017-01-01

    Patient: Female, 64 Final Diagnosis: Pulmonary air embolism Symptoms: Shortness of breath Medication: — Clinical Procedure: — Specialty: Critical Care Medicine Objective: Unusual or unexpected effect of treatment Background: Air embolism can occur in a number of medical-surgical situations. Venous air embolism is frequently lethal when a substantial amount enters the venous circulation rapidly and can lead to significant morbidity if crossover to the systemic arterial circulation occurs. The diagnosis of massive air embolism is usually made on clinical grounds by the development of abrupt hemodynamic compromise. The true incidence, morbidity, and mortality of this event is unknown given the difficulties in diagnosis. Case Report: An inadvertent antecubital venous injection of 150 mL of air using a contrast power injector during a computed tomography (CT) is reported. Immediate imaging (CT) showed a significant amount of air in the right atrium and right ventricular cavity, and air mixed with contrast in the main pulmonary artery and proximal divisions of the pulmonary circulation. Patient condition deteriorated requiring mechanical ventilation for 48 hours. Condition improved over the next few days and patient was successfully extubated and discharged home. Conclusions: Air embolism is a rare complication, the potential for this to be life threatening makes prevention and early detection of this condition essential. This condition should be suspected when patients experience sudden onset respiratory distress and/or experience a neurological event in the setting of a known risk factor. Treatment options include Durant’s maneuver; left-lateral decubitus, head-down positioning; to decrease air entry into the right ventricle outflow tract, hyperbaric therapy, 100% O2 and supportive care. PMID:28115731

  15. Partial pulmonary embolization disrupts alveolarization in fetal sheep

    Directory of Open Access Journals (Sweden)

    Hooper Stuart B

    2010-04-01

    Full Text Available Abstract Background Although bronchopulmonary dysplasia is closely associated with an arrest of alveolar development and pulmonary capillary dysplasia, it is unknown whether these two features are causally related. To investigate the relationship between pulmonary capillaries and alveolar formation, we partially embolized the pulmonary capillary bed. Methods Partial pulmonary embolization (PPE was induced in chronically catheterized fetal sheep by injection of microspheres into the left pulmonary artery for 1 day (1d PPE; 115d gestational age; GA or 5 days (5d PPE; 110-115d GA. Control fetuses received vehicle injections. Lung morphology, secondary septal crests, elastin, collagen, myofibroblast, PECAM1 and HIF1α abundance and localization were determined histologically. VEGF-A, Flk-1, PDGF-A and PDGF-Rα mRNA levels were measured using real-time PCR. Results At 130d GA (term ~147d, in embolized regions of the lung the percentage of lung occupied by tissue was increased from 29 ± 1% in controls to 35 ± 1% in 1d PPE and 44 ± 1% in 5d PPE fetuses (p VEGF and Flk-1, although a small increase in PDGF-Rα expression at 116d GA, from 1.00 ± 0.12 in control fetuses to 1.61 ± 0.18 in 5d PPE fetuses may account for impaired differentiation of alveolar myofibroblasts and alveolar development. Conclusions PPE impairs alveolarization without adverse systemic effects and is a novel model for investigating the role of pulmonary capillaries and alveolar myofibroblasts in alveolar formation.

  16. Pulmonary embolism findings on chest radiographs and multislice spiral CT

    Energy Technology Data Exchange (ETDEWEB)

    Coche, Emmanuel; Goncette, Louis [Department of Radiology, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels (Belgium); Verschuren, Franck [Department of Intensive Care and Emergency Medicine, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels (Belgium); Hainaut, Philippe [Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels (Belgium)

    2004-07-01

    Multislice spiral CT is becoming an increasingly important tool for diagnosing pulmonary embolism. However, in many instances, a chest radiograph is usually performed as a first-line examination. Many parenchymal, vascular, and other ancillary findings may be observed on both imaging modalities with a highly detailed depiction of abnormalities on multislice CT. A comprehensive review of chest radiograph findings is presented with side-by-side correlations of CT images reformatted mainly in the frontal plane. (orig.)

  17. Pulmonary embolism findings on chest radiographs and multislice spiral CT.

    Science.gov (United States)

    Coche, Emmanuel; Verschuren, Franck; Hainaut, Philippe; Goncette, Louis

    2004-07-01

    Multislice spiral CT is becoming an increasingly important tool for diagnosing pulmonary embolism. However, in many instances, a chest radiograph is usually performed as a first-line examination. Many parenchymal, vascular, and other ancillary findings may be observed on both imaging modalities with a highly detailed depiction of abnormalities on multislice CT. A comprehensive review of chest radiograph findings is presented with side-by-side correlations of CT images reformatted mainly in the frontal plane.

  18. Pulmonary Embolism as the First Manifestation of Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    N. Vallianou

    2013-01-01

    Full Text Available Multiple myeloma is considered a hypercoagulable state due to several mechanisms such as the increased IL-6 and immunoglobulins production, the defective fibrinolytic mechanism, and the acquired resistance to activated protein C that are involved in the pathogenesis and clinical futures of the disease. We describe a case of a female patient who presented to the hospital with pulmonary embolism as the first manifestation of the hypercoagulability of multiple myeloma.

  19. Pulmonary embolism in young natives of high altitude

    Directory of Open Access Journals (Sweden)

    Sanjay Singhal

    2016-01-01

    Full Text Available Thrombotic events are relatively common in high altitude areas and known to occur in young soldiers working at high altitude without usual risk factors associated with thrombosis at sea-level. However, till now, cases with thrombotic events were reported only in lowlanders staying at high altitude. These two cases of pulmonary embolism demonstrate that thrombotic events can occur in highlanders after a prolonged stay at the extreme altitude.

  20. Pulmonary cement embolism after pedicle screw vertebral stabilization

    Directory of Open Access Journals (Sweden)

    Massimo Tonolini

    2012-01-01

    Full Text Available Pulmonary arterial embolization of polymethylmethacrylate cement, most usually occurring after vertebroplasty or kyphoplasty, is very uncommon following vertebral stabilization procedures. Unenhanced CT scans viewed at lung window settings allow confident identification of cement emboli in the pulmonary circulation along with possible associate parenchymal changes, whereas hyperdense emboli may be less conspicuous on CT-angiographic studies with high-flow contrast medium injection. Although clinical manifestations are largely variable from asymptomatic cases to severe respiratory distress, most cases are treated with anticoagulation.

  1. Deep venous thrombosis and pulmonary embolism in psychiatric settings

    Directory of Open Access Journals (Sweden)

    Els G. Van Neste

    2009-03-01

    Full Text Available Background and objectives: Deep venous thrombosis and pulmonary embolism are serious, possibly life-threatening events which are often ignored in psychiatric settings. This article investigates which psychiatric patients are at increased risk of developing a venous thromboembolism. To our knowledge we are the first to perform a literature review of clinical studies relating venous thrombosis and pulmonary embolism to psychotropic drugs and mental disorders. Methods: A Medline search for English studies using the appropriate search terms was performed. In addition, cross references of the relevant articles` literature references were considered. We withheld 12 observational studies, 29 case-reports and one review-article. Results: We found evidence that low potency antipsychotic drugs like chlorpromazine and thioridazine, and clozapine for treatment of resistant schizophrenia have an increased risk of venous thromboembolism. There is no evidence that antidepressants, benzodiazepines or mood stabilizers have a similar effect. Also psychiatric conditions like physical restraint, catatonia and neuroleptic malignant syndrome are related to a higher incidence of deep venous thrombosis. Conclusions: Limitations of the studies and hypotheses about underlying biological mechanisms are reviewed. The rationale for prophylactic measures is discussed and recommendations to prevent deep venous thrombosis and pulmonary embolism are given.

  2. Microscopic Pulmonary Tumour Embolism: An Unusual Presentation of Thymic Carcinoma

    Directory of Open Access Journals (Sweden)

    Brita L Sperling

    2002-01-01

    Full Text Available The present report describes the first reported case of microscopic pulmonary tumour embolism (MPTE from thymic carcinoma. The carcinoma was discovered during an autopsy in a 55-year-old man who had undergone surgery for a pilonidal sinus two weeks before presentation. Pulmonary thromboembolism was suspected. This case was unusual because MPTE has never before been associated with thymic carcinoma, MPTE was the first clinical indication of an occult malignancy, and the clinical presentation was that of sudden onset of dyspnea associated with acute cor pulmonale. The cause of death was determined to be hypoxia secondary to extrinsic compression of the right pulmonary artery and extensive tumour emboli in the small arteries, arterioles and venules of the pulmonary parenchyma. A review of the clinical presentation and diagnosis of MPTE is included.

  3. [Massive pulmonary embolism treated with selective infusion of tenecteplase].

    Science.gov (United States)

    Di Rosa, Salvatore; Caramanno, Giuseppe; Catalano, Calogero; Andò, Giuseppe; Innocente, Piero; Cutaia, Angelo; Carlino, Gabriella; Vaccaro, Giovanni; Vaccaro, Ignazio

    2011-09-01

    Massive pulmonary embolism (PE) is a cardiovascular emergency due to a substantial obstruction of the pulmonary vascular bed, resulting in rapid right heart failure with a potentially fatal outcome.We present the case of a 50-year-old woman with massive PE and recent trans-sphenoid surgery because of pituitary adenoma. An occluding embolus, arising from deep venous thrombosis of the lower limbs, was demonstrated in the right pulmonary artery with selective angiography and treated with selective loco-regional infusion of low-dose tenecteplase. To the best of our knowledge, this is the first case of selective administration of low-dose tenecteplase in the pulmonary artery with successful resolution of PE without the need for adjunctive interventional procedures.

  4. Pulmonary embolism and LVAD: is there compatibility?

    Science.gov (United States)

    Bejko, Jonida; Bortolussi, Giacomo; Tarzia, Vincenzo; Gerosa, Gino; Bottio, Tomaso

    2015-08-01

    A 41-year-old-male with diagnosis of dilated cardiomyopathy was referred to our hospital for heart failure, despite standard medical therapy, to evaluate indications for heart transplantation or mechanical cardiac support. Preoperative contrast computer tomography (CT) scan diagnosed pulmonary thrombosis of the left branch of the pulmonary artery. Treatment with low molecular weight heparin was established and the next day a thrombus-arteriectomy and Heartware (Heartware, Framingham, MA, USA) left ventricular assist device (LVAD) implantation were performed simultaneously. The patient was discharged home with oral anticoagulant and antiplatelet therapy, according to our center's VAD protocol. Currently, the patient has been assisted with the LVAD for the past 24 months. The CT scan confirmed the absence of pulmonary artery thrombosis.

  5. Evaluation of Hemodynamic Changes and Respiratory Physical Findings in Patients with Pulmonary Embolism

    Directory of Open Access Journals (Sweden)

    Masome Rabieepour

    2014-07-01

    Full Text Available Introduction: Pulmonary thromboembolism (PTE is a potentially fatal disease with nonspecific symptoms and signs. Patients with Pulmonary embolism often have dyspnea, chest pain, haemoptysis, tachycardia tachypnea and respiratory physical finding including hypoxia and decreased ETCO2. Daily patients with Pulmonary embolism are very few in hospital course and we aimed to determine clinical and paraclinical findings in hospital pulmonary embolism patients. Methods: we assessed in hospital course of 104 patients with pulmonary embolism with symptom (dyspnea, chest pain, and hemoptysis and signs (tachypnea, tachycardia, DVT signs, blood pressure and respiratory physical findings (PO2, ETCO2. Results: majority of patients had risk factor for PTE; the most common was cancer. 21.2% of patients had apparent DVT in Doppler sonography. Isolated dyspnea (38%, chest pain with and without hemoptysis (60% and syncope (2% were observed in patients. Mean duration of dyspnea resolution was 3.4 days. Mean duration of chest pain resolution was 1.76 days. Mean duration of hemoptysis resolution was 2 days. 64.4% of the patients were hypoxic and mean duration of hypoxic resolution was 2.63 days. Mean duration of tachycardia resolution was 2.37 days. No relation was observed between size of PTE and mortality or hypotension and PO2. Mean ETCO2 was 23±2 mmHg and 86.5% of patients had ETCO2 lower than 28. Mean duration of ETCO2 resolution was 3.6 days. Most common physical finding that resolved later than others was ETCO2. In 32.7% of patients, ETCO2 did not resolve.   Key words: Pulmonary thromboembolism; Tachycardia; Tachypnea; Hemoptysis; Hypoxic; ETCO2

  6. Incidence of pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease:a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    王芳

    2013-01-01

    Objective To evaluate the incidence of pulmonary embolism in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) .Methods Comprehensive searches as of June 2012 were performed in PubMed (1966—) ,Embase (1974—) ,Chinese

  7. Non-severe pulmonary embolism: Prognostic CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Moroni, Anne-Line [University J Fourrier, Grenoble (France); Department of Radiology, CHU Grenoble, BP 218, 38043 Grenoble cedex (France); Bosson, Jean-Luc [University J Fourrier, Grenoble (France); Department of Statistics, CIC, CHU Grenoble, BP 218, 38043 Grenoble cedex (France); Hohn, Noelie [Department of Radiology, CHU Grenoble, BP 218, 38043 Grenoble cedex (France); Carpentier, Francoise [University J Fourrier, Grenoble (France); Department of Emergency Medicine, CHU Grenoble, BP 218, 38043 Grenoble cedex (France); Pernod, Gilles [University J Fourrier, Grenoble (France); Department of Vascular Diseases, CHU Grenoble, BP 218, 38043 Grenoble cedex (France); Ferretti, Gilbert R., E-mail: gferretti@chu-grenoble.fr [University J Fourrier, Grenoble (France); Department of Radiology, CHU Grenoble, BP 218, 38043 Grenoble cedex (France)

    2011-09-15

    The goal of this study was to retrospectively evaluate CT cardiovascular parameters and pulmonary artery clot load score as predictors of 3-month mortality in patients with clinically non-severe pulmonary embolism (PE). We included 226 CT positive for PE in hemodynamically stable patients (112 women; mean age 67.1 years {+-}16.9). CT were independently reviewed by two observers. Results were compared with occurrence of death within 3 months using Cox regression. Twenty-four (10.6%) patients died, for whom 9 were considered to be due to PE. Interobserver agreement was moderate for the shape of interventricular septum ({kappa} = 0.41), and for the ratio between the diameters of right and left ventricle (RV/LV) ({kappa} = 0.76). Observers found no association between interventricular septum shape and death. A RV/LV diameter ratio >1 was predictive of death (OR, 3.83; p < 0.01) only when we also took into account the value of the embolic burden (<40%). In a multivariate model, CT cardiovascular parameters were not associated with death. Concomitant lower limb DVT and comorbid conditions were important predictors of death. In clinically non-severe PE, a RV/LV diameter ratio >1 is predictive of death when the embolic burden is low (<40%).

  8. Pulmonary Embolism Masquerading as High Altitude Pulmonary Edema at High Altitude.

    Science.gov (United States)

    Pandey, Prativa; Lohani, Benu; Murphy, Holly

    2016-12-01

    Pandey, Prativa, Benu Lohani, and Holly Murphy. Pulmonary embolism masquerading as high altitude pulmonary edema at high altitude. High Alt Med Biol. 17:353-358, 2016.-Pulmonary embolism (PE) at high altitude is a rare entity that can masquerade as or occur in conjunction with high altitude pulmonary edema (HAPE) and can complicate the diagnosis and management. When HAPE cases do not improve rapidly with descent, other diagnoses, including PE, ought to be considered. From 2013 to 2015, we identified eight cases of PE among 303 patients with initial diagnosis of HAPE. Upon further evaluation, five had deep vein thrombosis (DVT). One woman had a contraceptive ring and seven patients had no known thrombotic risks. PE can coexist with or mimic HAPE and should be considered in patients presenting with shortness of breath from high altitude regardless of thrombotic risk.

  9. Varicose vein trauma: a risk for pulmonary embolism.

    Science.gov (United States)

    Joy, Parijat S; Marak, Creticus P; Ponea, Anna M; Guddati, Achuta K

    2014-10-01

    Pulmonary embolism (PE) is a deceptive condition which is often incorrectly diagnosed leading to high morbidity and mortality. We present a case where symptoms were localised to different areas of the body starting with post-traumatic pain over lower extremity varicosities that migrated sequentially over a month to the knee, hip, back, abdomen and chest finally presenting as syncope. Despite a low pre-test clinical probability, a very high index of suspicion led to a timely diagnosis of a massive bilateral PE that eventually caused a troponin leak. The aetiology is highly suspicious of a thrombus which originated in the veins of the leg due to trauma over varicose veins.The case described here exemplifies the importance of considering trauma to varicosities as a risk factor for embolism when the clinical picture is concerning but other signs and symptoms of PE are not apparent.

  10. Unusual ventilation perfusion scintigram in a case of immunologic pulmonary edema clinically simulating pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Campeau, R.J.; Faust, J.M.; Ahmad, S.

    1987-11-01

    A case of immunologic pulmonary edema secondary to hydrochlorothiazide allergy developed in a 55-year-old woman that clinically simulated pulmonary embolism. The patient had abnormal washin images with normal washout images on an Xe-133 ventilation study. On the perfusion study, large bilateral central and posterior perfusion defects were present that showed an unusual mirror image pattern on the lateral and posterior oblique views. Resolution of radiographic and scintigraphic abnormalities occurred over a 3-day period in conjunction with corticosteroid therapy.

  11. Rescue surgical pulmonary embolectomy for acute massive pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Ahmed Abdulrahman Elassal

    2016-08-01

    Conclusion: Surgical pulmonary embolectomy is a rescue operation in high-risk PE. It could save patients with preoperative cardiac arrest. Early diagnosis, interdisciplinary team action, appropriate and emergent treatment strategy are necessary for favorable outcome.

  12. Syncope as a presentation of acute pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Altınsoy B

    2016-06-01

    Full Text Available Bülent Altınsoy, Fatma Erboy, Hakan Tanrıverdi, Fırat Uygur, Tacettin Örnek, Figen Atalay, Meltem Tor Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Kozlu, Zonguldak, Turkey Purpose: Syncope is an atypical presentation for acute pulmonary embolism (APE. There are conflicting data concerning syncope and prognosis of APE. Patients and methods: One hundred and seventy-nine consecutive patients aged 22–96 years (median, 68 years with APE were retrospectively enrolled in the study. Results: Prevalence of syncope was 13% (n=23 at the time of presentation. Compared to patients without syncope, those with syncope had a higher rate of central embolism (83% vs 43%, respectively, P=0.002, right ventricular dysfunction (91% vs 68%, P=0.021, and troponin positivity (80% vs 39%, P=0.001 but not 30-day mortality (13% vs 10%, P=0.716. Multivariate analysis showed that central localization (odds ratio: 9.08 and cardiac troponin positivity (odds ratio: 4.67 were the independent correlates of the presence of syncope in the patients with APE. Frequency of cardiopulmonary disease was lower, and duration from symptom onset to hospital admission was shorter in patients with syncope (P=0.138 and 0.118, respectively, although not significant. Conclusion: Syncope most likely represents an intermediate condition between massive APE and hypotension. In APE patients with syncope, the prognosis seems to depend on the underlying pathology, the patient’s age, comorbidities and duration from symptom onset to hospital admission, and the use of thrombolytic therapy. Keywords: syncope, prognosis, pulmonary embolism, mortality rate, compression sonography, right ventricular dysfunction

  13. State-of-the-Art Imaging in Pulmonary Embolism

    DEFF Research Database (Denmark)

    Hess, Søren; Frary, Charles; Gerke, Oke

    2016-01-01

    Pulmonary embolism (PE) is a common, ubiquitous, and potentially lethal disease. As symptoms and clinical findings are notoriously nonspecific, diagnostic imaging is essential to avoid undertreatment as well as overtreatment. Controversies remain regarding first-line imaging in suspected PE...... (93.0 vs. 93.8%), negative predictive values (98.6 vs. 84.7%), and accuracies (96.5 vs. 88.6%). We further address some of the ongoing controversies regarding the various modalities, that is, radiation exposure, the issues of subsegmental PE, nondiagnostic studies, and various challenges in specific...

  14. Atypical Presentation of a Pulmonary Embolism in the Perioperative Setting.

    Science.gov (United States)

    Viswanath, Omar; Simpao, Allan F; Santhosh, Sushmitha

    2015-08-15

    We present the case of an asymptomatic 82-year-old patient with no coronary artery disease and a negative cardiac workup who presented to the hospital for an elective total knee replacement. The patient had stable vital signs in the preanesthesia holding unit, yet the anesthesiologist recognized new-onset atrial fibrillation on the patient's monitor. The dysrhythmia was confirmed with a 12-lead electrocardiogram. The procedure was canceled, and the patient was sent for additional evaluation. An echocardiogram revealed a pulmonary embolism. This case report illustrates the need for a questioning attitude and diligent monitoring in all phases of perioperative care.

  15. Massive pulmonary embolism at the onset of acute promyelocytic leukemia

    Directory of Open Access Journals (Sweden)

    Federica Sorà

    2016-07-01

    Full Text Available Life-threatening bleeding is a major and early complication of acute promyelocytic leukemia (APL, but in the last years there is a growing evidence of thromboses in  APL. We report the first case of a young woman with dyspnea as the first symptom of APL due to massive pulmonary embolism (PE successfully treated with thrombolysis for PE and heparin. APL has been processed with a combination of all-trans retinoic acid (ATRA and arsenic trioxide (ATO obtaining complete remission.

  16. Pulmonary embolism as the primary presenting feature of nephrotic syndrome

    Directory of Open Access Journals (Sweden)

    Pallavi Periwal

    2016-01-01

    Full Text Available A 36-year-old previously healthy male presented with subacute onset of shortness of breath and chest pain. He was diagnosed with bilateral extensive pulmonary embolism (PE. In the absence of any predisposing factors, an extensive workup for unprovoked thrombophilia was done. During the course of his illness, the patient developed anasarca and was diagnosed to be suffering from nephrotic syndrome (NS, secondary to membranous glomerulopathy. Although, thrombotic complications are commonly associated with NS, it is unusual for PE to be the primary presenting feature in these patients.

  17. Unresolved major pulmonary embolism: Importance of follow-up lung scan in diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, H.S.; Intenzo, C.M.; Park, C.H.

    1986-09-01

    Unresolved major pulmonary embolism (UMPE) is an uncommon condition which causes pulmonary hypertension, cor pulmonale and death. An accurate and prompt diagnosis of UMPE is very important in the management of such patients with pulmonary embolectomy. Folow-up lung scans can lead to earlier diagnosis of UMPE, especially in patients who have a history of acute pulmonary embolism and present with pulmonary hypertension, respiratory insufficiency and cor pulmonale. We report a case of UMPE strongly suggested by follow-up lung scans and subsequently confirmed by pulmonary angiography and postmortem examination.

  18. Endometrial stromal sarcoma with selective polyvinyl alcohol embolization of a pulmonary metastasis after recurrent hemoptysis and expansive growth

    OpenAIRE

    Thula Walter; Ulf Teichgräber; Florian Streitparth; Maximilian de Bucourt

    2010-01-01

    A 63-year-old female with a well-vascularized pulmonary metastasis of an endometrial stromal sarcoma (ESS) of 6x6 cm received selective embolization with 150-250 mm polyvinyl alcohol (Contour; Boston Scientific, Natick, MA, USA) via a bronchial artery. Post-interventional loss of perfusion was qualitatively estimated to be >80%. The lesion was located in direct proximity to the pulmonary hilar vessels. Owing to recurrent and sudden hemoptyses, an interdisciplinary tumor board assessed the ris...

  19. Suspected Pulmonary Embolism during Hickman Catheterization in a Child: What Else Should Be Considered besides Pulmonary Embolism?

    Directory of Open Access Journals (Sweden)

    Haemi Lee

    2016-02-01

    Full Text Available A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.

  20. New Oral Anticoagulants in the Treatment of Pulmonary Embolism: Efficacy, Bleeding Risk, and Monitoring

    Directory of Open Access Journals (Sweden)

    Kelly M. Rudd

    2013-01-01

    Full Text Available Anticoagulation therapy is mandatory in patients with pulmonary embolism to prevent significant morbidity and mortality. The mainstay of therapy has been vitamin-K antagonist therapy bridged with parenteral anticoagulants. The recent approval of new oral anticoagulants (NOACs: apixaban, dabigatran, and rivaroxaban has generated significant interest in their role in managing venous thromboembolism, especially pulmonary embolism due to their improved pharmacokinetic and pharmacodynamic profiles, predictable anticoagulant response, and lack of required efficacy monitoring. This paper addresses the available literature, on-going clinical trials, highlights critical points, and discusses potential advantages and disadvantages of the new oral anticoagulants in patients with pulmonary embolism.

  1. Deep venous thrombosis and pulmonary embolism following physical restraint

    DEFF Research Database (Denmark)

    Laursen, S B; Jensen, T N; Bolwig, T

    2005-01-01

    physical restraint may occur in spite of no pre-existing risk factors. Medical guidelines for the prevention of thrombosis following physical restraint are presented. Despite the absence of controlled trials of treatment effectiveness, the catastrophic outcome of DVT and PE warrants early and vigorous......OBJECTIVE: We describe a case of deep venous thrombosis (DVT) and pulmonary embolism (PE) following the use of physical restraint in a patient with a diagnosis of acute delusional psychotic disorder. METHOD: A new case report of DVT and PE associated with prolonged physical restraint is presented....... The literature on physical restraint, DVT, and PE was reviewed using a search of Medline and Psychinfo from 1966 to the present. RESULTS: Four other reported cases of DVT and PE were found in association with physically restrained patients. CONCLUSION: Risk of DVT and PE in association with immobilization during...

  2. Pulmonary Embolism Related to Amisulpride Treatment: A Case Report

    Directory of Open Access Journals (Sweden)

    Maria Skokou

    2013-01-01

    Full Text Available Venous thromboembolism has been associated with antipsychotic drugs, but the underlying mechanisms are largely unknown. Hypotheses that have been made include body weight gain, sedation, enhanced platelet aggregation, increased levels of antiphospholipid antibodies, hyperhomocysteinemia, whereas hyperprolactinemia has recently attracted attention as a potential contributing factor. The highest risk has been demonstrated for clozapine, olanzapine, and low-potency first-generation antipsychotics; however, presently there is no data for amisulpride. In the present paper we describe a case of pulmonary embolism in a female bipolar patient, receiving treatment with amisulpride, aripiprazole, and paroxetine. Although a contribution of aripiprazole and paroxetine cannot completely be ruled out, the most probable factor underlying the thromboembolic event seems to be hyperprolactinemia, which was caused by amisulpride treatment. Increased plasma levels of prolactin should probably be taken into account during the monitoring of antipsychotic treatment as well as in future research concerning venous thromboembolism in psychiatric settings.

  3. Pulmonary embolism related to amisulpride treatment: a case report.

    Science.gov (United States)

    Skokou, Maria; Gourzis, Philippos

    2013-01-01

    Venous thromboembolism has been associated with antipsychotic drugs, but the underlying mechanisms are largely unknown. Hypotheses that have been made include body weight gain, sedation, enhanced platelet aggregation, increased levels of antiphospholipid antibodies, hyperhomocysteinemia, whereas hyperprolactinemia has recently attracted attention as a potential contributing factor. The highest risk has been demonstrated for clozapine, olanzapine, and low-potency first-generation antipsychotics; however, presently there is no data for amisulpride. In the present paper we describe a case of pulmonary embolism in a female bipolar patient, receiving treatment with amisulpride, aripiprazole, and paroxetine. Although a contribution of aripiprazole and paroxetine cannot completely be ruled out, the most probable factor underlying the thromboembolic event seems to be hyperprolactinemia, which was caused by amisulpride treatment. Increased plasma levels of prolactin should probably be taken into account during the monitoring of antipsychotic treatment as well as in future research concerning venous thromboembolism in psychiatric settings.

  4. Management of intermediate-risk pulmonary embolism: uncertainties and challenges.

    Science.gov (United States)

    Klok, Frederikus Albertus; Meyer, Guy; Konstantinides, Stavros

    2015-12-01

    Current guidelines on the treatment of acute pulmonary embolism (PE) recommend stratification of hemodynamically stable patients in 'low risk' and 'intermediate risk'. Validated risk scores, cardiac biomarkers, and imaging of the right ventricle all help in distinguishing both patient categories. The relevance of this risk stratification lies in the determination of the most optimal treatment for the individual patient. In this clinical review, we will discuss how patients with 'intermediate-risk' PE can be identified as well as recent advances in their therapeutic management. Based on a clinical case, we will highlight the indications for reperfusion therapy and the current experience with non-vitamin K-dependent oral anticoagulant (NOACs) in this specific patient's category.

  5. Diagnostic implications of computed tomography pulmonary angiography in patients with pulmonary embolism

    Science.gov (United States)

    El-Menyar, Ayman; Nabir, Syed; Ahmed, Nadeem; Asim, Mohammad; Jabbour, Gaby; Al-Thani, Hassan

    2016-01-01

    INTRODUCTION: Pulmonary embolism (PE) is a serious cardiovascular and pulmonary complication worldwide. We aimed to assess the implications of different computed tomography pulmonary angiography (CTPA) parameters in patients with acute PE. METHODS: A retrospective observational study to include patients presented with clinical suspicious of PE who underwent CTPA was conducted. Patients' demographics, clinical presentation, risk factors, laboratory investigations, management, and outcome were analyzed. Computed tomography findings included clot burden (Qanadli score [QS]) and right ventricular dysfunction (RVD) parameters. RESULTS: A total of 45 patients with radiologically confirmed diagnosis of PE were included in the study; of these patients, 8 (17.8%) died during the hospital course. Patients who died were 13 years older than those who survived, and the mortality rate was significantly higher in patients with cancer. The two groups were comparable for cardiovascular parameters. The mean clot burden (QS) was 19.5 ± 11.3 points and 53% of patients had QS >18 points. Obesity (52.4% vs. 12.5%; P = 0.01), hypertension (54.4% vs. 23.8%; P = 0.03), and median D-dimer levels (7.8 vs. 3.4; P = 0.03) were significantly higher in patients with QS >18. Among right ventricular (RV) dysfunction parameters, only higher RV/left ventricular (LV) ratio (P = 0.001) and bowing of interventricular septum (P = 0.001) were associated with higher QS. A significant positive correlation was found between RV short axis (r = 0.499, P = 0.001), RV/LV ratio (r = 0.592, P = 0.001), and pulmonary artery (PA) diameter (r = 0.301, P = 0.04) with the PA clot burden. Receiver operating characteristic curve for clot burden showed a cutoff value of 17.5 points to accurately predict RV dysfunction. CONCLUSIONS: Clot burden >18 is associated with RV dysfunction in patients with acute PE. Echocardiography and RVD parameters showed no correlation with in-hospital deaths. CTPA has clinicoradiological

  6. Multidetector-CT angiography in pulmonary embolism - can image parameters predict clinical outcome?

    Energy Technology Data Exchange (ETDEWEB)

    Heyer, Christoph M.; Lemburg, Stefan P.; Nicolas, Volkmar; Roggenland, Daniela [Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum, Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Bochum (Germany); Knoop, Heiko [Berufsgenossenschaftliches Universitaetsklinikum Bergmannsheil GmbH, Medical Clinic III - Pneumology, Allergology, and Sleep Medicine, Bochum (Germany); Holland-Letz, Tim [Ruhr-University of Bochum, Department of Medical Informatics, Biometry and Epidemiology, Bochum (Germany)

    2011-09-15

    To assess if pulmonary CT angiography (CTA) can predict outcome in patients with pulmonary embolism (PE). Retrospective analysis of CTA studies of patients with PE and documentation of pulmonary artery (PA)/aorta ratio, right ventricular (RV)/left ventricular (LV) ratio, superior vena cava (SVC) diameter, pulmonary obstruction index (POI), ventricular septal bowing (VSB), venous contrast reflux (VCR), pulmonary infarction and pleural effusion. Furthermore, duration of total hospital stay, necessity for/duration of ICU therapy, necessity for mechanical ventilation and mortality were recorded. Comparison was performed by logistic/linear regression analysis with significance at 5%. 152 patients were investigated. Mean duration of hospital stay was 21 {+-} 24 days. 66 patients were admitted to the ICU; 20 received mechanical ventilation. Mean duration of ICU therapy was 3 {+-} 8 days. Mortality rate was 8%. Significant positive associations of POI, VCR and pulmonary infarction with necessity for ICU therapy were shown. VCR was significantly associated with necessity for mechanical ventilation and duration of ICU treatment. Pleural effusions were significantly associated with duration of total hospital stay whereas the RV/LV ratio correlated with mortality. Selected CTA findings showed significant associations with the clinical course of PE and may thus be used as predictive parameters. (orig.)

  7. Are pulmonary embolism and deep-vein thrombosis always one disease?

    NARCIS (Netherlands)

    Langevelde, Kirsten van

    2012-01-01

    Pulmonary embolism is traditionally, since autopsy studies by Virchow in the mid 1800s, thought to originate from embolization of a deep-vein thrombosis, resulting in two clinical manifestations of one disease: venous thrombosis. The incidence of deep-vein thrombosis in the population is twice as hi

  8. Dual-energy CT angiography of the lung in patients with suspected pulmonary embolism. Initial results

    Energy Technology Data Exchange (ETDEWEB)

    Fink, C.; Michaely, H.J. [Inst. fuer Klinische Radiologie und Nuklearmedizin, Universitaetsklinikum Mannheim, Univ. Heidelberg (Germany); Inst. fuer Klinische Radiologie, Campus Grosshadern, Klinikum der Univ. Muenchen (Germany); Johnson, T.R.; Morhard, D.; Becker, C.; Reiser, M.; Nikolaou, K. [Inst. fuer Klinische Radiologie, Campus Grosshadern, Klinikum der Univ. Muenchen (Germany)

    2008-10-15

    To evaluate the feasibility of dual-energy CT angiography (CTA) of the lung in patients with suspected pulmonary embolism (PE). 24 patients with suspected PE were examined with a single-acquisition, dual-energy CTA protocol (A-system: 140 kV/65 mAsref, B-system: 80 kV/190 mAsref) on a dual-source CT system. Lung perfusion was visualized by color-coding voxels containing iodine and air using dedicated dual-energy post-processing software. Perfusion defects were classified by two blinded radiologists as being consistent or non-consistent with PE. Subjective image quality of perfusion maps and CTA was rated using a 5-point scale (1: excellent, 5: poor). The reading of a third independent radiologist served as the standard of reference for the diagnosis of PE. In all patients with PE (n = 4), perfusion defects classified as being consistent with PE were identified in lung areas affected by PE. Both readers did not record perfusion defects classified as being consistent with PE in any of the patients without PE. Thus, on a per patient basis the sensitivity and specificity for the assessment of PE was 100% for both readers. On a per segment basis the sensitivity and specificity ranged between 60 - 66.7% and 99.5 - 99.8%. The interobserver agreement was good (k = 0.81). Perfusion defects rated as non-consistent with PE were most frequently caused by streak artifacts from dense contrast material in the great thoracic vessels. The median score of the image quality of both the perfusion maps and CTA was 2. In conclusion, dual-energy CTA of pulmonary embolism is feasible and allows the assessment of perfusion defects caused by pulmonary embolism. Further optimization of the injection protocol is required to reduce artifacts from dense contrast material. (orig.)

  9. Surgical treatment of acute pulmonary embolism--a 12-year retrospective analysis

    DEFF Research Database (Denmark)

    Lehnert, Per; Møller, Christian H; Carlsen, Jørn

    2012-01-01

    Surgical embolectomy for acute pulmonary embolism (PE) is considered to be a high risk procedure and therefore a last treatment option. We wanted to evaluate the procedures role in modern treatment of acute PE....

  10. Aspergillus endocarditis in a paediatric patient after a cardiac surgery, associated with septic pulmonary embolism and pulmonary hypertension.

    Science.gov (United States)

    Miranda, Joana O; de Sousa, António Rodrigues; Monterroso, José

    2015-03-01

    We report a rare case of pulmonary prosthetic valve endocarditis due to Aspergillus fumigatus, associated with septic pulmonary embolism and secondary pulmonary hypertension, in a 4-year-old boy with surgically corrected tetralogy of Fallot. The diagnosis and treatment of Aspergillus endocarditis remains highly challenging. The best therapeutic option for chronic thromboembolic pulmonary hypertension due to an infectious thromboembolic event is highly debatable and the results are poor.

  11. Fatal pulmonary embolism in hospitalized patients. Clinical diagnosis versus pathological confirmation

    Directory of Open Access Journals (Sweden)

    Cláudio Tinoco Mesquita

    1999-09-01

    Full Text Available OBJECTIVE - To assess the incidence of fatal pulmonary embolism (FPE, the accuracy of clinical diagnosis, and the profile of patients who suffered an FPE in a tertiary University Hospital. METHODS - Analysis of the records of 3,890 autopsies performed at the Department of General Pathology from January 1980 to December 1990. RESULTS - Among the 3,980 autopsies, 109 were cases of clinically suspected FPE; of these, 28 cases of FPE were confirmed. FPE accounted for 114 deaths, with clinical suspicion in 28 cases. The incidence of FPE was 2.86%. No difference in sex distribution was noted. Patients in the 6th decade of life were most affected. The following conditions were more commonly related to FPE: neoplasias (20% and heart failure (18.5%. The conditions most commonly misdiagnosed as FPE were pulmonary edema (16%, pneumonia (15% and myocardial infarction (10%. The clinical diagnosis of FPE showed a sensitivity of 25.6%, a specificity of 97.9%, and an accuracy of 95.6%. CONCLUSION - The diagnosis of pulmonary embolism made on clinical grounds still has considerable limitations.

  12. New approach to diagnosis of pulmonary embolism using multislice CT

    Science.gov (United States)

    Niethammer, Matthias U.; Schoepf, Uwe J.; Wildberger, Hoachim E.; Klotz, Ernst; Fichte, Heinz; Schaller, Stefan

    2001-05-01

    Suspected pulmonary embolism (PE) is a common indication for CT scanning of the thorax. Usually, intravenous contrast agent is administered utilizing a power-injector and the vascular structures are examined for the presence of pulmonary emboli. Current Multi-Slice CT-technology allows extending this morphological analysis by adding a more functional visualization of the actual parenchymal perfusion disturbance. We have developed a new image processing technique which allows selective color encoded display of parenchymal enhancement of the lung, which will be reduced in the presence of PE. Based on thin slice reconstructions an automatic 3D segmentation of the lung is performed followed by threshold based extraction of the major airways and vascular structures. This allows applying an adaptive 3D low-pass filter to the parenchymal volume only. The filtered volume data are then color encoded and overlaid onto the original CT-images. This combination of low-resolution perfusion-weighted color maps and high-resolution gray scale structural data from the same data set greatly enhances visualization of spatial relationships. The resulting images can be displayed in axial, sagittal and coronal orientation. Initial experience indicates that this new technique provides relevant additional information for the clinical management of patients with proven PE. A larger controlled patient study is under way.

  13. Contrast-enhanced CT of Pulmonary Embolism:Report of 20 cases

    Institute of Scientific and Technical Information of China (English)

    Feng Shiting; Li Ziping; Chen Jingdi; Meng Quanfei; Li Xiangmin; Kuang Jianyi; Zhou Xuhui

    2007-01-01

    Objectives To study the characteristic of pulmonary embolism (PE) in contrast-enhanced CT. Methods The radiological features were described in 20 patients with lobar and proximal PE diagnosed with a Toshiba Xpress/SX CT scanner after contrast material was administrated. Results There were 7 cases of pulmonary embolism (PE) secondary to lower limb deep vein thrombosis (DVT), of which 2 cases were related to sauna bath. We grouped the cases according to their extensiveness of embolism: mild, moderate, severe, or complete embolism. Mild embolism: the emboli occupied less than 30%, of the inner diameter of pulmonary artery (PA). Median embolism: the emboli occupied 30~50% of the PA diameter. Severe embolism: the emboli occupied over half of the PA (50%), but there were contrast flow. Completed embolism: there was no contrast found around the emboli. The direct sign of PE was a filling defect or no opacification in the affected branch of pulmonary artery (PA). There were 9 other secondary signs: ①widen PA, ②enlarged right ventricle and the right atrium, ③increased translucency of the lung and decreased bronchovascular shadows, ④shrunken pulmonary veins liked dried rattan, ⑤decreased left atrium and the left ventricle size, ⑥shifting of interventricular septum to the left and posterior direction,⑦The lateral lung parenchyma demonstrated in a triangular shape,⑧pleural effusion and ⑨pericardiacle effusion. Conclusions The diagnosis of PE was revealed by 10 radiological signs by contrast-enhanced CT:With full understanding of the pathophysiological basis of these 10 signs:correct diagnosis of pulmonary embolism can be made. PE is commonly caused by lower limb. And sauna bath is one of the main predisposing causes.

  14. Acute pulmonary embolism: prediction of cor pulmonale and short-term patient survival from assessment of cardiac dimensions in routine multidetector-row CT; Mehrschicht-Spiral-CT bei vermuteter und inzidenteller akuter Lungenembolie: prognostischer Wert morpholoqischer Herzparameter

    Energy Technology Data Exchange (ETDEWEB)

    Engeike, C. [Radiologie, Klinikum rechts der Isar der Technischen Univ. Muenchen (Germany); Rummeny, E.; Marten, K. [Inst. fuer Roentgendiagnostik, Klinikum rechts der Isar der Technischen Univ. Muenchen (Germany)

    2006-10-15

    Purpose: evaluation of the prognostic value of morphological cardiac parameters in patients with suspected and incidental acute pulmonary embolism (PE) using multidetector-row chest CT (MSCT). Materials and methods: 2335 consecutive MSCT scans were evaluated for the presence of PE. The arterial enhancement and analysability of pulmonary arteries and the heart were assessed as parameters of the scan quality. The diastolic right and left ventricular short axes (RV{sub D}, LV{sub D}) and the interventricular septal deviation (ISD) were measured in all PE-positive patients and the echocardiography reports were reviewed. The clinical data assessment included cardio-respiratory and other co-morbidities, systemic anticoagulant therapy (ACT), and the 30-day outcome. Predictors of acute cor pulmonale and the short-term outcome were calculated by univariate and multivariate logistic regressions including odds ratios (OR) and ROC analyses using positive (PPV) and negative predictive values (NPV). Results: 90 patients with acute PE were included (36 with clinically suspected PE, 54 with incidental PE). 26 patients had cardio-respiratory co-morbidities. Four patients underwent systemic thrombolysis, 43 underwent anticoagulation in therapeutic doses, 19 underwent anticoagulation in prophylactic doses, and 24 patients did not undergo ACT. 15 of 41 patients had echocardiographic evidence of acute cor pulmonale. 8 patients died within 30 days. The RV{sub D} was the best independent predictor of acute cor pulmonale (p = 0,002, OR = 9.16, PPV = 0.68, NPV=1 at 4.49 cm cut off) and short-term outcome (p= 0,0005, OR = 2.82, PPV = 0.23, NPV = 0.98 at 4.75 cm cut off). The RV{sub D}/LV{sub D} ratio had a PPV of 0.85 for cor pulmonale. (orig.)

  15. Predictors of long-term clinical outcome of patients with acute massive pulmonary embolism after thrombolytic therapy

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Objective To assess the in-hospital clinical course and the long-term evolution of acute massive pulmonary embolism after thrombolytic therapy and to identify predictors of adverse clinical outcome.Methods A total of 260 patients hospitalized from January 1989 to October 1998 were retrospectively reviewed and followed up for 3.9 to 8.4 years. Baseline characteristics and variables pre- and post-thrombolysis were identified. Particular attention was paid to the clinical events, including death, recurrent thromboembolism, chronic thromboembolic pulmonary hypertension, and major bleeding attributable to the use of anticoagulants. Kaplan-Meier event-free survival curves were generated. Univariate analysis by means of the log-rank test was used to test each candidate variable for association with clinical outcome. Multivariate analysis with the Cox proportional hazard model was used to determine independent predictors of the long-term outcome.Results The in-hospital mortality rate was 8.5%, with 68.2% due to pulmonary embolism itself, and the follow-up mortality rate was 31.7%, with 29.2% due to recurrent embolism. Factors associated with an adverse outcome in univariate analysis were: (1) prior thromboembolic diseases; (2) duration of anticoagulant therapy 50 mmHg after thrombolysis; and (6) greater than 30% obstruction of pulmonary vasculature identified by pulmonary ventilation/perfusion scintigraphy before hospital discharge. Multivariate analysis identified three independent predictors of poor long-term outcome for patients with acute massive pulmonary embolism after thrombolysis; which were: (1) Doppler recording of pulmonary artery systolic pressure >50 mmHg, with relative risk of 3.78 and a 95% confidence interval of 2.70 to 4.86; (2) echocardiographic evidence of right ventricular dysfunction/dilatation (relative risk: 2.18; 95% confidence interval: 1.48 to 2.88); and (3) greater than 30% obstruction of pulmonary vasculature documented by lung scan (relative

  16. Pulmonary embolism and patent foramen ovale thrombosis: the key role of TEE

    Directory of Open Access Journals (Sweden)

    Reverberi Claudio

    2007-08-01

    Full Text Available Abstract This is a case report of a 35 young man with Klinefelter Syndrome presented breathlessness, palpitations and chest pain. It shows a rare case of a thrombus located through the PFO, in patient with pulmonary and paradoxical embolism, which takes back to exciting hypothesis on thrombus growth. A thrombus, which has grown 'in situ' or trapped through the patent foramen ovale, may be a cause of relapsing pulmonary or systemic embolism during anticoagulation therapy. To prevent recurrent paradoxical embolism, percutaneous closure of PFO is recommended, but in this case, thrombus was trapped through the PFO and the patient was referred to the surgeon. We believe that under these circumstances the clinician should be informed of the presence of PFO in critical pulmonary embolism; this case points out the key role of TEE to face a diagnostic and therapeutic scenarios.

  17. Peculiarities of Blood Flow Changes in Venae Cavae during Experimental Pulmonary Embolism.

    Science.gov (United States)

    Evlakhov, V I; Poyassov, I Z; Shaidakov, E V

    2016-10-01

    The model of acute pulmonary embolism in rabbits demonstrated reduced pulmonary blood flow, cardiac output, left atrial pressure, and blood flow in venae cavae against the background of elevated left pulmonary artery pressure and increased pulmonary vascular resistance. Simultaneously, the blood flow in the superior vena cava decreased to a lesser extent than that in the inferior vena cava, which was a characteristic feature of the model of pulmonary pathology. In contrast, when histamine was infused into the left jugular vein to equally elevate pressure in pulmonary artery as in the above model, the blood flow in the superior vena cava decreased to a greater extent than that in inferior vena cava. During stenosis of inferior vena cava that decreased the cardiac output to the level observed during modeled pulmonary embolism, the blood flows in both venae cavae dropped equally.

  18. [Echocardiography in acute pulmonary embolism. Not a routine method but useful in the diagnosis of simultaneous hemodynamic disorders].

    Science.gov (United States)

    Kierkegaard, A

    1998-08-19

    Echocardiographic diagnosis of acute pulmonary embolism as illustrated by three case reports is discussed in the article. Acute pulmonary embolism was diagnosed by demonstration of right heart strain in one case, of long vermiform thrombi floating in the right atrium in another, and in the third case by demonstration of a long thrombus lodged in the foramen ovale, astride the atrial septum, and with its ends floating in either atrium. Thus, as echocardiography enables pulmonary embolism to be diagnosed by demonstration either of right heart strain or of intracardial thrombi, it is a useful diagnostic tool in cases of haemodynamic compromise, though it does not detect minor pulmonary embolism.

  19. Use of the Trauma Embolic Scoring System (TESS) to predict symptomatic deep vein thrombosis and fatal and non-fatal pulmonary embolism in severely injured patients.

    Science.gov (United States)

    Ho, K M; Rao, S; Rittenhouse, K J; Rogers, F B

    2014-11-01

    Fatal pulmonary embolism is the third most common cause of death after major trauma. We hypothesised that the Trauma Embolic Scoring System (TESS) would have adequate calibration and discrimination in a group of severely injured trauma patients in predicting venous thromboembolism (VTE), and could be used to predict fatal and non-fatal symptomatic pulmonary embolism. Calibration and discrimination of the TESS were assessed by the slope and intercept of the calibration curve and the area under the receiver operating characteristic curve, respectively. Of the 357 patients included in the study, 74 patients (21%) developed symptomatic VTE after a median period of 14 days following injury. The TESS predicted risks of VTE were higher among patients who developed VTE than those who did not (14 versus 9%, P=0.001) and had a moderate ability to discriminate between patients who developed VTE and those who did not (area under the receiver operating characteristic curve 0.71, 95% confidence interval 0.65 to 0.77). The slope and intercept of the calibration curve were 2.76 and 0.34, respectively, suggesting that the predicted risks of VTE were not sufficiently extreme and overall, underestimated the observed risks of VTE. Using 5% predicted risk of VTE as an arbitrary cut-point, TESS had a high sensitivity and negative predictive value (both ≥0.97) in excluding fatal and non-fatal pulmonary embolism. The TESS had a reasonable ability to discriminate between patients who developed VTE and those who did not and may be useful to select different strategies to prevent VTE in severely injured patients.

  20. The dynamic study of the pulmonary artery obstruction degree and the right ventricular function in massive pulmonary embolism on CT pulmonary angiography

    Institute of Scientific and Technical Information of China (English)

    Jianguo Wang; Yulin Guo; Xiaojuan Guo; Min Liu; Youmin Guo; Chen Wang; Yuanhua Yang; Zhenguo Zhai; Li Zhu; Hongxia Ma

    2008-01-01

    Objective: To analyze the value of CTPA in assessing the dissolve of embolus and the function of the fight ventricle dynamically.Methods:Twenty-three cases of massive pulmonary embolism were analyzed retrospectively. The pulmonary artery obstruction index and the fight ventricular function parameters were collected and analyzed on CTPA before thrombolytic therapy, 24 hours and 14 days after therapy, respectively. Results:The pulmonary artery obstruction index decreased gradually, and there was significant difference before therapy, 24 hours and 2 weeks after therapy. Twenty-four hours after therapy, the maximal short axes diameter and the maximal transverse area of fight ventricle(RVd, RVs) decreased significantly, the maximal short axes diameter and the maximal transverse area of left ventricle(LVd, LVs) increased significantly, and the RVd/LVd, RVs/LVs decreased apparently. The pulmonary artery symbolic pressure before and 24 hours after therapy were apparently different. There was no significant difference between azygos vein, the super vena cava, the main pulmonary artery and vein reflux before and after therapy. Conclusion:CTPA can evaluate the pulmonary artery obstruction degree and right ventricular function dynamically.

  1. Variable D-dimer thresholds for diagnosis of clinically suspected acute pulmonary embolism

    NARCIS (Netherlands)

    Van der Hulle, T.; Den Exter, P. L.; Erkens, P. G. M.; Van Es, J.; Mos, I. C. M.; Ten Cate, H.; Kamphuisen, P. W.; Hovens, M. M. C.; Buller, H. R.; Klok, F. A.; Huisman, M. V.

    2013-01-01

    Background Computed tomography pulmonary angiography (CTPA) is frequently requested using diagnostic algorithms for suspected pulmonary embolism (PE). For suspected deep vein thrombosis, it was recently shown that doubling the D-dimer threshold in patients with low pretest probability safely decreas

  2. Peripheral primitive neuroectodermal tumor of the kidney presenting with pulmonary tumor embolism: A case report

    Institute of Scientific and Technical Information of China (English)

    Sathya; Chinnaa; Chandan; J; Das; Sanjay; Sharma; Prabhjot; Singh; Amlesh; Seth; Suvendu; Purkait; Sandeep; R; Mathur

    2014-01-01

    Peripheral primitive neuroectodermal tumor(PNET) of the kidney is a rare, aggressive tumor known for its recurrence and metastatic potential. Despite the frequency of venous extension to the renal veins and inferior vena cava, pulmonary tumor embolism at the initial presentation is not common. We report a case of 22-year-old female with PNET of the kidney who presented with tumor embolism in the inferior vena cava(IVC) and bilateral pulmonary artery. The patient underwent surgical resection and histopathological analysis confirmed the presence of tumor within the IVC and pulmonary arteries. The patient received adjuvant chemotherapy and is currently doing well on follow-up.

  3. Successful treatment of massive pulmonary embolism with prolonged catheter-directed thrombolysis.

    LENUS (Irish Health Repository)

    Kelly, Peter

    2012-02-03

    This is a case report of a young woman who presented with an extensive pulmonary embolism and echocardiographic evidence of right ventricular dysfunction. Although hemodynamically stable, the patient\\'s clinical condition failed to improve with standard heparin anticoagulation. Successful local catheter-directed thrombolysis was performed over an extended period of 48 h with regular monitoring of response to therapy by computed tomography-pulmonary angiography and echocardiography. To our knowledge, treatment of a pulmonary embolism by catheter-directed thrombolytic infusion over an extended period of 48 h has not previously been described.

  4. Electroconvulsive therapy and anticoagulation after pulmonary embolism: a case report

    Directory of Open Access Journals (Sweden)

    Julio Cesar Lazaro

    2014-07-01

    Full Text Available Introduction Electroconvulsive therapy (ECT is considered the most effective treatment for catatonia regardless its underlying condition. The rigid fixed posture and immobility observed in catatonia may lead to several clinical complications, of which, pulmonary embolism (PE is one of the most severe. The rapid improvement of the psychiatric condition in catatonia-related PE is essential, since immobility favors the occurrence of new thromboembolic events and further complications. In that scenario, ECT should be considered, based on a risk-benefit analysis, aiming at the faster resolution of the catatonia. Methods Case report and literature review. Results A 66-years-old woman admitted to the psychiatric ward with catatonia due to a depressive episode presented bilateral PE. Clinically stable, but still severely depressed after a trial of antidepressants, she was treated with ECT in the course of full anticoagulation with enoxaparin. After five ECT sessions, her mood was significantly better and she was walking and eating spontaneously. She did not present complications related either to PE or to anticoagulation. After the eighth ECT session, she evolved with hypomania, which was managed with oral medication adjustments. The patient was completely euthymic at discharge. Conclusion The case we presented provides further evidence to the anecdotal case reports on the safety of ECT in the course of concomitant full anticoagulant therapy after PE, and illustrates how, with the proper precautions, the benefits of ECT in such condition might outweigh its risks.

  5. Developments in the management and treatment of pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Rachel Limbrey

    2015-09-01

    Full Text Available Pulmonary embolism (PE is a serious and costly disease for patients and healthcare systems. Guidelines emphasise the importance of differentiating between patients who are at high risk of mortality (those with shock and/or hypotension, who may be candidates for thrombolytic therapy or surgery, and those with less severe presentations. Recent clinical studies and guidelines have focused particularly on risk stratification of intermediate-risk patients. Although the use of thrombolysis has been investigated in these patients, anticoagulation remains the standard treatment approach. Individual risk stratification directs initial treatment. Rates of recurrence differ between subgroups of patients with PE; therefore, a review of provoking factors, along with the risks of morbidity and bleeding, guides the duration of ongoing anticoagulation. The direct oral anticoagulants have shown similar efficacy and, in some cases, reduced major bleeding compared with standard approaches for acute treatment. They also offer the potential to reduce the burden on patients and outpatient services in the post-hospital phase. Rivaroxaban, dabigatran and apixaban have been shown to reduce the risk of recurrent venous thromboembolism versus placebo, when given for >12 months. Patients receiving direct oral anticoagulants do not require regular coagulation monitoring, but follow-up, ideally in a specialist PE clinic in consultation with primary care providers, is recommended.

  6. Acute kidney injury in patients with pulmonary embolism

    Science.gov (United States)

    Chang, Chih-Hsiang; Fu, Chung-Ming; Fan, Pei-Chun; Chen, Shao-Wei; Chang, Su-Wei; Mao, Chun-Tai; Tian, Ya-Chung; Chen, Yung-Chang; Chu, Pao-Hsien; Chen, Tien-Hsing

    2017-01-01

    Abstract Acute kidney injury (AKI) is overlooked in patients with pulmonary embolism (PE). Risk factors for and long-term outcomes of this complication remain unknown. This study evaluated the predictors and prognosis of AKI in patients with PE. This retrospective cohort study used Taiwan's National Health Insurance Research Database. We enrolled a total of 7588 patients who were admitted to a hospital for PE from January1997 to December 2011 and administered anticoagulation or thrombolytic agents. All demographic data, risk factors, and outcomes were analyzed. AKI was diagnosed in 372 (4.9%) patients. Multivariate logistic regression analysis revealed pre-existing chronic kidney disease, hypertension, diabetes mellitus, massive PE, anemia, and sepsis as independent risk factors for AKI. In the long-term follow-up, the survival rate was similar in the AKI and non-AKI groups. Careful risk factor screening and intensive intervention in patients with AKI might yield outcomes similar to those in patients without AKI. PMID:28248851

  7. Pulmonary mucormycosis with embolism: two autopsied cases of acute myeloid leukemia.

    Science.gov (United States)

    Kogure, Yasunori; Nakamura, Fumihiko; Shinozaki-Ushiku, Aya; Watanabe, Akira; Kamei, Katsuhiko; Yoshizato, Tetsuichi; Nannya, Yasuhito; Fukayama, Masashi; Kurokawa, Mineo

    2014-01-01

    Mucormycosis is an increasingly important cause of morbidity and mortality for patients with hematological malignancies. The diagnosis of mucormycosis usually requires mycological evidence through tissue biopsy or autopsy because the signs and symptoms are nonspecific and there are currently no biomarkers to identify the disease. We herein present two autopsied cases of acute myeloid leukemia with prolonged neutropenia who developed invasive mucormycosis accompanied by pulmonary artery embolism. Our cases were featured by unexplained fever and rapidly progressive dyspnea. Computed tomography scan detected nodular lesions or nonspecific consolidations in the lungs. Cultures, cytological study, and serum fungal markers consistently gave negative results. Autopsy revealed embolism of the pulmonary artery which consisted of fibrin clots by filamentous fungi. Genomic DNA was extracted from the paraffin-embedded clots and was applied to polymerase chain reaction amplification, leading to the diagnosis of infection by Rhizopus microsporus. We should carefully search for life-threatening pulmonary embolism when patients with hematological malignancies develop pulmonary mucormycosis.

  8. Intravascular lymphoma presenting as a specific pulmonary embolism and acute respiratory failure: a case report

    Directory of Open Access Journals (Sweden)

    Georgin-Lavialle Sophie

    2009-05-01

    Full Text Available Abstract Introduction The occurrence of an intravascular lymphoma with severe pulmonary involvement mimicking pulmonary embolism is described. Case presentation A 38-year-old man was referred to our intensive care unit with acute respiratory failure and long lasting fever. Appropriate investigations failed to demonstrate any bacterial, viral, parasitic or mycobacterial infection. A chest computed tomography scan ruled out any proximal or sub-segmental pulmonary embolism but the ventilation/perfusion lung scan concluded that there was a high probability of pulmonary embolism. The cutaneous biopsy pathology diagnosed intravascular lymphoma. Conclusion Intravascular lymphoma is a rare disease characterized by exclusive or predominant growth of neoplastic cells within the lumina of small blood vessels. Lung involvement seems to be common, but predominant lung presentation of this disease is rare. In our patient, urgent chemotherapy, along with adequate supportive care allowed complete recovery.

  9. The influence of weather and environment on pulmonary embolism: pollutants and fossil fuels.

    Science.gov (United States)

    Clauss, Ralf; Mayes, Julian; Hilton, Paul; Lawrenson, Ross

    2005-01-01

    Previous publications have highlighted seasonal variations in the incidence of thrombosis and pulmonary embolism, and that weather patterns can influence these. While medical risk factors for pulmonary thrombo-embolism such as age, obesity, hypercoagulable states, cancer, previous thrombo-embolism, immobility, limb paralysis, surgery, major illness, trauma, hypotension, tachypnoea and right ventricular hypokinesis are not directly implicated regarding environmental factors such as weather, they could be influenced indirectly by these. This would be especially relevant in polluted areas that are associated with a higher pulmonary embolism risk. Routine nuclear medicine lung ventilation/perfusion studies (V/Q scans) of 2071 adult patients referred to the nuclear medicine department of the Royal Surrey County Hospital in Guildford, UK, between January 1998 and October 2002 were reviewed and 316 of these patients were classified as positive for pulmonary embolism with high probability scan on PIOPED criteria. The occurrence of positive scans was compared to environmental factors such as temperature, humidity, vapour pressure, air pressure and rainfall. Multiple linear regression was used to establish the significance of these relations. The incidence of pulmonary embolism was positively related to vapour pressure and rainfall. The most significant relation was to vapour pressure (p=0.010) while rainfall was less significant (p=0.017). There was no significant relation between pulmonary embolism and air pressure, humidity or temperature. It is postulated that rainfall and water vapour may be contributary factors in thrombosis and pulmonary embolism by way of pollutants that are carried as condensation nuclei in micro-droplets of water. In particular, fossil fuel pollutants are implicated as these condensation nuclei. Pollutants may be inhaled by populations exposed to windborne vapour droplets in cities or airports. Polluted vapour droplets may be absorbed by the lung

  10. Solid malignancies complicated with pulmonary embolism: clinical analysis of 120 patients

    Institute of Scientific and Technical Information of China (English)

    MA Shui-qing; LIN Yi; YING Hong-yan; SHAO Ya-juan; LI Xiao-yuan; BAI Chun-mei

    2010-01-01

    Background Pulmonary embolism, a potentially fatal event, occurs more frequently in cancer patients than in the general population. To offer an accurate diagnosis and effective treatment to such patients in China, we analyzed the incidence rate and clinical features of pulmonary embolism in patients with solid tumor hospitalized in the Peking Union Medical College (PUMC) Hospital.Methods A retrospective analysis was made of the hospitalized patients with solid malignancies complicated with pulmonary embolism who had been admitted into the PUMC Hospital from January 2002 to December 2008. Results The incidence of pulmonary embolism in hospitalized patients with solid malignancies was 0.27% (120/43 967). The median age at diagnosis was 57.5 years. The male to female ratio was 1.0:1.4 (49:71). Patients with non-small-cell lung cancer (NSCLC) constituted the largest proportion of the 120 patients (37.5%), followed by patients with breast (9.2%), ovarian (8.3%), pancreatic (6.7%), and liver cancer (6.7%). Eighty patients (66.7%) had stage IV cancer. Bone was the most common site of distant metastasis (46.3%). D-dimer level was elevated in 90.9% of the 66 tested patients. The incidence of bleeding due to anti-coagulation therapy was 3.6%. Thirty-six (30.0%) of the 120 patients had concurrent deep venous thrombosis in the lower extremities. Seventeen patients developed acute pulmonary embolism within 2 weeks after surgery, 3 of whom died suddenly. Four patients presented with deep venous thrombosis and 1 with pulmonary embolism prior to the identification of malignancy.Conclusions Patients with cancer of the lung, ovarian, breast, pancreas, and liver are more likely to be complicated with pulmonary embolism than those with other types of solid tumors. Patients with distant metastasis are at a higher risk of pulmonary embolism. Pulmonary embolism without concurrent deep venous thrombosis is more frequently observed than concurrence of both disorders in the clinical setting.

  11. Endometrial stromal sarcoma with selective polyvinyl alcohol embolization of a pulmonary metastasis after recurrent hemoptysis and expansive growth

    Directory of Open Access Journals (Sweden)

    Maximilian de Bucourt

    2010-05-01

    Full Text Available A 63-year-old female with a well-vascularized pulmonary metastasis of an endometrial stromal sarcoma (ESS of 6x6 cm received selective embolization with 150-250 mm polyvinyl alcohol (Contour; Boston Scientific, Natick, MA, USA via a bronchial artery. Post-interventional loss of perfusion was qualitatively estimated to be >80%. The lesion was located in direct proximity to the pulmonary hilar vessels. Owing to recurrent and sudden hemoptyses, an interdisciplinary tumor board assessed the risk of life-threatening blood loss to be greater than that of angiography with particle embolization and agreed on an endovascular approach. Hemoptysis did not recur in a follow-up period of six months. Initial clinical symptoms were noted 25 years ago. However, establishing a definite diagnosis has, for a long time, remained a histopathological challenge.

  12. Endovascular embolization prior to surgical resection of symptomatic intralobar pulmonary sequestration in an adult

    OpenAIRE

    Jernej Avsenik; Tomaž Štupnik; Peter Popovič

    2015-01-01

    Intralobar pulmonary sequestration is a rare congenital malformation, conventionally managed by surgical resection. Recently, the endovascular embolization has been proposed for the definite treatment of this disease. Additionally, preoperative embolization of aberrant arteries to minimize the risk of serious intraoperative haemorrhage has also been described. We report the case of 43-year old female patient who presented with cough and haemoptysis, and was successfully treated with endovascu...

  13. Efficacy and safety of tenecteplase in pulmonary embolism.

    Science.gov (United States)

    Shukla, Anand N; Thakkar, Bhavesh; Jayaram, Ashwal A; Madan, Tarun H; Gandhi, Gaurav D

    2014-07-01

    Pulmonary embolism (PE) is a relatively common life-threatening cardiovascular condition associated with significant morbidity and mortality. We present the efficacy and safety data of weight-adjusted tenecteplase in 30 consecutive patients of acute PE. 30 patients (22 male, 8 female) with acute PE were included in the study and divided into three groups: (1) Acute PE complicated by shock stage and/or persistent hypotension (12 patients). (2) RV dilatation and/or dysfunction without hypotension (14 patients). (3) Severe hypoxemia without hypotension and RV dysfunction (4 patients). Predominant symptoms were dyspnoea, cough, chest pain, syncope and haemoptysis, noted in 100% (30), 40% (12), 54% (16), 32% (9) and 10% (3) of patients respectively. RV dilatation and dyskinesia were present in 86%, septal paradoxical movement in 73% and inferior venacava collapse absent in 53% of patients respectively. 12 patients presented with acute PE and cardiogenic shock, 14 patients showed RV dilatation and dysfunction with systolic BP >90 mmHg and four patients were having RV dilation without dysfunction but severe hypoxemia. There was significant reduction in right ventricular systolic pressure and improvement in right ventricular dysfunction. Our study shows that tenecteplase is very effective and safe in the treatment of PE with minimal risk of bleeding in high risk group and intermediate risk and even in selective low risk category group of patients. However, in view of small number of patients in study group, a large multicentre randomized study would be required to draw a firm conclusion regarding the thrombolysis in low risk category patient.

  14. Benefits of texture analysis of dual energy CT for Computer-Aided pulmonary embolism detection.

    Science.gov (United States)

    Foncubierta-Rodríguez, Antonio; Jiménez del Toro, Óscar Alfonso; Platon, Alexandra; Poletti, Pierre-Alexandre; Müller, Henning; Depeursinge, Adrien

    2013-01-01

    Pulmonary embolism is an avoidable cause of death if treated immediately but delays in diagnosis and treatment lead to an increased risk. Computer-assisted image analysis of both unenhanced and contrast-enhanced computed tomography (CT) have proven useful for diagnosis of pulmonary embolism. Dual energy CT provides additional information over the standard single energy scan by generating four-dimensional (4D) data, in our case with 11 energy levels in 3D. In this paper a 4D texture analysis method capable of detecting pulmonary embolism in dual energy CT is presented. The method uses wavelet-based visual words together with an automatic geodesic-based region of interest detection algorithm to characterize the texture properties of each lung lobe. Results show an increase in performance with respect to the single energy CT analysis, as well as an accuracy gain compared to preliminary work on a small dataset.

  15. Endovascular Management of Acute Pulmonary Embolism Using the Ultrasound-Enhanced EkoSonic System.

    Science.gov (United States)

    Garcia, Mark J

    2015-12-01

    Acute, symptomatic pulmonary embolism (PE) in the massive and submassive categories continues to be a healthcare concern with significant risk for increased morbidity and mortality. Despite increased awareness and venous thromboembolism prophylaxis, endovascular treatment is still an important option for many of these patients. There are a variety of techniques and devices used for treating PE, but none have been evaluated as extensively as the EkoSonic endovascular system that is also currently the only FDA-approved device for the treatment of pulmonary embolism. This article describes the use of the EkoSonic device for this patient population.

  16. ANP, BNP and D-dimer predict right ventricular dysfunction in patients with acute pulmonary embolism

    DEFF Research Database (Denmark)

    Mortensen, Jann; Jensen, Claus V; Von Der Recke, Peter;

    2010-01-01

    The aim of this study was to predict right ventricular dysfunction (RVD) using plasma concentration of D-dimer, pro-atrial natriuretic peptide (pro-ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1) and cardiac troponin I (TNI) in patients with pulmonary embolism (PE).......The aim of this study was to predict right ventricular dysfunction (RVD) using plasma concentration of D-dimer, pro-atrial natriuretic peptide (pro-ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1) and cardiac troponin I (TNI) in patients with pulmonary embolism (PE)....

  17. Cerebral fat embolism: pulmonary contusion is a more important etiology than long bone fractures.

    Science.gov (United States)

    Aydin, M D; Akçay, F; Aydin, N; Gündogdu, C

    2005-01-01

    Lipid embolism is a serious and life-threatening problem and usually arises as a complication of severe trauma associated with long bone or pelvic fractures. It is generally thought that fat droplets enter the circulation at the site of fracture. In the systemic circulation, they become emboli to brain, kidney and other areas. Lipids are absorbed from the intestinal tract and transported into pulmonary tissue via thoracic duct and exposed to first catabolic procedures in the lungs. We have predicted that systemic lipid embolism may not occur unless bone fractures lead to pulmonary injury. This study was planned to investigate this hypothesis with respect to the role of pulmonary contusion and long bone fractures in the formation of cerebral fat embolism. Twenty male hybrid rabbits were included in this study. Pulmonary contusion was performed on half of the rabbits (n = 10) and femur fracture was applied to the remaining ones (n = 10). Ten days after procedure, all rabbits were sacrificed. Brain specimens were taken by frozen-section method and stained with Sudan black. Intraarteriolar lipid particles in the brain were examined microscopically. Cerebral fat embolism was detected in seven animals exposed to pulmonary contusion and only in one animal exposed to femur fracture. The mean number of branches of middle cerebral artery at midparietal level occluded with fat particles were higher in the pulmonary contusion group than in the long bone fracture group. In conclusion, we found that pulmonary contusion had more deleterious effects than long bone fracture in the formation of cerebral fat embolism.

  18. Assessment of risk and prophylaxis for deep vein thrombosis and pulmonary embolism in medically ill patients during their early days of hospital stay at a tertiary care center in a developing country

    Directory of Open Access Journals (Sweden)

    Ambarish Pandey

    2009-08-01

    Full Text Available Ambarish Pandey, Nivedita Patni, Mansher Singh, Randeep GuleriaDepartment of Medicine, All India Institute of Medical Sciences, New Delhi, IndiaAim: Deep vein thrombosis (DVT and pulmonary thromboembolism (PE are important causes of morbidity and mortality in medically ill patients. This study was done to assess risk factors and prophylaxis given for DVT and PE in newly admitted medically ill patients during the first two weeks of their hospital stay at a tertiary care center hospital in India.Methods: All patients within one week of their admission in intensive care unit (ICU and wards were enrolled in the study after an informed written consent. Patients who had DVT prophylaxis within the past month or any contraindications for DVT prophylaxis were excluded. A structured proforma was designed and effective risk stratification for DVT was done. Patients were followed for up to two weeks to record any changes in the risk categories and document any signs of PE or DVT if present. Any prophylaxis given for DVT or PE was noted.Results: Seventy-five percent of patients had the highest risk for DVT and PE. Only 12.5% had DVT prophylaxis within the first two days of admission. Within two weeks of admission, 30.8% of patients were discharged, and 16.2% died. 72.6% of the patients still in the wards belonged to the highest risk category. Clinical signs and symptoms of DVT and PE were present in 25.8% and 9.8% of patients, respectively after the second week of admission. 86% of symptomatic patients belonged to the highest risk category initially and none of them received any prophylaxis. 21.6% of the highest risk category patients died within two weeks of their admission. A statistically significant correlation was found between mortality and risk score of the patients for DVT and between lack of prophylaxis and mortality (p < 0.05.Conclusion: A significant risk for DVT and PE exists in medically ill patients, but only a small proportion of the patients

  19. Anticoagulant treatment of cancer patients with pulmonary embolism in the real world Actual use of low-molecular-weight heparin in cancer

    NARCIS (Netherlands)

    Kleinjan, A.; Hutten, B. A.; Di Nisio, M.; Buller, H. R.; Kamphuisen, P. W.

    2014-01-01

    Background: Since 2004, guidelines recommend long-term treatment with low-molecular-weight heparin (LMWH) in patients with cancer and pulmonary embolism (PE). We assessed the proportion of cancer patients with PE actually treated with LMWH and the duration of anticoagulant treatment in the Netherlan

  20. Clinical Analysis of Pulmonary Lipiodol Embolism in Patients with Hepatic Carcinoma after Transcatheter Arterial Chemoembolization

    OpenAIRE

    2015-01-01

    Objective:To explore the clinical manifestations, therapeutic methods and preventive measures of pulmonary lipiodol embolism (PLE) induced by transcatheter arterial chemoembolization (TACE) so as to improve the cognition and management of PLE. Methods:A total of 2 613 patients with hepatic cancer without history of pulmonary disease who were treated with TACE in our hospital from Sept., 2004 to Mar., 2013 were selected. The clinical manifestations, therapeutic methods and preventing measures ...

  1. Massive pulmonary embolism immediately diagnosed by transthoracic echocardiography and treated with tenecteplase fibrinolysis.

    Science.gov (United States)

    Brunetti, Natale Daniele; Ieva, Riccardo; Correale, Michele; De Gennaro, Luisa; Pellegrino, Pier Luigi; Dioguardi, Ezio; Bux, Francesca; Di Biase, Matteo

    2009-08-01

    We report the case of a 75-year-old woman with new onset dyspnoea, hypotension, and right bundle branch block. Transthoracic echocardiography (TTE) showed a thrombus in the right pulmonary artery and acute pulmonary embolism was diagnosed. The patient immediately underwent fibrinolysis with tenecteplase, with prompt recovery of clinical conditions and ECG anomalies. Bedside TTE might be helpful for immediate diagnosis of massive PE needing rapid treatment by fibrinolysis.

  2. Percutaneous transhepatic venous embolization of pulmonary artery aneurysm in Hughes-Stovin syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Ah; Kim, Man Deuk; Oh, Do Yun; Park, Pil Won [Bundang CHA General Hospital, Pochon CHA University, Seongnam (Korea, Republic of)

    2007-08-15

    Hughes-Stovin syndrome is an extremely rare entity. We present a case of a 42-year-old man, who developed deep vein and inferior vena cava (IVC) thrombosis, repeated internal bleeding and pulmonary artery aneurysms (PAAs). The patient presented with massive hemoptysis and with PAAs of a 2.5 cm maximum diameter. We describe the successful percutaneous transhepatic venous embolization of the PAAs due to occluded common vascular pathways to the pulmonary artery.

  3. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study

    Science.gov (United States)

    Dalichampt, Marie; Raguideau, Fanny; Ricordeau, Philippe; Blotière, Pierre-Olivier; Rudant, Jérémie; Alla, François; Zureik, Mahmoud

    2016-01-01

    Objective To assess the risk of pulmonary embolism, ischaemic stroke, and myocardial infarction associated with combined oral contraceptives according to dose of oestrogen (ethinylestradiol) and progestogen. Design Observational cohort study. Setting Data from the French national health insurance database linked with data from the French national hospital discharge database. Participants 4 945 088 women aged 15-49 years, living in France, with at least one reimbursement for oral contraceptives and no previous hospital admission for cancer, pulmonary embolism, ischaemic stroke, or myocardial infarction, between July 2010 and September 2012. Main outcome measures Relative and absolute risks of first pulmonary embolism, ischaemic stroke, and myocardial infarction. Results The cohort generated 5 443 916 women years of oral contraceptive use, and 3253 events were observed: 1800 pulmonary embolisms (33 per 100 000 women years), 1046 ischaemic strokes (19 per 100 000 women years), and 407 myocardial infarctions (7 per 100 000 women years). After adjustment for progestogen and risk factors, the relative risks for women using low dose oestrogen (20 µg v 30-40 µg) were 0.75 (95% confidence interval 0.67 to 0.85) for pulmonary embolism, 0.82 (0.70 to 0.96) for ischaemic stroke, and 0.56 (0.39 to 0.79) for myocardial infarction. After adjustment for oestrogen dose and risk factors, desogestrel and gestodene were associated with statistically significantly higher relative risks for pulmonary embolism (2.16, 1.93 to 2.41 and 1.63, 1.34 to 1.97, respectively) compared with levonorgestrel. Levonorgestrel combined with 20 µg oestrogen was associated with a statistically significantly lower risk than levonorgestrel with 30-40 µg oestrogen for each of the three serious adverse events. Conclusions For the same dose of oestrogen, desogestrel and gestodene were associated with statistically significantly higher risks of pulmonary embolism but not arterial

  4. Pulmonary embolism following ankle fractures treated without an operation - an analysis using National Health Service data.

    Science.gov (United States)

    Jameson, Simon S; Rankin, Kenneth S; Desira, Nicola L; James, Philip; Muller, Scott D; Reed, Mike R; Rangan, Amar

    2014-08-01

    The majority of ankle fractures are stable and can be treated without an operation, most commonly with cast immobilisation. Based on concerns regarding the risk of a venous thromboembolic event (VTE) while immobilised, there is currently debate as to whether these patients should receive VTE prophylaxis for the duration of treatment. Rates of pulmonary embolism (PE) in this patient group are unknown. This retrospective cohort study was designed to identify patients treated without an operation for ankle fracture and determine the occurrence of PE and inpatient mortality within 90 days of injury using the English National Health Service administrative databases. Logistic regression models were used to assess the influence of age, gender and Charlson co-morbidity score on these outcomes. We identified 14777 adult patients over a 54-month period (April 2007-September 2011) that met our linkage and inclusion criteria (isolated, unilateral closed ankle fracture that did not require hospitalisation). Mean age was 46.4 years (range 18-99) and the majority had a Charlson 0 score (97.7%). There were 32 (0.22%) PEs within 90 days of the fracture (including in one patient who subsequently died). After adjustment, Charlson score of ≥1 was associated with a greater risk of PE (Odds ratio = 11.97, p < 0.001) compared to Charlson 0. Risk for these patients was 2.08%. In total, fifteen patients (0.11%) died in hospital within 90 days. Pulmonary embolism is rare following ankle fractures treated without an operation. Patients with multiple co-morbidities are at a higher risk. Based on this evidence, an ankle fracture treated without an operation does not appear to be an indication for routine VTE prophylaxis.

  5. Sudden death in a case of catatonia due to pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Archana Javadekar

    2014-01-01

    Full Text Available Catatonic syndrome carries relatively high mortality. One of the causes of death is pulmonary embolism. Prolonged immobility, dehydration, use of low-potency antipsychotic drugs, and electroconvulsive therapy (ECT increase the risk of venous thromboembolism. Evaluating the risk of catatonic patients is of paramount importance. Prevention of venous thromboembolism by reducing the risk factors and relieving catatonic symptoms early is essential.

  6. Symptomatology, Clinical Presentation and Basic Work up in Patients with Suspected Pulmonary Embolism

    DEFF Research Database (Denmark)

    Madsen, Poul Henning; Hess, Søren

    2017-01-01

    referral to a relevant facility should be a part of the skills of all clinicians. Sudden onset dyspnea, chest pain, syncope and hemoptysis are essential symptoms of pulmonary embolism, and in most of these patients basic investigations like arterial blood gas analysis, electrocardiogram, chest x...

  7. Use of bisphosphonates and raloxifene and risk of deep venous thromboembolism and pulmonary embolism

    DEFF Research Database (Denmark)

    Vestergaard, P; Schwartz, K; Pinholt, E M;

    2010-01-01

    Prior studies have associated raloxifene and strontium ranelate with deep venous thromboembolism and pulmonary embolism. In a cohort study, we observed an increased risk also with the bisphosphonates. However, the increase was present already before the start of bisphosphonates pointing at an eff...

  8. Acute pulmonary embolism | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available the Trial E.1 Medical condition or disease under investigation E.1.1Medical condition(s) being investigated Acute... pulmonary embolism Embolismo pulmonar agudo E.1.1.1Medical condition in easily understood language Acute...rial contains a sub-study No E.3Principal inclusion criteria 1) Acute symptomatic PE confirmed by multidetec

  9. A case of heart failure due to alcoholic cardiomyopathy combined with acute pulmonary embolism.

    Science.gov (United States)

    Xiao, Feng; Yuan, Wei; Li, Xiaorong; Wang, Gannan; Jiang, Ting; Wang, Weiwei; Zhang, Jinsong; Li, Ping; Qi, Lianwen; Chen, Yan

    2014-09-01

    It has not been reported that cases of alcoholic cardiomyopathy (ACM) combined with acute pulmonary embolism (PE). We hereby present a case of a 48-year-old male with ACM with significant enlargement of the heart and heart failure is described. Then, the patient was seized with acute PE which was confirmed by specific examination and his symptoms.

  10. The Location and Size of Pulmonary Embolism in Antineoplastic Chemotherapy Patients

    Energy Technology Data Exchange (ETDEWEB)

    Park, Yun Joo; Kwon, Woo cheol; Lee, Won Yeon; Koh, Sang Baek; Kim, Seong Ah; Kim, Myung Soon; Kim, Young Ju [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    To retrospectively evaluate the prevalent location and size of pulmonary embolism (PE) in anti-neoplastic chemotherapy patients by multidetector row CT (MDCT). This study was conducted on 101 patients that were positively diagnosed with PE by CT. Among these patients, 23 had received or were undergoing chemotherapy. The location and the mean size of the largest PE were compared between anti-neoplastic chemotherapy patients and non-cancer patients using the Chisquare test and paired t-test, respectively. We also used a multiple linear regression to assess the risk posed by the other risk factors of PE. The most prevalent location of PE in patients on anti-neoplastic chemotherapy was in the lobar or segmental pulmonary arteries and was not significantly different from non-cancer patients. The size of the PE was smaller in patients on anti-neoplastic chemotherapy (1.14 mL [standard error = 0.29]) compared to non-cancer patients. (2.14 mL [standard error = 0.40]) (p < 0.05). The size of PE is smaller in anti-neoplastic chemotherapy patients than in non-cancer patients

  11. Recovery of right and left ventricular function after acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Klok, F.A., E-mail: f.a.klok@lumc.nl [Section of Vascular Medicine, Department of General Internal Medicine-Endocrinology, Leiden University Medical Center, Leiden (Netherlands); Romeih, S. [Department of Cardiology, Leiden University Medical Center, Leiden (Netherlands); Kroft, L.J.M.; Westenberg, J.J.M. [Department of Radiology, Leiden University Medical Center, Leiden (Netherlands); Huisman, M.V. [Section of Vascular Medicine, Department of General Internal Medicine-Endocrinology, Leiden University Medical Center, Leiden (Netherlands); Roos, A. de [Department of Radiology, Leiden University Medical Center, Leiden (Netherlands)

    2011-12-15

    Aim: To evaluate recovery of cardiac function after acute pulmonary embolism (PE). Materials and methods: Routine breath-held computed tomography (CT)-pulmonary angiography was performed in patients with suspected PE to confirm or exclude the diagnosis of PE at initial presentation. Electrocardiogram (ECG)-triggered cardiac CT was performed to assess biventricular function. After 6 months, cardiac magnetic resonance imaging (MRI) was performed. In total, 15 consecutive patients with PE and 10 without were studied. A significant change in ventricular volume was defined as a >15% change in end-diastolic or -systolic volumes (EDV, ESV), and significant ventricular function improvement as a >5% increase in ejection fraction (EF) as based on reported cut-off values. Results: Right and left ventricular (RV and LV) EDV and ESV changed non-significantly (<1.3%) in the patients without PE, indicating good comparability of those values measured by CT and MRI. PE patients with baseline normal RV function (RVEF {>=}47%) revealed a >5% improvement in the RVEF (+5.4 {+-} 3.1%) due to a decrease in the RVESV. Patients with baseline abnormal RV function showed a >5% improvement in the RVEF (+14 {+-} 15%) due to decreases in both the RVESV and RVEDV. Furthermore, the LVEDV increased in this latter patient group. Conclusions: The present study demonstrated an improvement in RV function in the majority of patients with PE, independent of baseline RV function. The degree of RV and LV recovery was dependent on the severity of baseline RV dysfunction.

  12. Isolated Pulmonary Infective Endocarditis with Septic Pulmonary Embolism Complicating a Right Ventricular Outflow Tract Obstruction: Scarce and Devious Presentation

    Directory of Open Access Journals (Sweden)

    Abdelrahmen Abdelbar

    2013-01-01

    Full Text Available We present a case of a fifty-three-year-old male who presented with severe sepsis. He had been treated as a pneumonia patient for five months before the admission. Investigations revealed isolated pulmonary valve endocarditis and septic pulmonary embolism in addition to undiagnosed right ventricular outflow tract (RVOT obstruction. The patient underwent surgery for the relief of RVOT obstruction by substantial muscle resection of the RVOT, pulmonary artery embolectomy, pulmonary valve replacement, and reconstruction of RVOT and main pulmonary artery with two separate bovine pericardial patches. He was discharged from our hospital after 6 weeks of intravenous antibiotics. He recovered well on follow-up 16 weeks after discharge. A high-suspicion index is needed to diagnose right-side heart endocarditis. Blood cultures and transesophageal echocardiogram are the key diagnostic tools.

  13. Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting.

    Science.gov (United States)

    Hirata, Naoyuki; Kanaya, Noriaki; Yamazaki, Yutaka; Sonoda, Hajime; Namiki, Akiyoshi

    2010-02-01

    We report a rare case of pulmonary embolism (PE) caused by a carbon dioxide (CO2) blower during off-pump coronary artery bypass grafting (OPCAB). When the anastomosis of the right internal thoracic artery to left anterior descending artery was performed, the operator tore the right ventricle outflow track (RVOT) that was adjacent to the left anterior descending artery. Immediately after the anastomosis and repair of the torn RVOT with CO2 blower, the systolic pulmonary artery pressure (PAP) increased from 28 to 64 mmHg, and end-tidal CO2 decreased from 32 to 12 mmHg. Because transesophageal echocardiograph (TEE) showed numerous gas bubbles in the main pulmonary artery, we diagnosed PE caused by invasion of CO2 gas bubbles via the torn RVOT. Although a CO2 blower is useful to enhance visualization of the anastomosis during OPCAB, it should not be used for the venous system because it may cause CO2 embolism.

  14. Computed tomography angiography with pulmonary artery thrombus burden and right-to-left ventricular diameter ratio after pulmonary embolism.

    Science.gov (United States)

    Ouriel, Kenneth; Ouriel, Richard L; Lim, Yeun J; Piazza, Gregory; Goldhaber, Samuel Z

    2017-02-01

    Purpose Computed tomography angiography is used for quantifying the significance of pulmonary embolism, but its reliability has not been well defined. Methods The study cohort comprised 10 patients randomly selected from a 150-patient prospective trial of ultrasound-facilitated fibrinolysis for acute pulmonary embolism. Four reviewers independently evaluated the right-to-left ventricular diameter ratios using the standard multiplanar reformatted technique and a simplified (axial) method, and thrombus burden with the standard modified Miller score and a new, refined Miller scoring system. Results The intraclass correlation coefficient for intra-observer variability was .949 and .970 for the multiplanar reformatted and axial methods for estimating right-to-left ventricular ratios, respectively. Inter-observer agreement was high and similar for the two methods, with intraclass correlation coefficient of .969 and .976. The modified Miller score had good intra-observer agreement (intraclass correlation coefficient .820) and was similar to the refined Miller method (intraclass correlation coefficient .883) for estimating thrombus burden. Inter-observer agreement was also comparable between the techniques, with intraclass correlation coefficient of .829 and .914 for the modified Miller and refined Miller methods. Conclusions The reliability of computed tomography angiography for pulmonary embolism was excellent for the axial and multiplanar reformatted methods for quantifying the right-to-left ventricular ratio and for the modified Miller and refined Miller scores for quantifying of pulmonary artery thrombus burden.

  15. Effect of low-molecular-weight heparin and urokinase on pulmonary arteries involved in pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    WU Jun-ping; SUN Xin; WU Qi; DU Zhong-zhen; LI Li; WU Qian; SUN Hong-fen

    2013-01-01

    Background Pulmonary embolism (PE) is a common and often fatal disease.Early after pulmonary thromboembolism,inflammation and associated intimal hyperplasia occur within the pulmonary arteries,similar to what is observed with chronic thromboembolic pulmonary hypertension.This study tested the hypothesis that thrombolytic and anticoagulant agents would have anti-inflammatory effects or inhibit intimal hyperplasia of involved pulmonary arteries.Methods Seventy-two male New Zealand white rabbits were randomly divided into two groups (54 rabbits in the PE group and 18 in the sham group).Experimental PE was induced in 54 rabbits by femoral vein injection of autologous blood clots and confirmed with pulmonary angiography,and other 18 rabbits underwent sham operations.Fifty-four rabbits in the PE group were randomly divided into three groups:a control group (treated with normal saline),a low-molecularweight heparin (LMWH) group (treated with LMWH),and a urokinase (UK) group (treated with UK).Arterial blood gas was analyzed at 2,7,and 28 days (n=6 per time point by random group division),then lung tissues were removed and were analyzed for pro-inflammatory cytokines and chemokines,and were stained for intimal hyperplasia.Results The overall survival of rabbits undergoing PE was 100%.PE distribution detected on digital signal angiography (DSA) and histopathology was shown in 67% of rabbits (36/54) in the bilateral low lobar pulmonary arteries (PAs).The results showed that alveolar-arterial partial pressure of oxygen (PO2) difference (PA-aO2) significantly increased and PO2 decreased in the control group compared with the sham group.Compared with controls,the UK group had a decreased level of PA-aO2 on day 2 (P <0.05),however,there was no significant difference in the LMWH group.Compared with controls,the LMWH group had a decreased level of monocyte chemoattractant protein-1 (MCP-1) in affected tissue and serum samples on days 7 and 28 (P <0.05),and the UK group had

  16. The Massachusetts General Hospital Pulmonary Embolism Response Team (MGH PERT): creation of a multidisciplinary program to improve care of patients with massive and submassive pulmonary embolism.

    Science.gov (United States)

    Provias, Tim; Dudzinski, David M; Jaff, Michael R; Rosenfield, Kenneth; Channick, Richard; Baker, Joshua; Weinberg, Ido; Donaldson, Cameron; Narayan, Rajeev; Rassi, Andrew N; Kabrhel, Christopher

    2014-02-01

    New and innovative tools have emerged for the treatment of massive and submassive pulmonary embolism (PE). These novel treatments, when considered alongside existing therapy, such as anticoagulation, systemic intravenous thrombolysis, and open surgical pulmonary embolectomy, have the potential to improve patient outcomes. However, data comparing different treatment modalities are sparse, and guidelines provide only general advice for their use. Treatment decisions rest on clinician expertise and institutional resources. Because various medical and surgical specialties offer different perspectives and expertise, a multidisciplinary approach to patients with massive and submassive PE is required. To address this need, we created a novel multidisciplinary program - the Massachusetts General Hospital (MGH) Pulmonary Embolism Response Team (PERT) - which brings together multiple specialists to rapidly evaluate intermediate- and high-risk patients with PE, formulate a treatment plan, and mobilize the necessary resources to provide the highest level of care. Development of a clinical, educational, and research infrastructure, as well as the creation of a national PERT consortium, will make our experience available to other institutions and serve as a platform for future studies to improve the care of complex patients with massive and submassive PE.

  17. Qualitative indices and enhancement rate of CT pulmonary angiography in patients with suspected pulmonary embolism: Comparison between test bolus and bolus-tracking methods

    Directory of Open Access Journals (Sweden)

    Maryam Moradi

    2016-01-01

    Full Text Available Background: The aim of the present study was to assess the qualitative indices and enhancement rate of computed tomographic pulmonary angiography (CTPA in patients with suspected pulmonary embolism using Test bolus and Bolus-tracking techniques. Materials and Methods: Fifty-two patients with suspected pulmonary embolism that passed informed consent were randomly divided in the two groups. In each group, demographic characteristics, qualitative indices, and enhancement rate of CTPA were recorded. Results: The diagnostic result obtained in majority of the participants in the two groups (88.5 % in Test bolus group vs. 73.1% in the Bolus tracking group. In the case of quantitative variables, no statistically significant differences were found between the groups (P > 0.05. The only statistically significant difference between the two groups is average of "X-ray dose". Conclusion: The results of our study show that there is no statistically significant difference between the Bolus Tracking and Test Bolus techniques for producing more homogeneous enhancement.

  18. Quantitative evaluation of MR perfusion imaging using blood pool contrast agent in subjects without pulmonary diseases and in patients with pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Hansch, Andreas; Hinneburg, Uta [University Hospital Jena, Institute of Diagnostic and Interventional Radiology II, Jena (Germany); University Hospital Jena, Institute of Diagnostic and Interventional Radiology II, Gera (Germany); Kohlmann, Peter; Laue, Hendrik [Fraunhofer MEVIS - Institute for Medical Image Computing, Bremen (Germany); Boettcher, Joachim [SRH Klinikum Gera, Institute of Diagnostic and Interventional Radiology, Gera (Germany); Malich, Ansgar [Suedharzkrankenhaus Nordhausen, Institute of Diagnostic and Interventional Radiology, Nordhausen (Germany); Wolf, Gunter [University Hospital Jena, Department of Internal Medicine III, Jena (Germany); Pfeil, Alexander [University Hospital Jena, Institute of Diagnostic and Interventional Radiology II, Jena (Germany); University Hospital Jena, Institute of Diagnostic and Interventional Radiology II, Gera (Germany); University Hospital Jena, Department of Internal Medicine III, Jena (Germany)

    2012-08-15

    To assess the feasibility of time-resolved parallel three-dimensional magnetic resonance imaging (MRI) for quantitative analysis of pulmonary perfusion using a blood pool contrast agent. Quantitative perfusion analysis was performed using novel software to assess pulmonary blood flow (PBF), pulmonary blood volume (PBV) and mean transit time (MTT) in a quantitative manner. The evaluation of lung perfusion in the normal subjects showed an increase of PBF, PBV ventrally to dorsally (gravitational direction), and the highest values at the upper lobe, with a decrease to the middle and lower lobe (isogravitational direction). MTT showed no relevant changes in either the gravitational or isogravitational directions. In comparison with normally perfused lung areas (in diseased patients), the pulmonary embolism (PE) regions showed a significantly lower mean PBF (20 {+-} 0.6 ml/100 ml/min, normal region 94 {+-} 1 ml/100 ml/min; P < 0.001), mean PBV (2 {+-} 0.1 ml/100 ml, normal region 9.8 {+-} 0.1 ml/100 ml; P < 0.001) and mean MTT (3.8 {+-} 0.1 s; normal region 6.3 {+-} 0.1; P < 0.001). Our results demonstrate the feasibility of using time-resolved dynamic contrast-enhanced MRI to determine normal range and regional variation of pulmonary perfusion and perfusion deficits in patients with PE. (orig.)

  19. Pulmonary embolization as primary manifestation of hepatocellular carcinoma with intracardiac penetration: A case report

    Institute of Scientific and Technical Information of China (English)

    Elod Papp; Zsuzsanna Keszthelyi; Nagy Karoly Kalmar; Lajos Papp; Csaba Weninger; Tamas Tornoczky; Endre Kalman; Kalman Toth; Tamas Habon

    2005-01-01

    Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously.In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (ⅣC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the ⅣC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in MC or right atrium and tumor-embolization.

  20. Aortic and tricuspid endocarditis in hemodialysis patient with systemic and pulmonary embolism.

    Science.gov (United States)

    Rosa, Silvia Aguiar; Germano, Nuno; Santos, Ana; Bento, Luis

    2015-01-01

    This is a case report of a 43-year-old Caucasian male with end-stage renal disease being treated with hemodialysis and infective endocarditis in the aortic and tricuspid valves. The clinical presentation was dominated by neurologic impairment with cerebral embolism and hemorrhagic components. A thoracoabdominal computerized tomography scan revealed septic pulmonary embolus. The patient underwent empirical antibiotherapy with ceftriaxone, gentamicin and vancomycin, and the therapy was changed to flucloxacilin and gentamicin after the isolation of S. aureus in blood cultures. The multidisciplinary team determined that the patient should undergo valve replacement after the stabilization of the intracranial hemorrhage; however, on the 8th day of hospitalization, the patient entered cardiac arrest due to a massive septic pulmonary embolism and died. Despite the risk of aggravation of the hemorrhagic cerebral lesion, early surgical intervention should be considered in high-risk patients.

  1. [Hydatic pulmonary embolism complicating a cardiac hydatic cyst. A case report].

    Science.gov (United States)

    Kammoun, Ikram; Ben Halima, Afef; Ammar, Jamel; Chine, Samira; Chaabane, Olfa; Zouaoui, Walid; Rebeh, Balsam; Keskes, Hend; Gargouri, Sami; Lefi, Abdellatif; Hamzaoui, Agnès; Kachboura, Salem

    2004-08-01

    Hydatic pulmonary embolism: complication of a cardiac hydatic cyst:a case report hydatic cardiac cyst is a rare condition and represents only 0.5 to 2% of all visceral localisations of the hydatid disease. We reported a 28 year old patient with a multiple hydatic pulmonary embolism caused by the rupture of a hydatic cyst of the interventricular septum. The diagnosis was established by transthoracic echocardiography and CT Scan. Surgery was performed without delay and the outcome was good after a five month follow-up. This case illustrates the diagnostic value of the non invasive imaging means in hydatic cyst of the heart and underlines the importance of surgery realized before complications occur.

  2. CT angiography of pulmonary embolism using a 64 slice multi-detector scanner

    Institute of Scientific and Technical Information of China (English)

    QIN Nai-shan; JIANG Xue-xiang; QIU Jian-xing; ZHU Ying; WANG Ji-chen

    2009-01-01

    Background Multi-detector computed tomography (MDCT) has already been the first line investigation method for diagnosis of pulmonary embolism (PE). Reducing the amount of contrast medium used during CT scanning could decrease the incidental rate of adverse reactions. Our study amied to evaluate the image quality of pulmonary arteries using 64 slice multi-detector CT with small volumes of contrast media injection.Methods Forty nonconsecutive patients without PE or other lung diseases were randomly assigned to two groups.Group A underwent CT scanning with 16×1.25 mm collimation and a 70 ml contrast injection, while group B had CT with 64×0.625 mm collimation and 20 ml of contrast injection. Two readers independently depicted the segmental and subsegmental pulmonary arteries. Reasons we could not analyze the pulmonary artery or that led to misdiagnosis of pulmonary embolism were evaluated, including the degree of contrast enhancement of the main pulmonary artery, and factors that caused misdiagnosis of PE (flow-related artifacts, partial volume artifact, beam-hardening artifacts and enhancement of pulmonary vein). The independent samples t-test, Mann-Whitney U test and Pearson chi-square test were applied.Results There were no significant differences in image quality of segmental and subsegmental arteries between the two groups. No significant difference was found for factors that made pulmonary arteries non-analyzable or in the misdiagnosis of PE, except the degree of contrast enhancement.Conclusion 64×0.625 mm collimation with 20 ml contrast injection could depict the pulmonary arteries well.

  3. Non-traumatic thoracic emergencies: CT venography in an integrated diagnostic strategy of acute pulmonary embolism and venous thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Ghaye, Benoit; Dondelinger, Robert F. [Department of Medical Imaging, University Hospital Sart Tilman, Domaine Universitaire du Sart Tilman B35, 4000 Liege (Belgium)

    2002-08-01

    Deep venous thrombosis and pulmonary embolism are the two aspects of venous thrombo-embolism. Investigation of lower limb veins has been part of various diagnostic algorithms in the past 15 years. Recently, the combination of CT venography (CTV) of lower limbs and abdominal veins together with CT angiography of the pulmonary arteries has allowed a complete examination of venous thrombo-embolism in one session. The technical aspects, imaging findings, venous anatomy on CT, interpretative pitfalls, results and advantages of CT venography are reviewed. (orig.)

  4. Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature.

    Science.gov (United States)

    Ende-Verhaar, Yvonne M; Cannegieter, Suzanne C; Vonk Noordegraaf, Anton; Delcroix, Marion; Pruszczyk, Piotr; Mairuhu, Albert T A; Huisman, Menno V; Klok, Frederikus A

    2017-02-01

    The incidence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is relevant for management decisions but is currently unknown.We performed a meta-analysis of studies including consecutive PE patients followed for CTEPH. Study cohorts were predefined as "all comers", "survivors" or "survivors without major comorbidities". CTEPH incidences were calculated using random effects models.We selected 16 studies totalling 4047 PE patients who were mostly followed up for >2-years. In 1186 all comers (two studies), the pooled CTEPH incidence was 0.56% (95% CI 0.1-1.0). In 999 survivors (four studies) CTEPH incidence was 3.2% (95% CI 2.0-4.4). In 1775 survivors without major comorbidities (nine studies), CTEPH incidence was 2.8% (95% CI 1.5-4.1). Both recurrent venous thromboembolism and unprovoked PE were significantly associated with a higher risk of CTEPH, with odds ratios of 3.2 (95% CI 1.7-5.9) and 4.1 (95% CI 2.1-8.2) respectively. The pooled CTEPH incidence in 12 studies that did not use right heart catheterisation as the diagnostic standard was 6.3% (95% CI 4.1-8.4).The 0.56% incidence in the all-comer group probably provides the best reflection of the incidence of CTEPH after PE on the population level. The ∼3% incidences in the survivor categories may be more relevant for daily clinical practice. Studies that assessed CTEPH diagnosis by tests other than right heart catheterisation provide overestimated CTEPH incidences.

  5. A patient with pulmonary embolism and patent foramen ovale. The value of transcranial doppler

    Directory of Open Access Journals (Sweden)

    Maria Stougianni

    2013-06-01

    Full Text Available SUMMARY: The case is presented of a 46 year-old male, obese and a heavy smoker, who presented with acute dyspnea a few hours after elective arthroscopy of his left knee. He was admitted to the intensive care unit (ICU because of severe hypoxaemia, and was started on anticoagulant therapy because of intermediate risk of pulmonary embolism. In view of the refractory hypoxaemia that worsened during intense Valsalva manoeuvre, the suspicion of an intracardiac (interatrial right-to-left shunt was raised, most probably a patent foramen ovale (PFO or atrial septal defect (ASD. In view of the severe hypoxaemia and the anticoagulant therapy, initial assessment with transcranial Doppler (TCD examination with bubble test study was deemed preferable and this confirmed a shunt. Subsequent transoesophageal echocardiography (TEE bubble test assessment demonstrated the presence of a PFO. Recent recommendations favour TCD as the method of choice for detecting PFO because it is non-invasive, cheaper, faster to perform and comparable with TEE in terms of sensitivity and specificity. The introduction of portable ultrasound devices into the everyday hospital routine renders the application of TCD easier for clinicians of various specialties.

  6. Elevated Fibrinogen Levels Associate with Risk of Pulmonary Embolism, but not with Deep Venous Thrombosis

    DEFF Research Database (Denmark)

    Klovaite, Jolanta; Nordestgaard, Børge G; Tybjærg-Hansen, Anne;

    2013-01-01

    RATIONALE: It is unclear whether elevated plasma fibrinogen associates with both deep venous thrombosis(DVT) and its complication pulmonary embolism(PE), and whether elevated fibrinogen is a direct cause of these disorders. OBJECTIVES: We tested the hypotheses that elevated plasma fibrinogen...... relationship using a Mendelian randomization approach, we genotyped for FGB(rs1800790; rs4220) encoding fibrinogen beta chain. MEASUREMENTS AND MAIN RESULTS: Increasing plasma fibrinogen quintiles associated with increased risk of PE in combination with DVT(P-trend...

  7. A rare case of tricuspid valve thrombus with acute pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    GUO Chun-yan; TENG Ying-xing; YANG Chuan-rui; SHEN Lu-hua; GU Fu-sheng; LI Hong-wei

    2011-01-01

    The development of thrombus on the tricuspid valve is very rare.This report describes a case of acute pulmonary embolism (PE) with a mass on the tricuspid valve in a normal heart,detected by bedside transthoracic echocardiography (TTE).After successful surgical management,the histopathological examination revealed the mass from the tricuspid valve to be mixed thrombus.The early use of bedside TrE can facilitate the prompt diagnosis and aggressive therapy when PE is suspected.

  8. Pulmonary Embolism following Endovenous Laser Ablation (EVLA of the Great Saphenous Vein

    Directory of Open Access Journals (Sweden)

    Nnamdi Nwaejike

    2008-08-01

    Full Text Available

    A 70yr old lady presented to accident and emergency with sudden onset pleuritic chest pain. A pulmonary embolus (PE was diagnosed by CTPA. Ten days earlier she had bilateral EVLA for recurrent long saphenous vein disease. Confounding risk factors for pulmonary embolism included bilateral ligation and stripping of the long saphenous vein a year earlier, malignancy, EVLA and phlebitic tributary varices. EVLA has been shown to be an effective treatment for superficial venous insufficiency with low morbidity and high patient satisfaction. The investigation of confounding risk factors and possible causes should not compromise the initial treatment of PE.

  9. Recurrent acute pulmonary embolism and paroxysmal atrial fibrillation associated with subclinical hyperthyroidism.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Currò, Alessio; Cimino, Claudia

    2010-07-09

    Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease or mortality from cardiovascular causes but it is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. It has also been reported that increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. Elevated D-dimer levels have been reported in acute pulmonary embolism and it has also been reported that right ventricular overload and hypoxia in acute pulmonary embolism may lead to right ventricular myocardium injury reflected by elevated cardiac troponin levels too. We present a case of recurrent pulmonary embolism associated with subclinical hyperthyroidism, in an 81-year-old Italian woman. Also this case focuses attention on the importance of a correct evaluation of subclinical hyperthyroidism.

  10. Free Floating Right Heart Thrombus Associated with Acute Pulmonary Embolism: An Unsettled Therapeutic Difficulty

    Directory of Open Access Journals (Sweden)

    Clovis Nkoke

    2015-01-01

    Full Text Available Free floating right heart thrombus is a rare phenomenon in the context of acute pulmonary embolism and it is associated with a poor outcome. The increased use of echocardiography has led to an increased detection of right heart thrombi. However, optimal management of free floating right heart thrombus remains controversial with no clear consensus. We present the case of a 74-year-old woman who presented to the emergency department with acute onset dyspnea on minimal exertion which had developed over a period of 1 day. A computed tomography of the chest demonstrated massive bilateral proximal pulmonary embolism. A bedside transthoracic echocardiography performed showed a moderately dilated, poorly functioning right ventricle with visible highly mobile serpiginous thrombus moving to and fro across the tricuspid valve. Thrombolytic therapy was immediately initiated with tenecteplase which resulted in excellent results. Although there is no clear consensus for the management of right heart thrombus associated with pulmonary embolism, thrombolysis is readily available and can be effective in carefully selected patients.

  11. A Possible Association of Diindolylmethane with Pulmonary Embolism and Deep Venous Thrombosis

    Science.gov (United States)

    Moualla, Maan

    2016-01-01

    Introduction. 3,3′-Diindolylmethane is available as a supplement in the United States for “cancer prevention” and “augmentation of physical fitness.” A derivative of indole-3-carbinol found in plants, diindolylmethane, binds to receptors associated with the sex steroid pathways and has unclear effects on estrogen and androgen physiology. We present a patient who had been taking diindolylmethane and developed right lower extremity deep venous thrombosis and bilateral pulmonary embolism. Case Presentation. A 65-year-old man presented with swelling, erythema, and warmth of his right lower extremity for three to four weeks. He had been taking diindolylmethane one tablet daily for three to four months. Risk factors for venous thromboembolism included tobacco use, personal history of possible pulmonary embolism, body mass index, and age. Imaging studies found extensive deep venous thrombosis in his right lower extremity and bilateral pulmonary embolism with probable right middle lobe infarction. Follow-up imaging showed chronic deep venous thrombosis in his right lower extremity. Discussion. As suggested in this single case, patients who take diindolylmethane may be at greater risk for venous thromboembolism. Further reports and studies are necessary in order to elucidate this possible association. Clinicians should question patients about supplements in the setting of venous thromboembolism. PMID:28050169

  12. Free Floating Right Heart Thrombus Associated with Acute Pulmonary Embolism: An Unsettled Therapeutic Difficulty

    Science.gov (United States)

    Nkoke, Clovis; Faucher, Olivier; Camus, Lise; Flork, Laurence

    2015-01-01

    Free floating right heart thrombus is a rare phenomenon in the context of acute pulmonary embolism and it is associated with a poor outcome. The increased use of echocardiography has led to an increased detection of right heart thrombi. However, optimal management of free floating right heart thrombus remains controversial with no clear consensus. We present the case of a 74-year-old woman who presented to the emergency department with acute onset dyspnea on minimal exertion which had developed over a period of 1 day. A computed tomography of the chest demonstrated massive bilateral proximal pulmonary embolism. A bedside transthoracic echocardiography performed showed a moderately dilated, poorly functioning right ventricle with visible highly mobile serpiginous thrombus moving to and fro across the tricuspid valve. Thrombolytic therapy was immediately initiated with tenecteplase which resulted in excellent results. Although there is no clear consensus for the management of right heart thrombus associated with pulmonary embolism, thrombolysis is readily available and can be effective in carefully selected patients. PMID:26078887

  13. A Possible Association of Diindolylmethane with Pulmonary Embolism and Deep Venous Thrombosis

    Directory of Open Access Journals (Sweden)

    Peter V. Bui

    2016-01-01

    Full Text Available Introduction. 3,3′-Diindolylmethane is available as a supplement in the United States for “cancer prevention” and “augmentation of physical fitness.” A derivative of indole-3-carbinol found in plants, diindolylmethane, binds to receptors associated with the sex steroid pathways and has unclear effects on estrogen and androgen physiology. We present a patient who had been taking diindolylmethane and developed right lower extremity deep venous thrombosis and bilateral pulmonary embolism. Case Presentation. A 65-year-old man presented with swelling, erythema, and warmth of his right lower extremity for three to four weeks. He had been taking diindolylmethane one tablet daily for three to four months. Risk factors for venous thromboembolism included tobacco use, personal history of possible pulmonary embolism, body mass index, and age. Imaging studies found extensive deep venous thrombosis in his right lower extremity and bilateral pulmonary embolism with probable right middle lobe infarction. Follow-up imaging showed chronic deep venous thrombosis in his right lower extremity. Discussion. As suggested in this single case, patients who take diindolylmethane may be at greater risk for venous thromboembolism. Further reports and studies are necessary in order to elucidate this possible association. Clinicians should question patients about supplements in the setting of venous thromboembolism.

  14. Percutaneous Retrieval of an Embolized Kyphoplasty Cement Fragment From the Pulmonary Artery: A Case Report and Literature Review

    Science.gov (United States)

    Lamparello, Nicole A.; Jaswani, Vijay; DeSousa, Keith; Shapiro, Maksim; Kovacs, Sandor

    2016-01-01

    We present a case of a 41-year-old man with symptomatic pulmonary cement embolism following percutaneous vertebral augmentation, which was successfully retrieved via a percutaneous endovascular approach, a novel technique with only two prior cases reported. Cement leakage, including venous embolization of cement into the cardiopulmonary circulation, is a known potential complication following percutaneous kyphoplasty and vertebroplasty. While many patients with pulmonary cement embolism are asymptomatic and likely go undiagnosed, others experience respiratory distress and hemodynamic compromise requiring surgical and medical intervention. The optimal management for pulmonary cement embolism must be tailored to fit each individual patient, dependent upon the acuity of the clinical presentation, coexisting patient comorbidities, and the risks of systemic anticoagulation. In our patient, cement migration was visualized in real-time during vertebral augmentation. Endovascular retrieval by our Interventional Radiology section obviated the need for anticoagulation therapy or more invasive open surgical procedures. PMID:27761188

  15. Risk-Adapted Management of Acute Pulmonary Embolism: Recent Evidence, New Guidelines

    Directory of Open Access Journals (Sweden)

    Anja Käberich

    2014-10-01

    Full Text Available Venous thromboembolism (VTE, the third most frequent acute cardiovascular syndrome, may cause life-threatening complications and imposes a substantial socio-economic burden. During the past years, several landmark trials paved the way towards novel strategies in acute and long-term management of patients with acute pulmonary embolism (PE. Risk stratification is increasingly recognized as a cornerstone for an adequate diagnostic and therapeutic management of the highly heterogeneous population of patients with acute PE. Recently published European Guidelines emphasize the importance of clinical prediction rules in combination with imaging procedures (assessment of right ventricular function and laboratory biomarkers (indicative of myocardial stress or injury for identification of normotensive PE patients at intermediate risk for an adverse short-term outcome. In this patient group, systemic full-dose thrombolysis was associated with a significantly increased risk of intracranial bleeding, a complication which discourages its clinical application unless hemodynamic decompensation occurs. A large-scale clinical trial program evaluating new oral anticoagulants in the initial and long-term treatment of venous thromboembolism showed at least comparable efficacy and presumably increased safety of these drugs compared to the current standard treatment. Research is continuing on catheter-directed, ultrasound-assisted, local, low-dose thrombolysis in the management of intermediate-risk PE.

  16. Weight-based contrast administration in the computerized tomography evaluation of acute pulmonary embolism

    Science.gov (United States)

    Laurent, Lisa; Zamfirova, Ina; Sulo, Suela; Baral, Pesach

    2017-01-01

    Abstract Compare individualized contrast protocol, or weight-based protocol, to standard methodology in evaluating acute pulmonary embolism. Retrospective chart review was performed on patients undergoing computed tomography angiography with standard contrast protocol (n = 50) or individualized protocol (n = 50). Computerized tomography images were assessed for vascular enhancement and image quality. Demographics were comparable, however, more patients in the individualized group were admitted to intensive care unit (48% vs 16%, P = 0.004). Vascular enhancement and image quality were also comparable, although individualized protocol had significantly fewer contrast and motion artifact limitations (28% vs 48%, P = 0.039). Fifteen percent decrease in intravenous contrast volume was identified in individualized group with no compromise in image quality. Individualized contrast protocol provided comparable vascular enhancement and image quality to the standard, yet with fewer limitations and lower intravenous contrast volume. Catheter-gauge flow rate restrictions resulting in inconsistent technologist exam execution were identified, supporting the need for further investigation of this regimen. PMID:28151887

  17. Variable Resistance to Plasminogen Activator Initiated Fibrinolysis for Intermediate-Risk Pulmonary Embolism

    Science.gov (United States)

    Stubblefield, William B.; Alves, Nathan J.; Rondina, Matthew T.; Kline, Jeffrey A.

    2016-01-01

    Background We examine the clinical significance and biomarkers of tissue plasminogen activator (tPA)-catalyzed clot lysis time (CLT) in patients with intermediate-risk pulmonary embolism (PE). Methods Platelet-poor, citrated plasma was obtained from patients with PE. Healthy age- and sex-matched patients served as disease-negative controls. Fibrinogen, α2-antiplasmin, plasminogen, thrombin activatable fibrinolysis inhibitor (TAFI), plasminogen activator Inhibitor 1 (PAI-1), thrombin time and D-dimer were quantified. Clotting was induced using CaCl2, tissue factor, and phospholipid. Lysis was induced using 60 ng/mL tPA. Time to 50% clot lysis (CLT) was assessed by both thromboelastography (TEG) and turbidimetry (A405). Results Compared with disease-negative controls, patients with PE exhibited significantly longer mean CLT on TEG (+2,580 seconds, 95% CI 1,380 to 3,720 sec). Patients with PE and a short CLT who were treated with tenecteplase had increased risk of bleeding, whereas those with long CLT had significantly worse exercise tolerance and psychometric testing for quality of life at 3 months. A multivariate stepwise removal regression model selected PAI-1 and TAFI as predictive biomarkers of CLT. Conclusion The CLT from TEG predicted increased risk of bleeding and clinical failure with tenecteplase treatment for intermediate-risk PE. Plasmatic PAI-1 and TAFI were independent predictors of CLT. PMID:26866684

  18. Variable Resistance to Plasminogen Activator Initiated Fibrinolysis for Intermediate-Risk Pulmonary Embolism.

    Directory of Open Access Journals (Sweden)

    William B Stubblefield

    Full Text Available We examine the clinical significance and biomarkers of tissue plasminogen activator (tPA-catalyzed clot lysis time (CLT in patients with intermediate-risk pulmonary embolism (PE.Platelet-poor, citrated plasma was obtained from patients with PE. Healthy age- and sex-matched patients served as disease-negative controls. Fibrinogen, α2-antiplasmin, plasminogen, thrombin activatable fibrinolysis inhibitor (TAFI, plasminogen activator Inhibitor 1 (PAI-1, thrombin time and D-dimer were quantified. Clotting was induced using CaCl2, tissue factor, and phospholipid. Lysis was induced using 60 ng/mL tPA. Time to 50% clot lysis (CLT was assessed by both thromboelastography (TEG and turbidimetry (A405.Compared with disease-negative controls, patients with PE exhibited significantly longer mean CLT on TEG (+2,580 seconds, 95% CI 1,380 to 3,720 sec. Patients with PE and a short CLT who were treated with tenecteplase had increased risk of bleeding, whereas those with long CLT had significantly worse exercise tolerance and psychometric testing for quality of life at 3 months. A multivariate stepwise removal regression model selected PAI-1 and TAFI as predictive biomarkers of CLT.The CLT from TEG predicted increased risk of bleeding and clinical failure with tenecteplase treatment for intermediate-risk PE. Plasmatic PAI-1 and TAFI were independent predictors of CLT.

  19. Successful thrombolysis of major pulmonary embolism 5 days after lobectomy

    DEFF Research Database (Denmark)

    Eckardt, Jens; Licht, Peter B

    2012-01-01

    Aggressive intravenous thrombolysis of pulmonary emboli after major thoracic surgery has rarely been reported and is controversial because of an assumed risk of fatal bleeding. We report a 62-year old female who underwent left upper lobectomy. Her postoperative course was complicated...

  20. Safety of ventilation/perfusion single photon emission computed tomography for pulmonary embolism diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Le Roux, Pierre-Yves; Palard, Xavier; Robin, Philippe; Abgral, Ronan; Querellou, Solene; Salaun, Pierre-Yves [Universite Europeenne de Bretagne, Brest (France); Universite de Brest, Brest (France); CHRU de la Cavale Blanche, Service de medecine nucleaire, Brest (France); Delluc, Aurelien; Couturaud, Francis [Universite Europeenne de Bretagne, Brest (France); Universite de Brest, Brest (France); CHRU de la Cavale Blanche, Departement de medecine interne et de pneumologie, Brest (France); Le Gal, Gregoire [Universite Europeenne de Bretagne, Brest (France); University of Ottawa, Ottawa Hospital Research Institute, Ottawa (Canada); CHRU de la Cavale Blanche, Departement de medecine interne et de pneumologie, Brest (France); Universite de Brest, Brest (France)

    2014-10-15

    The aim of this management outcome study was to assess the safety of ventilation/perfusion single photon emission computed tomography (V/Q SPECT) for the diagnosis of pulmonary embolism (PE) using for interpretation the criteria proposed in the European Association of Nuclear Medicine (EANM) guidelines for V/Q scintigraphy. A total of 393 patients with clinically suspected PE referred to the Nuclear Medicine Department of Brest University Hospital from April 2011 to March 2013, with either a high clinical probability or a low or intermediate clinical probability but positive D-dimer, were retrospectively analysed. V/Q SPECT were interpreted by the attending nuclear medicine physician using a diagnostic cut-off of one segmental or two subsegmental mismatches. The final diagnostic conclusion was established by the physician responsible for patient care, based on clinical symptoms, laboratory test, V/Q SPECT and other imaging procedures performed. Patients in whom PE was deemed absent were not treated with anticoagulants and were followed up for 3 months. Of the 393 patients, the prevalence of PE was 28 %. V/Q SPECT was positive for PE in 110 patients (28 %) and negative in 283 patients (72 %). Of the 110 patients with a positive V/Q SPECT, 78 (71 %) had at least one additional imaging test (computed tomography pulmonary angiography or ultrasound) and the diagnosis of PE was eventually excluded in one patient. Of the 283 patients with a negative V/Q SPECT, 74 (26 %) patients had another test. The diagnosis of PE was finally retained in one patient and excluded in 282 patients. The 3-month thromboembolic risk in the patients not treated with anticoagulants was 1/262: 0.38 % (95 % confidence interval 0.07-2.13). A diagnostic management including V/Q SPECT interpreted with a diagnostic cut-off of ''one segmental or two subsegmental mismatches'' appears safe to exclude PE. (orig.)

  1. Pulmonary embolus

    Science.gov (United States)

    ... Blood clot - lung; Embolus; Tumor embolus; Embolism - pulmonary; DVT-pulmonary embolism; Thrombosis - pulmonary embolism ... area). This type of clot is called a deep vein thrombosis (DVT) . The blood clot breaks off and travels ...

  2. [Nursing care of pulmonary embolism in out-of-hospital emergencies].

    Science.gov (United States)

    Carrión-Martínez, Aurora; Rivera-Caravaca, José Miguel

    2016-01-01

    Pulmonary embolism is one of the most severe venous thromboembolic diseases, both in mortality and the high number of associated complications and their impact on quality of life. The early hours are critical and proper management during this period can determine future sequels. Therefore, in the outpatient setting, nurses must have adequate knowledge and tools to act quickly and efficiently. In this paper, we present a case of a 77 year-old male in his home that after being discharged from a knee replacement surgery starts with symptoms compatible with pulmonary thromboembolism. A Nursing Care Process is performed, according to the functional patterns of Margory Gordon and a care plan is developed based on NNN taxonomy (NANDA, NOC, NIC). As main nursing diagnosis 'ineffective breathing pattern' is selected and as possible potential complication of the pulmonary embolism the 'pulmonary infarction' is chosen. The results obtained after conducting the care plan are satisfactory, improving the signs and symptoms presented by the patient, hence why we believe it is useful for nurses when facing similar clinical situations.

  3. Cerebral embolism through hematogenous dissemination of pulmonary mucormycosis complicating relapsed leukemia.

    Science.gov (United States)

    Higo, Takashi; Kobayashi, Takashi; Yamazaki, Sho; Ando, Sumiyo; Gonoi, Wataru; Ishida, Masanori; Okuma, Hidemi; Nakamura, Fumihiko; Ushiku, Tetsuo; Ohtomo, Kuni; Fukayama, Masashi; Kurokawa, Mineo

    2015-01-01

    Invasive mucormycosis in patients with hematological diseases mostly occurs in the lungs. Invasive mucormycosis of other anatomical sites is relatively infrequent and its pathogenesis has not so far been well elucidated. Here, we describe an autopsy case of pulmonary invasive mucormycosis complicated by cerebral embolism with infarct. A 77-year-old Japanese woman with relapsed acute myeloid leukemia complained of left visual disturbance and weakness of the lower limbs. The diagnosis of leukemic infiltration to the central nervous system was made. Repeated intrathecal injection of methotrexate plus cytarabine resulted in partial amelioration of the neurologic symptoms. However, the patient then developed fever, dyspnea, and subsequent right hemiparesis. A computed tomography (CT) scan showed a consolidative shadow with halo sign in the left lung field, which was compatible with either invasive pulmonary aspergillosis or mucormycosis. These findings accounted for fever and dyspnea, but not hemiparesis. Despite antifungal therapy, the patient succumbed to death after two weeks. Autopsy revealed pulmonary invasive mucormycosis with a fungal ball in the lumina of the adjacent ascending aorta. Intriguingly, autopsy and postmortem CT scan identified left cerebral infarct due to mucormycosis, which accounted for the right hemiparesis. It is likely that the fungal ball caused the cerebral embolism through hematogenous dissemination. We should suspect hematogenous dissemination when we see a patient with pulmonary invasive mucormycosis developing neurologic symptoms.

  4. Reducing radiation dose in the diagnosis of pulmonary embolism using adaptive statistical iterative reconstruction and lower tube potential in computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kaul, David [Campus Virchow-Klinikum, Department of Radiation Oncology, Charite School of Medicine and University Hospital, Berlin (Germany); Charite School of Medicine and University Hospital, Department of Radiology, Berlin (Germany); Grupp, Ulrich; Kahn, Johannes; Wiener, Edzard; Hamm, Bernd; Streitparth, Florian [Charite School of Medicine and University Hospital, Department of Radiology, Berlin (Germany); Ghadjar, Pirus [Campus Virchow-Klinikum, Department of Radiation Oncology, Charite School of Medicine and University Hospital, Berlin (Germany)

    2014-11-15

    To assess the impact of ASIR (adaptive statistical iterative reconstruction) and lower tube potential on dose reduction and image quality in chest computed tomography angiographies (CTAs) of patients with pulmonary embolism. CT data from 44 patients with pulmonary embolism were acquired using different protocols - Group A: 120 kV, filtered back projection, n = 12; Group B: 120 kV, 40 % ASIR, n = 12; Group C: 100 kV, 40 % ASIR, n = 12 and Group D: 80 kV, 40 % ASIR, n = 8. Normalised effective dose was calculated; image quality was assessed quantitatively and qualitatively. Normalised effective dose in Group B was 33.8 % lower than in Group A (p = 0.014) and 54.4 % lower in Group C than in Group A (p < 0.001). Group A, B and C did not show significant differences in qualitative or quantitative analysis of image quality. Group D showed significantly higher noise levels in qualitative and quantitative analysis, significantly more artefacts and decreased overall diagnosability. Best results, considering dose reduction and image quality, were achieved in Group C. The combination of ASIR and lower tube potential is an option to reduce radiation without significant worsening of image quality in the diagnosis of pulmonary embolism. (orig.)

  5. A Cerebral Air Embolism That Developed Following Defecation in a Patient with Extensive Pulmonary Tuberculosis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Ji Young; Park, Dong Woo; Hahm, Chang Kok; Park, Choong Ki; Lee, Seung Ro; Lee, Young Jun [Hanyang University College of Medicine, Guri Hospital, Guri (Korea, Republic of)

    2010-08-15

    Cerebral air embolisms generally result from invasive procedures such as a percutaneous needle biopsy, chest tube insertion, central venous catheter access or removal, operations and so on. Likewise, they are mostly iatrogenically induced and present various degrees of severity depending on the number of air bubbles. With the exception of divers, the occurrence of a cerebral air embolism in the absence of invasive procedures is very rare. We report a case of a cerebral air embolism that developed following defecation and was detected by CT in a patient with extensive pulmonary tuberculosis

  6. Severity of acute pulmonary embolism: evaluation of a new spiral CT angiographic score in correlation with echocardiographic data

    Energy Technology Data Exchange (ETDEWEB)

    Mastora, Ioana; Remy-Jardin, Martine; Masson, Pascal; Remy, Jacques [Department of Radiology, University Center Hospital Calmette, Boulevard Jules Leclerc, 59037 Lille Cedex (France); Medical Research Group ' ' Equipe d' Accueil no. 2682' ' , Boulevard Jules Leclerc, 59037 Lille Cedex (France); Galland, Eric; Bauchart, Jean-Jacques [Department of Cardiology, University Center Cardiology Hospital; Boulevard Jules Leclerc, 59037 Lille Cedex (France); Delannoy, Valerie [Department of Medical Statistics, University of Lille, Place de Verdun, 59037 Lille Cedex (France)

    2003-01-01

    The purpose of this study was to investigate whether the severity of acute pulmonary embolism (PE) could be quantitatively assessed with spiral CT angiography (SCTA). Thirty-six consecutive patients without underlying cardiopulmonary disease and high clinical suspicion of PE underwent prospectively thin-collimation SCTA and echocardiography at the time of the initial diagnosis (T0) and after initial therapy (T1; mean interval of time T1-T2: 32 days). The CT severity score was based on the percentage of obstructed surface of each central and peripheral pulmonary arterial section using a 5-point scale (1: <25%; 2: 25-49%; 3: 50-74%; 4: 75-99%; 5: 100%). The sum of the detailed scores attributed to 5 mediastinal, 6 lobar and 20 segmental arteries per patient led to the determination of central, peripheral and global CT severity scores and subsequent determination of percentages of obstruction of the pulmonary circulation. Echocardiographic severity criteria included the presence of signs of acute cor pulmonale and/or systolic pulmonary hypertension (>40 mm Hg). The SCTA depicted acute PE in all patients at T0 with complete resolution of endovascular clots in 10 patients at T1. At T0, the mean percentage of obstruction of the pulmonary arterial bed was significantly higher in the 22 patients with echocardiographic signs of severity (56{+-}13 vs 28{+-}32%; p<0.001). A significant reduction in the mean percentage of pulmonary artery obstruction was observed in the 19 patients with resolution of echocardiographic criteria of severity between T0 and T1 T0: 57{+-}14%; T1: 7{+-}11%; p<0.001. The threshold value for severe PE on CT angiograms was 49% (sensitivity: 0.773; specificity: 0.214). The mean ({+-}SD) pulmonary artery pressure was significantly higher in the 26 patients with more than 50% obstruction of the pulmonary artery bed (45{+-}15 mm Hg) than in the 10 patients with less than 50% obstruction of pulmonary artery bed at T0 (31{+-}11 mm Hg; p<0.01). The CT

  7. Non-ECG-gated CT pulmonary angiography and the prediction of right ventricular dysfunction in patients suspected of pulmonary embolism

    DEFF Research Database (Denmark)

    Gutte, Henrik; Mortensen, Jann; Mørk, Mette Louise;

    2016-01-01

    PURPOSE: Right ventricular dysfunction (RVD) is an important prognostic factor of 30-day mortality in patients with acute pulmonary embolism (PE). The aim of our study was to evaluate whether non-electrocardiogram (ECG)-gated cardiovascular parameters attained during computed tomography pulmonary...... angiography (CTPA) could predict RVD in patients suspected of PE using ECG-gated cardiac CT angiography as reference. METHODS: Consecutive patients suspected of PE were referred to a ventilation/perfusion single-photon emission tomography (V/Q-SPECT) as first-line imaging procedure. Patients had a V....../Q-SPECT/CT, a CTPA and an ECG-gated cardiac CT angiography performed the same day. RESULTS: A total of 71 patients were available for analysis. Seventeen patients (24%) had RVD. The non-ECG-gated dimensions of left and right ventricle and the major vessels were correlated with ECG-gated cardiac dimensions. The size...

  8. Evaluation of the biphasic calcium composite (BCC), a novel bone cement, in a minipig model of pulmonary embolism.

    Science.gov (United States)

    Qin, Yi; Ye, Jichao; Wang, Peng; Gao, Liangbin; Jiang, Jianming; Wang, Suwei; Shen, Huiyong

    2016-01-01

    Polymethylmethacrylate (PMMA) bone cement, which is used as a filler material in vertebroplasty, is one of the major sources of pulmonary embolism in patients who have undergone vertebroplasty. In the present study, we established and evaluated two animal models of pulmonary embolism by injecting PMMA or biphasic calcium composite (BCC) bone cement with a negative surface charge. A total of 12 adults and healthy Wuzhishan minipigs were randomly divided into two groups, the PMMA and BBC groups, which received injection of PMMA bone cement and BBC bone cement with a negative surface charge in the circulation system through the pulmonary trunk, respectively, to construct animal models of pulmonary embolism. The hemodynamics, arterial blood gas, and plasma coagulation were compared between these two groups. In addition, morphological changes of the lung were examined using three-dimensional computed tomography. The results showed that both PMMA and BCC injections induced pulmonary embolisms in minipigs. Compared to the PMMA group, the BCC group exhibited significantly lower levels of arterial pressure, pulmonary artery pressure, blood oxygen pressure, blood carbon dioxide pressure, blood bicarbonate, base excess, antithrombin III and D-dimer. In conclusion, BCC bone cement with a negative surface charge is a promising filler material for vertebroplasty.

  9. The incidence of deep vein thrombosis and pulmonary embolism with the elective use of external fixators

    OpenAIRE

    Roberts, David J. S.; Panagiotidou, Anna; Sewell, Matthew; Calder, Peter; Goodier, David

    2015-01-01

    Little evidence exists about the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) with the use of external fixators. We investigated this in a cohort of 207 consecutive patients undergoing 258 elective frame applications by case note review. Case notes were obtained for 84 % of the sample population. The type of surgery, demographic data, thromboembolic risk factors and the incidence of DVT/PE were recorded. One patient experienced DVT (0.39 %) and one a PE (0.39 %). Both w...

  10. Severe pulmonary oedema following therapeutic embolization with Onyx for cerebral arteriovenous malformation.

    Science.gov (United States)

    Murugesan, C; Saravanan, Sundararaj; Rajkumar, John; Prasad, Jagadish; Banakal, Sanjay; Muralidhar, Kanchi

    2008-05-01

    Acute respiratory distress syndrome (ARDS) is characterized by sudden onset of respiratory distress, infiltrates on radiographs consistent with pulmonary oedema, hypoxaemia and increased work in breathing. Infiltrates on radiographs are bilateral, but may be patchy or diffuse and fluffy or dense. It is associated with absence of left heart failure and a PaO2/FiO2 ratio of SpO2, airway pressure monitoring) are important in the recognition of this possible event. One should be vigilant and anticipate this complication following therapeutic embolization with ethylene vinyl alcohol polymer for the treatment of cerebral AVM.

  11. Treatment of Acute Pulmonary Embolism: Update on Newer Pharmacologic and Interventional Strategies

    Directory of Open Access Journals (Sweden)

    Francesco Pelliccia

    2014-01-01

    Full Text Available Acute pulmonary embolism (PE is a common complication in hospitalized patients, spanning multiple patient populations and crossing various therapeutic disciplines. Current treatment paradigm in patients with massive PE mandates prompt risk stratification with aggressive therapeutic strategies. With the advent of endovascular technologies, various catheter-based thrombectomy and thrombolytic devices are available to treat patients with massive or submassive PE. In this paper, a variety of newer treatment strategies for PE are analyzed, with special emphasis on various interventional treatment strategies. Clinical evidence for utilizing endovascular treatment modalities, based on our institutional experience as well as a literature review, is provided.

  12. Multi-slice CT for visualization of acute pulmonary embolism: single breath-hold subtraction technique

    Energy Technology Data Exchange (ETDEWEB)

    Wildberger, J.E.; Mahnken, A.H.; Spuentrup, E.; Guenther, R.W. [Dept. of Diagnostic Radiology, Univ. of Technology, Aachen (Germany); Klotz, E.; Ditt, H. [Siemens Medical Solutions, Computed Tomography, Forchheim (Germany)

    2005-01-01

    Purpose: the purpose of our preliminary animal study was to evaluate the feasibility of a new subtraction technique for visualization of perfusion defects within the lung parenchyma in segmental and subsegmental pulmonary embolism (PE). Materials and methods: in three healthy pigs, PE were artificially induced by fresh human clot material. Within a single breath-hold, CT angiography (CTA) was performed on a 16-slice multi-slice CT scanner (SOMATOM Sensation 16; Siemens, Forchheim, Germany) before and after intravenous application of 80 mL of contrast-medium, followed by a saline chaser. Scan parameters were 120 kV and 100 mAs{sub eff.}, using a collimation of 16 x 1.5 mm and a table speed/rot. of 36 mm (pitch: 1.5; rotation time: 0.5 s). A new 3D subtraction technique was developed, which is based on automated segmentation, non-linear spatial filtering and non-rigid registration. Data were analysed using a color-encoded ''compound view'' of parenchymal enhancement and CTA information displayed in axial, coronal and sagittal orientation. Results: subtraction was technically feasible in all three data sets. The mean scan time for each series was 4.7 s, interscan delay was 14.7 s, respectively. Therefore, an average breath-hold of approximately 24 s was required for the overall scanning procedure. Downstream of occluded segmental and subsegmental arteries, perfusion defects were clearly assessable, showing lower or missing enhancement compared to normally perfused lung parenchyma. In all pigs, additional peripheral areas with triangular shaped perfusion defects were delineated, considered typical for PE. Conclusions: our initial results from the animal model studied slow that perfusion imaging of PE is feasible within a single breath-hold. It allows a comprehensive assessment of perfusion deficits as the direct proof of a pulmonary embolus, can be combined with an indirect visual quantification of the density changes in the adjacent lung tissue

  13. Unusual presentation of renal vein thrombosis with pulmonary artery embolism.

    Science.gov (United States)

    Mzayen, Khaled; Al-Said, Jafar; Nayak-Rao, Shobhana; Catacutan, Maria Teresa; Kamel, Olfat

    2013-05-01

    A young 23-year-old male patient presented with a two-day history of right flank pain. He had no history of any significant illnesses in the past. His investigations showed nephrotic range proteinuria with hypoalbuminemia. The patient developed cough and shortness of breath after having a left kidney biopsy. He did not respond to regular respiratory tract infection treatment. The kidney biopsy revealed membranoproliferative glomerulonephritis. Further investigations for the cough showed thromboembolism of the posterior and lateral basal segments of the right lower lobe. Moreover he was found to have thrombosis of the right upper pole renal vein. The patient was started on full anticoagulation along with three days pulse steroid, followed by 1 mg/kg oral steroid. Clinical improvement was noticed within 48 h. After eight weeks the proteinuria decreased from 8.5 gm/day to 1.1 gm/day. The kidney function was normal with eGFR 145 mL/min through the course of the disease. This case represent one of the unusual presentation of nephrotic syndrome with pulmonary and renal vascular thromboembolic events. The response to the combination of anticoagulation and steroid was remarkable.

  14. Unusual presentation of renal vein thrombosis with pulmonary artery embolism

    Directory of Open Access Journals (Sweden)

    Khaled Mzayen

    2013-01-01

    Full Text Available A young 23-year-old male patient presented with a two-day history of right flank pain. He had no history of any significant illnesses in the past. His investgations showed nephrotic range proteinuria with hypoalbuminemia. The patient developed cough and shortness of breath after having a left kidney biopsy. He did not respond to regular respiratory tract infection treat-ment. The kidney biopsy revealed membranoproliferative glomerulonephritis. Further investigations for the cough showed thromboembolism of the posterior and lateral basal segments of the right lower lobe. Moreover he was found to have thrombosis of the right upper pole renal vein. The patient was started on full anticoagulation along with three days pulse steroid, followed by 1 mg/kg oral steroid. Clinical improvement was noticed within 48 h. After eight weeks the proteinuria decreased from 8.5 gm/day to 1.1 gm/day. The kidney function was normal with eGFR 145 mL/min through the course of the disease. This case represent one of the unusual presentation of nephrotic syndrome with pulmonary and renal vascular thromboembolic events. The response to the combination of anticoagulation and steroid was remarkable.

  15. Appendicular arterial tumor embolization in two cats with pulmonary carcinoma.

    Science.gov (United States)

    Ibarrola, Patricia; German, Alexander J; Stell, Anneliese J; Fox, Richard; Summerfield, Nuala J; Blackwood, Laura

    2004-10-01

    A 13-year-old neutered male Persian cat and an 11-year-old neutered female Persian cat were examined because of an acute onset of lameness. In both cats, conscious proprioception and reflexes were diminished in the affected limb. In 1 cat, no blood flow was detected in the left brachial artery with a Doppler ultrasonic flow detector, whereas blood flow in the right brachial artery was easily documented. In the other cat, the right femoral pulse was not palpable. Neither cat had any echocardiographic evidence of cardiac disease. In both cats, treatment was primarily supportive. One cat died, and the other was euthanatized. At necropsy, lung lobe consolidation was seen. Microscopically, there was multifocal infiltration of the lung parenchyma with cuboidal to columnar neoplastic epithelial cells. Neoplastic epithelial cells of similar morphology were identified in nodular masses in sections of muscle, and intravascular tumor emboli were identified obliterating small and large arterioles. Immunohistochemical staining of pulmonary and muscular tissue for pan-cytokeratin antigen revealed intense cytoplasmic staining of neoplastic cells. Staining for factor VIII-related antigen confirmed that clusters of neoplastic cells represented intravascular emboli. Clinical signs in the cats were attributed to arterial occlusion by tumor emboli.

  16. What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia?

    Science.gov (United States)

    Ateş, Hale; Ateş, İhsan; Bozkurt, Bülent; Çelik, Hüseyin Tuğrul; Özol, Duygu; Yldrm, Zeki

    2016-04-01

    Because of similar clinical manifestations and laboratory findings, differential diagnosis of pulmonary embolism and community-acquired pneumonia (CAP) is generally difficult. Therefore, this study was conducted to find good markers for the easy, cheap, and fast differential diagnosis of pulmonary embolism and CAP. Thirty-four patients diagnosed with pulmonary embolism and 38 patients with CAP who were admitted to either emergency department or chest diseases outpatient clinic were included in this study. On admission and third day, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate, procalcitonin (PCT), and D-dimer levels of each patient were measured. Neutrophil-to-lymphocyte ratio (NLR) was calculated using the formula NLR = neutrophil count/lymphocyte count. NLR/D-dimer and PCT/D-dimer ratios were also calculated. First day neutrophil count (P = 0.005), NLR (P = 0.002), CRP (P differential diagnosis of pulmonary embolism and CAP, CRP, PCT/D-dimer, and NLR/D-dimer were found to be independent predictive factors for the presence of CAP. Among these factors, NLR/D-dimer ratio was found to be the most sensitive (97.4%) to have the highest negative predictive value 96.7% and to be the most accurate (area under curve = 0.921) (91.7%) parameter for the differential diagnosis of pulmonary embolism and CAP. In this study, NLR/D-dimer ratio was found to be more sensitive and more selective with negative predictive value and area under curve for the differential diagnosis of pulmonary embolism and CAP compared with other laboratory tests.

  17. V/P SPECT as a diagnostic tool for pregnant women with suspected pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Bajc, Marika; Olsson, Berit; Joegi, Jonas [Skaane University Hospital and Lund University, Clinical Physiology and Nuclear Medicine, Lund (Sweden); Gottsaeter, Anders [Skaane University Hospital, Vascular Diseases, Malmoe (Sweden); Hindorf, Cecilia [Skaane University Hospital, Radiation Physics, Lund (Sweden)

    2015-07-15

    The purpose of the study was to assess the prevalence of pulmonary embolism (PE) and other lung diseases among pregnant women with suspected PE and to calculate the radiation exposure to patient and fetus in this population. As a secondary aim, we evaluated the negative predictive value of a normal ventilation/perfusion single photon emission computed tomography (V/P SPECT) examination in pregnancy. We studied all 127 pregnant women who had suspected PE and had undergone V/P SPECT at our institution in the course of a 5-year period. Radiation exposure to patient and fetus and the negative predictive value of a normal V/P SPECT examination were also measured. V/P SPECT identified PE in 11 women (9 %). Moreover, in 15 women (12 %) the examination revealed pneumonia (in 2 cases in addition to PE) and in 1 woman signs of airway obstruction were revealed. Among the 116/127 women (91 %) where PE was ruled out by V/P SPECT, none was diagnosed subsequently with PE or deep venous thrombosis (DVT) during the same pregnancy or puerperal period. For P SPECT, the calculated fetal absorbed dose was < 0.6 mGy,and the calculated breast absorbed dose 0.6 mGy. For V SPECT, the calculated fetal absorbed dose was < 0.014 mGy and the breast absorbed dose 0.25 mGy. The prevalence of PE was low (9 %) among pregnant women with suspected disease. Pneumonia was diagnosed in 12 % of patients. The negative predictive value of V/P SPECT was high, and the radiation exposure from V/P SPECT was low both for fetus and patient. (orig.)

  18. The Effects of Aquaporin-1 in Pulmonary Edema Induced by Fat Embolism Syndrome.

    Science.gov (United States)

    Zhang, Yiwei; Tian, Kun; Wang, Yan; Zhang, Rong; Shang, Jiawei; Jiang, Wei; Wang, Aizhong

    2016-07-21

    This study was designed to investigate the role of aquaporin1 (AQP1) in the pathologic process of pulmonary edema induced by fat embolism syndrome (FES) and the effects of a free fatty acid (FFA) mixture on AQP1 expression in pulmonary microvascular endothelial cells (PMVECs). In vivo, edema was more serious in FES mice compared with the control group. The expression of AQP1 and the wet-to-dry lung weight ratio (W/D) in the FES group were significantly increased compared with the control group. At the same time, inhibition of AQP1 decreased the pathological damage resulting from pulmonary edema. Then we performed a study in vitro to investigate whether AQP1 was induced by FFA release in FES. The mRNA and protein level of AQP1 were increased by FFAs in a dose- and time-dependent manner in PMVECs. In addition, the up-regulation of AQP1 was blocked by the inhibitor of p38 kinase, implicating the p38 MAPK pathway as involved in the FFA-induced AQP1 up-regulation in PMVECs. Our results demonstrate that AQP1 may play important roles in pulmonary edema induced by FES and can be regarded as a new therapy target for treatment of pulmonary edema induced by FES.

  19. High risk of pulmonary embolism and deep venous thrombosis but not of stroke in granulomatosis with polyangiitis (Wegener's)

    DEFF Research Database (Denmark)

    Faurschou, Mikkel; Obel, Niels; Baslund, Bo

    2014-01-01

    OBJECTIVE: To assess the incidence of stroke, pulmonary embolism (PE), and deep venous thrombosis (DVT) in granulomatosis with polyangiitis (Wegener's) (GPA). METHODS: Patients diagnosed with GPA at a Danish tertiary care center during 1993-2011 were identified (n = 180). Each patient was matched...... with 19 population controls (n = 3,420). Information on hospitalizations for stroke, PE, and DVT was obtained from the Danish National Hospital Register. The occurrence of vascular events in the GPA cohort was compared with that in the control group by calculation of incidence rate ratios (IRRs). RESULTS......: The median duration of followup was 7.2 years (interquartile range 3.1-11.7 years) in the GPA cohort. Within the first 2 years following the diagnosis of vasculitis, the incidences of PE and DVT were substantially increased among the patients (IRR 25.7 [95% confidence interval (95% CI) 6.9-96] for PE and IRR...

  20. Effect of vasospasm on perfusion radionuclide imaging in experimental pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Feigin, D.S.; Bookstein, J.J.; Alazraki, N.P.

    Experiments were conducted to further evaluate previously observed discrepancies between postembolic perfusion scans and angiograms, and the relationship of these discrepancies to pulmonary vasospasm. Nonresorbable emboli were formed from Ivalon, muscle, or heated autologous clot. Scans and angiograms were compared at 24-hour intervals for two to eight days. During the first two days after embolism, angiographic-scan discrepancies occurred in most dogs, characterized by decreased size of scintigraphically demonstrated perfusion defects at the same times that the angiogram showed stable or even progressive obstruction. This discordant behavior of scan and angiogram is thought to reflect subsidence of postembolic vasospasm. In the 17 experimental dogs, 13 showed evidence of vasospasm, and four did not. In those that developed spasm, direct angiographic evidence of such spasm was present in all but one, manifest as diffuse constriction of small arteries and diminished parenchymal stain in vascular beds that were not directly obstructed mechanically. Although spasm diminished rapidly during the first 6 hours, there was continued and appreciable further resolution for over 48 hours in some dogs. This study reconfirms the frequent existence of vasospasm in three different embolic models, and indicates subsidence of spasm over a much longer time frame than was formerly supposed. Regression of spasm over an interval of several days suggests that perfusion scans should be performed clinically as soon as possible after a suspected embolic episode, prior to subsidence of spasm, in order to exploit the added sensitivity provided by spasm.

  1. Effectiveness of embolization for management of hemoptysis pulmonary tuberculosis: comparison of chest radiographic study and angiography

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Sang Chul; Kim, Yong Ju; Park, Joong Wha; Lee Myeong Sub; Kim Dong Jin; Hong In Soo [Yonsei Univ. College of Medicine, Wonju (Korea, Republic of)

    2001-01-01

    To compare the effectiveness of embolization of the bronchial artery embolization for the management of hemoptysis in pulmonary tuberculosis cases with the severity of lung parenchymal injury and pleural infiltration, as seen on plain chest radiographs, and with the findings of angiography of the branchial artery. Among 265 patients with hemoptysis due to pulmonary tuberculosis, the findings of plain chest radiography and angiography of the bronchial artery were comparatively analyzed in the 206 for whom the results of follow up were available. The chest radiographin findings were classified as follows: Type I refers to simple pulmonary tuberculosis; Type II includes cases in which pulmonary tuberculosis is complicated by bronchiectasis, aspergillosis, or cavitation; Type III si either Types I or II acompainted by pleural in filtrates limited to the lung apex, and Type IV includes cases in which pleural infiltrates have extended beyond the apex in the whole the lung. Bronchial angiographic findings were divided into four groups: Group I consists of cases which show abnormalities of only the bronchial artery; Group II includes those in which abnormalities are seen in the bronchial artery and either the internal mammary or an intercostal artery; Group III comprises cases which belong to Group I or II and which a bronch of the subclavian artery is abnormal, and Group IV includes those in which abnormalities occur in at least two branches of the subclavian artery, or there is direct visualization of hypervascularity of this vessel. The initial post-embolic hemostatic effect and the results of follow up were studied over a six-month period. As compared with simple pulmonary tuberculosis (Type I), we found that as the severity of pleural infiltration and complications revealed by plain chest radiographs increased (Type II, III, IV), so did the severity of the manifestation of systemic collateral arteries other than the bronchial artery, as depicted by increased on

  2. A minimally invasive technique for the detection and analysis of pulmonary fat embolism: a feasibility study.

    Science.gov (United States)

    Filograna, Laura; Bolliger, Stephan A; Kneubuehl, Beat; Jackowski, Christian; Hatch, Gary M; Thali, Michael J

    2012-09-01

    We investigated the feasibility of postmortem percutaneous needle biopsy (PNB) for obtaining pulmonary samples adequate for the study of pulmonary fat embolism (PFE). Samples of both lungs were obtained from 26 cadavers via two different methods: (i) PNB and (ii) the double-edged knife technique, the gold standard at our institute. After water storage and Sudan III staining, six forensic pathologists independently examined all samples for the presence and severity of PFE. The results were compared and analyzed in each case regarding the vitality of the PFE and its relationship to the cause of death. The results showed that PFE was almost identically diagnosed and graded on the samples obtained via both methods. The discrepancies between the two techniques did not affect the diagnoses of vitality or cause of death related to PFE. This study demonstrates the feasibility of the PNB sampling method for the diagnosis and interpretation of PFE in the postmortem setting.

  3. The iPad as a mobile device for CT display and interpretation: diagnostic accuracy for identification of pulmonary embolism.

    Science.gov (United States)

    Johnson, Pamela T; Zimmerman, Stefan L; Heath, David; Eng, John; Horton, Karen M; Scott, William W; Fishman, Elliot K

    2012-08-01

    Recent software developments enable interactive, real-time axial, 2D and 3D CT display on an iPad by cloud computing from a server for remote rendering. The purpose of this study was to compare radiologists' interpretative performance on the iPad to interpretation on the conventional picture archive and communication system (PACS). Fifty de-identified contrast-enhanced CT exams performed for suspected pulmonary embolism were compiled as an educational tool to prepare our residents for night call. Two junior radiology attendings blindly interpreted the cases twice, one reader used the PACS first, and the other interpreted on the iPad first. After an interval of at least 2 weeks, the cases were reinterpreted in different order using the other display technique. Sensitivity, specificity, and accuracy for identification of pulmonary embolism were compared for each interpretation method. Pulmonary embolism was present in 25 patients, ranging from main pulmonary artery to subsegmental thrombi. Both readers interpreted 98 % of cases correctly regardless of display platform. There was no significant difference in sensitivity (98 vs 100 %, p = 1.0), specificity (98 vs 96 %, p = 1.0), or accuracy (98 vs 98 %, p = 1.0) for interpretation with the iPad vs the PACS, respectively. CT interpretation on an iPad enabled accurate identification of pulmonary embolism, equivalent to display on the PACS. This mobile device has the potential to expand radiologists' availability for consultation and expedite emergency patient management.

  4. Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome – a comprehensive cancer center experience

    Directory of Open Access Journals (Sweden)

    Abdel-Razeq H

    2011-03-01

    Full Text Available Hikmat N Abdel-Razeq1, Asem H Mansour2, Yousef M Ismael11Department of Internal Medicine, 2Department of Radiology, King Hussein Cancer Center, Amman, JordanBackground and objectives: Cancer patients undergo routine imaging studies much more than others. The widespread use of the recently introduced multi-detector CT scanners has resulted in an increasing number of incidentally diagnosed pulmonary embolism (PE in asymptomatic cancer patients. The significance and clinical outcome of such incidental PE is described.Methods: Both radiology department and hospital databases were searched for all cancer patients with a diagnosis of incidental PE. CT scans were performed using a 64-slice scanner with a 5.0 mm slice thickness.Results: During the study period, 34 patients with incidental PE were identified. The mean age (±SD was 57.7 (±12.4 years. All patients had active cancer, gastric, lung, colorectal, and lymphomas being the most frequent. Most patients had advanced-stage disease at the time of PE diagnosis; 26 (77% patients had stage IV, whereas only 3 patients had stages I or II disease. Twenty-seven (79% patients had their PE while undergoing active treatment with chemotherapy (68% or radiotherapy (12%; none, however, were on hormonal therapy. Most (74% patients had their PE diagnosed without history of recent hospital admission. Except for 5 (15%, all other patients were anticoagulated. With follow-up, 2 patients developed recurrent PE, 2 others had clinical and echocardiographic evidence of pulmonary hypertension, and 9 (26% died suddenly within 30 days of the diagnosis of incidental PE; 2 of these where among the 5 patients who were not anticoagulated.Conclusion: Incidental PE in cancer patients is increasingly encountered. Similar to symptomatic PE, many were diagnosed in patients with advanced stage disease and while undergoing active anti-cancer therapy. A significant percentage of patients had recurrent emboli, pulmonary hypertension

  5. Risk of deep vein thrombosis and pulmonary embolism in asthma

    NARCIS (Netherlands)

    Majoor, Christof J.; Kamphuisen, Pieter W.; Zwinderman, Aeilko H.; Brinke, Anneketen; Amelink, Marijke; Rijssenbeek-Nouwens, Lucia; Sterk, Peter J.; Büller, Harry R.; Bel, Elisabeth H.

    2013-01-01

    Increasing evidence suggests that patients with asthma have activated coagulation within the airways. Whether this leads to an increase in venous thromboembolic events is unknown. We therefore assessed the incidence of venous thromboembolic events in patients with mild-to-moderate and severe asthma

  6. Incidental Findings in Patients Evaluated for Pulmonary Embolism Using Computed Tomography Angiography

    Directory of Open Access Journals (Sweden)

    Masoud Pezeshki Rad

    2014-05-01

    Full Text Available Introduction: Pulmonary embolism (PE is a common lethal disease that its clinical symptoms may be seen in many other diseases. Computed tomography pulmonary angiography (CTPA is a valuable diagnostic modality for detection of PE. In addition, it can accurately detect the other diseases with clinical symptoms similar to PE. The aim of this study is to evaluate the frequency of PE and nonembolic disease with similar clinical symptoms including pulmonary, pleural, mediastinal, and cardiovascular diseases that have been detected by CTPA and to describe the importance of reporting these CT findings. Materials and Methods: In this cross‐sectional study, we evaluated the medical records of CTPA in 300 patients of suspected PE between March 2012 and February 2013 in Imam Reza Hospital and Ghaem Hospital in Mashhad University of Medical Sciences, Mashhad, Iran. Demographic information and the results of CTPA of these patients were re‐evaluated. One radiologist reviewed all of the CTPA and the results have been analyzed by SPSS‐16 software. Results: In this study, PE was detected in 18.7% of patients. Multiple incidental imaging findings were diagnosed as follow: pulmonary consolidation (33.2%, pleural effusion (48.7%, pulmonary nodules (10%, pulmonary masses (1.3%, pneumothorax (4.7%, mediastinal mass and lymphadenopathy (9.3%, aortic calcification (42%, coronary arteries calcification (27.3%, mitral valve calcification (2 %, cardiomegaly (30.7%, and the evidences of right ventricular dysfunction (6.7%. Conclusion: A group of disease can cause the clinical symptoms similar to that of PE. Among them, pulmonary consolidation and pleural effusion have much higher frequency than PE. In addition, CTPA can show pathologic findings in the patients that need follow‐up. It is important to detect and report these imaging findings because some of them may change the treatment and prognosis of patient who are suspected to have PE.

  7. Deep venous thrombosis and pulmonary embolism. Part 1. Initial treatment: usually a low-molecular-weight heparin.

    Science.gov (United States)

    2013-04-01

    Patients with deep venous thrombosis are at a short-term risk of symptomatic or even life-threatening pulmonary embolism, and a long-term risk of post-thrombotic syndrome, characterised by lower-limb pain, varicose veins, oedema, and sometimes skin ulcers. What is the best choice of initial antithrombotic therapy following deep venous thrombosis or pulmonary embolism, in terms of mortality and short-term and long-term complications? How do the harm-benefit balances of the different options compare? To answer these questions, we reviewed the available literature using the standard Prescrire methodology. Unfractionated heparin has documented efficacy in reducing mortality and recurrent thromboembolic events in patients with pulmonary embolism or symptomatic proximal (above-knee) deep venous thrombosis. The authors of a systematic review selected 23 trials of low-molecular-weight heparin (LMWH) versus adjusted-dose unfractionated heparin in a total of 9587 patients. Deaths, recurrences and major bleeds were less frequent with LMWH than with unfractionated heparin. The results of other meta-analyses are similar, but all are undermined by a probable publication bias and methodological flaws. Compared to unfractionated heparin, LMWHs have the advantage of fixed-dose administration, once or twice daily, by subcutaneous injection. All available LMWHs seem to have similar efficacy. Those with the longest experience of use are enoxaparin, dalteparin and nadroparin. The harm-benefit balances of fondaparinux and rivaroxaban do not appear more favourable than that of an LMWH followed by an adjusted-dose vitamin K antagonist. A meta-analysis included 12 trials comparing thrombolysis with anticoagulation alone in 700 patients with deep venous thrombosis. Adding a thrombolytic drug did not reduce mortality or the incidence of pulmonary embolism, whereas it increased the incidence of bleeding. A meta-analysis of 13 trials failed to show that adding a thrombolytic drug to initial

  8. Prognostic stratification of acute pulmonary embolism: Focus on clinical aspects, imaging, and biomarkers

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2009-07-01

    Full Text Available Luca Masotti1, Marc Righini2, Nicolas Vuilleumier3, Fabio Antonelli4, Giancarlo Landini5, Roberto Cappelli6, Patrick Ray71Internal Medicine, 4Clinical Chemistry, Cecina Hospital, Cecina, Italy; 2Division of Angiology and Haemostasis, Department of Internal Medicine, Geneva University Hospital, Switzerland; 3Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals and University of Geneva, Switzerland; 5Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy; 6Thrombosis Center, University of Siena, Siena, Italy; 7Department of Emergency Medicine, Centre Hospitalo-Universitaire Pitié-Salpêtrière, UPMC Paris 6, Paris, FranceAbstract: Pulmonary embolism (PE represents a common disease in emergency medicine and guidelines for diagnosis and treatment have had wide diffusion. However, PE morbidity and mortality remain high, especially when associated to hemodynamic instability or right ventricular dysfunction. Prognostic stratification to identify high risk patients needing to receive more aggressive pharmacological and closer monitoring is of utmost importance. Modern guidelines for management of acute PE are based on risk stratification using either clinical, radiological, or laboratory findings. This article reviews the modern treatment of acute PE, which is customized upon patient prognosis. Accordingly the current risk stratification tools described in the literature such as clinical scores, echocardiography, helical computer tomography, and biomarkers will be reviewed.Keywords: pulmonary embolism, prognosis, troponin, BNP, NT-proBNP, echocardiography, computer tomography

  9. Gender as a risk factor for pulmonary embolism after air travel.

    Science.gov (United States)

    Lapostolle, Frédéric; Le Toumelin, Philippe; Chassery, Carine; Galinski, Michel; Ameur, Lydia; Jabre, Patricia; Lapandry, Claude; Adnet, Frédéric

    2009-12-01

    It was the objective of this study to confirm the hypothesis that women experience an increased risk of pulmonary embolism (PE) and/or thromboembolic events after long-distance air travel. We systematically reviewed the records of all patients with confirmed pulmonary embolism after arrival at Roissy-Charles-de-Gaulle (CDG) Airport (Paris, France) during a 13-year period. The incidence of PE was calculated as a function of distance travelled and gender using Bayesian conditional probabilities obtained in part from a control population of long-distance travellers arriving in French Polynesia (Tahiti). A total of 287.6 million passengers landed at CDG airport during the study period. The proportion of male to female long-distance travellers was estimated to be 50.5% to 49.5%. Overall, 116 patients experienced PE after landing [90 females (78%), 26 males (22%)]. The estimated incidence of PE was 0.61 (0.61-0.61) cases per million passengers in females and 0.2 (0.20-0.20) in males, and reached 7.24 (7.17-7.31) and 2.35 (2.33-2.38) cases, respectively, in passengers travelling over 10,000 km. Our study strongly suggests that there is a relationship between risk of PE after air travel and gender. This relationship needs to be confirmed in order to develop the best strategy for prophylaxis.

  10. An unusual presentation of a massive pulmonary embolism with misleading investigation results treated with tenecteplase.

    Science.gov (United States)

    Migneault, David; Levine, Zachary; de Champlain, François

    2015-01-01

    Background. There is no foolproof strategy to identify a pulmonary embolism (PE) in the emergency department, and atypical presentations are common. Negative test results may mislead physicians away from the diagnosis of PE. Objectives. The current report aims to raise awareness of an unusual presentation of massive PE and its diagnosis and management, in the face of limited evidence in the scientific literature. Case Reports. We report the case of a patient with a negative D-Dimer and a negative Computed Tomography contrast angiography of the chest who was diagnosed twenty-seven hours later with a massive PE, as suggested by a bedside echocardiography. The patient was successfully treated with tenecteplase (TNK). Conclusions/Summary. Pulmonary embolism frequently presents atypically and is often a diagnostic challenge. There is limited literature about the treatment of massive PE. Further research on bedside echocardiography for diagnosing PE in unstable patients is warranted. In addition, further study into new thrombolytic agents like tenecteplase in the context of massive and submassive PE is warranted.

  11. An Unusual Presentation of a Massive Pulmonary Embolism with Misleading Investigation Results Treated with Tenecteplase

    Directory of Open Access Journals (Sweden)

    David Migneault

    2015-01-01

    Full Text Available Background. There is no foolproof strategy to identify a pulmonary embolism (PE in the emergency department, and atypical presentations are common. Negative test results may mislead physicians away from the diagnosis of PE. Objectives. The current report aims to raise awareness of an unusual presentation of massive PE and its diagnosis and management, in the face of limited evidence in the scientific literature. Case Reports. We report the case of a patient with a negative D-Dimer and a negative Computed Tomography contrast angiography of the chest who was diagnosed twenty-seven hours later with a massive PE, as suggested by a bedside echocardiography. The patient was successfully treated with tenecteplase (TNK. Conclusions/Summary. Pulmonary embolism frequently presents atypically and is often a diagnostic challenge. There is limited literature about the treatment of massive PE. Further research on bedside echocardiography for diagnosing PE in unstable patients is warranted. In addition, further study into new thrombolytic agents like tenecteplase in the context of massive and submassive PE is warranted.

  12. Pulmonary embolism detection using localized vessel-based features in dual energy CT

    Science.gov (United States)

    Dicente Cid, Yashin; Depeursinge, Adrien; Foncubierta Rodríguez, Antonio; Platon, Alexandra; Poletti, Pierre-Alexandre; Müller, Henning

    2015-03-01

    Pulmonary embolism (PE) affects up to 600,000 patients and contributes to at least 100,000 deaths every year in the United States alone. Diagnosis of PE can be difficult as most symptoms are unspecific and early diagnosis is essential for successful treatment. Computed Tomography (CT) images can show morphological anomalies that suggest the existence of PE. Various image-based procedures have been proposed for improving computer-aided diagnosis of PE. We propose a novel method for detecting PE based on localized vessel-based features computed in Dual Energy CT (DECT) images. DECT provides 4D data indexed by the three spatial coordinates and the energy level. The proposed features encode the variation of the Hounsfield Units across the different levels and the CT attenuation related to the amount of iodine contrast in each vessel. A local classification of the vessels is obtained through the classification of these features. Moreover, the localization of the vessel in the lung provides better comparison between patients. Results show that the simple features designed are able to classify pulmonary embolism patients with an AUC (area under the receiver operating curve) of 0.71 on a lobe basis. Prior segmentation of the lung lobes is not necessary because an automatic atlas-based segmentation obtains similar AUC levels (0.65) for the same dataset. The automatic atlas reaches 0.80 AUC in a larger dataset with more control cases.

  13. Severe pulmonary oedema following therapeutic embolization with Onyx for cerebral arteriovenous malformation

    Energy Technology Data Exchange (ETDEWEB)

    Murugesan, C.; Saravanan, Sundararaj; Rajkumar, John; Prasad, Jagadish; Banakal, Sanjay; Muralidhar, Kanchi [Narayana Hrudayalaya Institute of Medical Sciences, Bangalore (India)

    2008-05-15

    Acute respiratory distress syndrome (ARDS) is characterized by sudden onset of respiratory distress, infiltrates on radiographs consistent with pulmonary oedema, hypoxaemia and increased work in breathing. Infiltrates on radiographs are bilateral, but may be patchy or diffuse and fluffy or dense. It is associated with absence of left heart failure and a PaO{sub 2}/FiO{sub 2} ratio of {<=}200. Ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide (DMSO), which was approved by the US FDA in July 2005, is used as an embolic agent for cerebral arteriovenous malformation (AVM). It is a biocompatible liquid polymer that precipitates and solidifies on contact with blood, thus forming a soft and spongy embolus. We report a case of ARDS following therapeutic embolization with ethylene vinyl alcohol copolymer for cerebral AVM under general anaesthesia. Experienced perioperative physicians adopted standard anaesthetic technique and monitoring for this procedure. Acute respiratory distress and hypoxaemia developed in the patient following extubation of the trachea. Infiltrates seen on postprocedural chest radiographs were consistent with pulmonary oedema. DMSO, the solvent for the ethylene vinyl alcohol copolymer, is excreted via the lungs after administration and we postulate that DMSO was the possible cause of ARDS in this patient. Monitoring of haemodynamic parameters (invasive blood pressure, electrocardiography) and ventilatory parameters (ETCO{sub 2}, SpO{sub 2}, airway pressure monitoring) are important in the recognition of this possible event. One should be vigilant and anticipate this complication following therapeutic embolization with ethylene vinyl alcohol polymer for the treatment of cerebral AVM. (orig.)

  14. A novel balloon assisted two-stents telescoping technique for repositioning an embolized stent in the pulmonary conduit.

    Science.gov (United States)

    Kobayashi, Daisuke; Gowda, Srinath T; Forbes, Thomas J

    2014-08-01

    A 9-year-old male, with history of pulmonary atresia and ventricular septal defect, status post complete repair with a 16 mm pulmonary homograft in the right ventricular outflow tract (RVOT) underwent 3110 Palmaz stent placement for conduit stenosis. Following deployment the stent embolized proximally into the right ventricle (RV). We undertook the choice of repositioning the embolized stent into the conduit with a transcatheter approach. Using a second venous access, the embolized stent was carefully maneuvered into the proximal part of conduit with an inflated Tyshak balloon catheter. A second Palmaz 4010 stent was deployed in the distal conduit telescoping through the embolized stent. The Tyshak balloon catheter was kept inflated in the RV to stabilize the embolized stent in the proximal conduit until it was successfully latched up against the conduit with the deployment of the overlapping second stent. One year later, he underwent Melody valve implantation in the pre-stented conduit relieving conduit insufficiency. This novel balloon assisted two-stents telescoping technique is a feasible transcatheter option to secure an embolized stent from the RV to the RVOT.

  15. Comparison of two prognostic models for acute pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Abd-ElRahim Ibrahim Youssef

    2016-10-01

    Conclusion: (1 There is an agreement to great extent in risk stratification of APE patients by PESI and ESC prognostic models, where mortality rate is increased among high risk classes of both models, (2 ESC prognostic model is more accurate than PESI model in mortality prediction of APE patients especially in the high risk class, (3 echocardiographic evidence of RVD and elevated plasma BNP can help to identify APE patients at increased risk of adverse short-term outcome and (4 integration of RVD assessment by echocardiography and BNP to clinical findings improves the prognostic value of ESC model.

  16. Ruling out pulmonary embolism in primary care : Comparison of the diagnostic performance of “gestalt” and the wells rule

    NARCIS (Netherlands)

    Hendriksen, Janneke M T; Lucassen, Wim A M; Erkens, Petra M G; Stoffers, Henri E J H; van Weert, Henk C P M; Büller, Harry R.; Hoes, Arno W.; Moons, Karel G M; Geersing, Geert Jan

    2016-01-01

    PURPOSE Diagnostic prediction models such as the Wells rule can be used for safely ruling out pulmonary embolism (PE) when it is suspected. A physician’s own probability estimate (“gestalt”), however, is commonly used instead. We evaluated the diagnostic performance of both approaches in primary car

  17. Myocardial infarction, ischaemic stroke and pulmonary embolism before and after breast cancer hospitalisation. A population-based study.

    NARCIS (Netherlands)

    M.P.P. van Herk-Sukel (Myrthe); S. Shantakumar (Sumitra); P.W. Kamphuisen (Pieter Willem); F.J.A. Penning-Van Beest (Fernie); R.M.C. Herings (Ron)

    2011-01-01

    textabstractWe studied the occurrence of myocardial infarction (MI), ischaemic stroke (IS) and pulmonary embolism (PE) before and after breast cancer hospitalisation compared with cancer-free controls. For this, women with a first breast cancer hospitalisation during 2000-2007 were selected from the

  18. Bullet embolism of pulmonary artery: a case report; Embolia pulmonar por projetil de arma de fogo: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Yamanari, Mauricio Gustavo Ieiri; Mansur, Maria Clara Dias; Kay, Fernando Uliana; Silverio, Paulo Rogerio Barboza; Jayanthi, Shri Krishna; Funari, Marcelo Buarque de Gusmao, E-mail: mauriciogustavo91@yahoo.com.br [Universidade de Sao Paulo (IHC-FMUSP), SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    2014-03-15

    The authors report the case of a patient victim of gunshots, with a very rare complication: venous bullet embolism from the left external iliac vein to the lingular segment of the left pulmonary artery. Diagnosis is made with whole-body radiography or computed tomography. Digital angiography is reserved for supplementary diagnosis or to be used as a therapeutic procedure. (author)

  19. [Castaneda-de Leval's modified Fontan operation in complex cyanotic defects with subsequent percutaneous transluminal embolization of systemic pulmonary collaterals].

    Science.gov (United States)

    Schubel, B; Gliech, V; Warnke, H; Göldner, B

    1990-01-01

    The case of a five year old boy with a double-inlet-left-ventricle and the aorta in 1-malposition, large VSD, ASD and pulmonary stenosis is reported, that showed after modified Fontan surgery severe effusions and a severe protein loss syndrome. Aortopulmonary collaterals were detected as the cause of this and successfully treated in several sessions by percutaneous transluminal embolization.

  20. Assessment of anemia during CT pulmonary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Caroline, E-mail: cjung@uke.de [Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany); Groth, Michael; Bley, Thorsten A.; Henes, Frank O. [Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany); Treszl, András [Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany); Adam, Gerhard; Bannas, Peter [Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg (Germany)

    2012-12-15

    Objectives: Anemia is associated with increased mortality in patients with acute symptomatic pulmonary embolism (PE). The purpose of this study was to evaluate the feasibility of Hounsfield unit (HU) measurements on the single unenhanced trigger slice of pulmonary CT angiography scans for diagnosis of anemia. Material and Methods: 150 consecutive patients (median age 64 ± 16 years) with suspected PE underwent pulmonary CT angiography. Two radiologists, blinded to laboratory results, performed HU measurements in the single unenhanced trigger scan independently by region-based analysis (ROI). HU values from ascending and descending aorta and the calculated mean of both were correlated with serum hemoglobin levels. Inter- and intraobserver variability was determined for HU measurements, and ROC analysis was performed for diagnosis of anemia. Calculated linear models were used to assess formulas for estimation of hemoglobin levels from HU measurements. Results: HU measurements revealed high intra- and interrater reliability (ICC > 0.981 and ICC > 0.965, respectively). Calculated mean HU values showed a strong correlation with serum hemoglobin levels (r = 0.734), which allowed generation of different formulas for calculation of hemoglobin levels from HU measurements. ROC analyses confirmed a high sensitivity (80.4 for men; 91.3 for women) and specificity (84.0 for men; 84.9 for women) for diagnosing anemia. Conclusion: Diagnosis of anemia and quantification of hemoglobin levels upon a single unenhanced trigger scan of pulmonary CT angiography is feasible. We suggest disclosing the anemic state in the radiological report, independent of the presence of PE, since anemia carries increased risks of morbidity and mortality.

  1. Multislice computed tomography perfusion imaging for visualization of acute pulmonary embolism: animal experience

    Energy Technology Data Exchange (ETDEWEB)

    Wildberger, Joachim Ernst; Spuentrup, Elmar; Mahnken, Andreas H.; Guenther, Rolf W. [University Hospital, RWTH Aachen, Department of Diagnostic Radiology, Aachen (Germany); Klotz, Ernst; Ditt, Hendrik [Computed Tomography, Siemens Medical Solutions, Forchheim (Germany)

    2005-07-01

    The purpose of our animal study was to evaluate a new computed tomography (CT) subtraction technique for visualization of perfusion defects within the lung parenchyma in subsegmental pulmonary embolism (PE). Seven healthy pigs were entered into a prospective trial. Acute PE was artificially induced by fresh clot material prior to the CT scans. Within a single breath-hold, whole thorax CT scans were performed with a 16-slice multidetector-row CT scanner (SOMATOM Sensation 16; Siemens, Forchheim, Germany) before and after intravenous application of 80 ml of contrast medium with a flow rate of 4 ml/s, followed by a saline chaser. The scan parameters were 120 kV and 100 mAs{sub eff}, using a thin collimation of 16 x 0.75 mm and a table speed/rotation of 15-18 mm (pitch, 1.25-1.5; rotation time, 0.5 s). Axial source images were reconstructed with an effective slice thickness of 1 mm (overlap, 30%). A new automatic subtraction technique was used. After 3D segmentation of the lungs in the plain and contrast-enhanced series, threshold-based extraction of major airways and vascular structures in the contrast images was performed. This segmentation was repeated in the plain CT images segmenting the same number of vessels and airways as in the contrast images. Both scans were registered onto each other using nonrigid registration. After registration both image sets were filtered in a nonlinear fashion excluding segmented airways and vessels. After subtracting the plain CT data from the contrast data the resulting enhancement images were color-encoded and overlaid onto the contrast-enhanced CT angiography (CTA) images. This color-encoded combined display of parenchymal enhancement of the lungs was evaluated interactively on a workstation (Leonardo, Siemens) in axial, coronal and sagittal plane orientations. Axial contrast-enhanced CTA images were rated first, followed by an analysis of the combination images. Finally, CTA images were reread focusing on areas with perfusion

  2. Quantification of right ventricular function in acute pulmonary embolism: relation to extent of pulmonary perfusion defects

    DEFF Research Database (Denmark)

    Kjaergaard, J.; Schaadt, B.K.; Lund, J.O.;

    2008-01-01

    and regional RV dysfunction in 58 consecutive patients with non-massive PE. Methods and results Patients were compared with 58 age-matched controls that had normal ventilation/perfusion scintigraphies. A 2D, Doppler and Tissue Doppler echocardiography performed on the same day, quantified RV pressure...... and global and regional performance. Intermediate and large pulmonary emboli were associated with a significant impact on RV pressure and function. For small pulmonary emboli obstructing

  3. The Interobserver Agreement between Residents and Experienced Radiologists for Detecting Pulmonary Embolism and DVT with Using CT Pulmonary Angiography and Indirect CT Venography

    Energy Technology Data Exchange (ETDEWEB)

    Yavas, Ulas Savas; Calisir, Cuneyt; Ozkan; Ibrahim Ragip [Eskisehir Osmangazi University, Eskisehir (Turkmenistan)

    2008-12-15

    We wanted to prospectively evaluate the interobserver agreement between radiology residents and expert radiologists for interpreting CT images for making the diagnosis of pulmonary embolism (PE). We assessed 112 consecutive patients, from April 2007 to August 2007, who were referred for combined CT pulmonary angiography and indirect CT venography for clinically suspected acute PE. CT scanning was performed with a 64x0.5 collimation multi-detector CT scanner. The CT studies were initially interpreted by the radiology residents alone and then the CT images were subsequently interpreted by a consensus of the resident plus an experienced general radiologist and an experienced chest radiologist. Two of the 112 CTs were unable to be interpreted (1.7%). Pulmonary artery clots were seen on 36 of the thoracic CT angiographies (32%). The interobserver agreement between the radiology residents and the consensus interpretation was good (a kappa index of 0.73). All of the disagreements (15 cases) were instances of overcall by the resident on the initial interpretation. Deep venous thrombosis was detected in 72% (26 of 36) of the patients who had PE seen on thoracic CT. The initial and consensus interpretations of the CT venography images disagreed for two cases (kappa statistic: 0.96). It does not seem adequate to base the final long-term treatment of PE on only the resident's reading, as false positives occurred in 13% of such cases. Timely interpretation of the CT pulmonary angiography and CT venography images should be performed by experienced radiologists for the patients with suspected PE.

  4. Systematic review and meta-analysis for thrombolysis treatment in patients with acute submassive pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Cao Y

    2014-02-01

    Full Text Available Yaoqian Cao,* Haiyan Zhao,* Wanpeng Gao, Yan Wang, Jie Cao Respiratory Department, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China *These two authors contributed equally to this work Purpose: The aim of this systematic review was to evaluate the efficacy and safety of thrombolytic treatment in patients with submassive pulmonary embolism (PE. Methods: An electronic search was carried out based on the databases from MEDLINE, Embase, Science Citation Index (SCI, and the Cochrane Library. We included prospective, randomized, and clinical trials in thrombolysis with heparin alone in adults who had evidence of right ventricular dysfunction and normotension. The main endpoints consist of mortality, recurrent PE, and bleeding risk. The relative risk (RR and the relevant 95% confidence intervals were determined by the dichotomous variable. Results: Only seven studies involving 594 patients met the inclusion criteria for further review. The cumulative effect of thrombolysis, compared with intravenous heparin, demonstrated no statistically significant difference in mortality (2.7% versus 4.3%; RR =0.64 [0.29–1.40]; P=0.27 or recurrent PE (2% versus 5%; RR =0.44 [0.19–1.05]; P=0.06. Thrombolytic therapy did not increase major hemorrhage compared with intravenous heparin (4.5% versus 3.3%; RR =1.16 [0.51–2.60]; P=0.73, but it was associated with an increased minor hemorrhage (41% versus 9%; RR =3.91 [1.46–10.48]; P=0.007. Conclusion: Compared with heparin alone, neither mortality nor recurrent PE is reduced by thrombolysis in patients with submassive PE, and it does not reveal an increasing risk of major bleeding. In addition, thrombolysis also produces the increased risk of minor bleeding; however, no sufficient evidence verifies the thrombolytic benefit in this review, because the number of patients enrolled in the trials is limited. Therefore, a large, double-blind clinical trial is required to prove the

  5. D-dimer testing for safe exclusion and risk stratification in patients with acute pulmonary embolism in primary care

    Directory of Open Access Journals (Sweden)

    Zhou Yin

    2015-01-01

    Full Text Available Background: Safe exclusion and risk stratification are currently recommended for the initial management of patients with acute pulmonary embolism (APE. The aim of this study was to assess the safe exclusion and risk stratification value of D-dimer (DD for APE when tested at the beginning of admission. Materials and Methods: All consecutive Chinese APE patients and controls were recruited from January 2010 to December 2012. All measurements of serum indexes were made in duplicate and blinded to the patients′ status. All the 40 patients with the first episode of APE were confirmed by multi-detector computed tomographic pulmonary angiography. The plasma prothrombin time (PT, activated partial thromboplastin time, thrombin time, fibrinogen, and DD levels were measured within 24 h of admission. We used the Mann-Whitney U-test to determine the differences between groups and drew receiver operator characteristic curve to evaluate the indexes′ value in the APE screening. Results: The PT and DD in the APE group were significantly higher than those in the disease control group (P 1820 μg/L as cut-off value, the sensitivity, specificity, positive and negative predictive value was 82.5%, 75.2%, 56.9%, and 91.6%, respectively. Conclusion: The patients with APE showed significant higher DD levels compared with disease controls, suggesting a negative qualitative DD test result can safely and efficiently exclude APE in primary care.

  6. Plasma copeptin for short term risk stratification in acute pulmonary embolism.

    Science.gov (United States)

    Wyzgał, Anna; Koć, Marcin; Pacho, Szymon; Bielecki, Maksymilian; Wawrzyniak, Radosław; Kostrubiec, Maciej; Ciurzyński, Michał; Kurnicka, Katarzyna; Goliszek, Sylwia; Paczyńska, Marzena; Palczewski, Piotr; Pruszczyk, Piotr

    2016-05-01

    Copeptin (COP) was reported to have prognostic value in various cardiovascular diseases. We hypothesized that COP levels reflect the severity of acute pulmonary embolism (PE) and may be useful in prognostic assessment. Plasma COP concentrations were measured on the Kryptor Compact Plus platform (BRAHMS, Hennigsdorf, Germany). The study included 107 consecutive patients with diagnosed acute PE (47 males, 60 females), with median age of 65 years (range 20-88). High risk PE was diagnosed in 3 patients (2.8 %), intermediate risk in 69 (64.5 %), and low risk PE in 35 (32.7 %) patients. Control group included 64 subjects (25 males, 39 females; median age 52.5 year, range 17-87). Four patients (3.7 %) died during 30-day observation. Complicated clinical course (CCC) was experienced by 10 (9.3 %) patients. COP level was higher in PE patients than in controls [11.55 pmol/L (5.16-87.97), and 19.00 pmol/L (5.51-351.90), respectively, p < 0.0001], and reflected PE severity. COP plasma concentration in low risk PE was 14.67 nmol/L (5.51-59.61) and in intermediate/high risk PE 19.84 mol/L (5.64-351.90) p < 0.05. Median COP levels in nonsurvivors was higher than in survivors, 84.6 (28.48-351.9) pmol/L and 18.68 (5.512-210.1) pmol/L, respectively, p = 0.009. Subjects with CCC presented higher COP levels than patients with benign clinical course 53.1 (17.95-351.9) pmol/L and 18.16 (5.51-210.1) pmol/L, respectively, p = 0.001. Log-transformed plasma COP was the significant predictor of CCC, OR 16.5 95 % CI 23.2-111.9, p < 0.001. AUC-for prediction of CCC using plasma COP was 0.811 (95 % CI 0.676-0.927). The COP cut off value of 17.95 nmol/l had sensitivity of 100 %, specificity 49.5 %, positive predictive value of 16.9 % and negative predictive value of 100 %. We conclude that plasma COP levels can be regarded for promising marker of severity of acute PE and show potential in risk stratification of these patients.

  7. Pulmonary embolism in a healthy woman using the oral contraceptives containing desogestrel

    Science.gov (United States)

    Park, Min-Jeong

    2017-01-01

    Venous thromboembolism is well known as one of the rare but serious adverse effects of combined oral contraceptives (COCs). The COCs with third and fourth generation progestogens were found to have higher risk of venous thrombosis than those with second generation progestogens. We present a case of pulmonary embolism in a 23-year-old nulligravid woman who was using COCs containing the third generation progestogen (desogestrel). At the time of presentation of the adverse effect, she had been using the COCs for 4 months. She had no additional risk factors for thrombosis such as smoking, surgery, tumor as well as genetic factors. This case demonstrates even young women in otherwise good health may be at risk of venous thromboembolism from low-dose formulations of COCs as an over-the-counter drug. We describe this case with a brief review of literatures. PMID:28344968

  8. Pulmonary embolism after endoscopic injection with N-butyl-2-cyanoacrylate for gastric varices

    Directory of Open Access Journals (Sweden)

    Gabriela Robaina

    2016-12-01

    Full Text Available Gastric varices occur in one-third of patients with portal hypertension. Bleeding from gastric varices remains a significant cause of death. Currently the first-line of treatment for gastric varices is endoscopic obliteration with N-butyl-2-cyanoacrylate. Though relatively safe, this option has several well-known complications. We report the case of a 61-year-old male patient with cryptogenic cirrhosis, who presented with fever, tachycardia and hypoxemia after endoscopic obliteration with N-butyl-2-cyanoacrylate. Radiographic findings were consistent with pulmonary embolism of the sclerosing substance. The aim of this case report is to emphasize the clinical and radiological findings of this complication in order to distinguish it from other similar medical conditions and prevent a delay in diagnosis

  9. Salvage intraosseous thrombolysis and extracorporeal membrane oxygenation for massive pulmonary embolism.

    Science.gov (United States)

    Northey, Luke Cameron; Shiraev, Timothy; Omari, Abdullah

    2015-01-01

    Intraosseous access is an alternative route of pharmacotherapy during cardiopulmonary resuscitation. Extracorporeal membrane oxygenation (ECMO) provides cardiac and respiratory support when conventional therapies fail. This case reports the use of intraosseous thrombolysis and ECMO in a patient with acute massive pulmonary embolism (PE). A 34-year-old female presented to the emergency department with sudden onset severe shortness of breath. Due to difficulty establishing intravenous access, an intraosseous needle was inserted into the left tibia. Echocardiography identified severe right ventricular dilatation with global systolic impairment and failure, indicative of PE. Due to the patient's hemodynamic compromise a recombinant tissue plasminogen activator (Alteplase) bolus was administered through the intraosseous route. After transfer to the intensive care unit, venous-arterial ECMO was initiated as further therapy. The patient recovered and was discharged 36 days after admission. This is the first report of combination intraosseous thrombolysis and ECMO as salvage therapy for massive PE.

  10. Axillary artery transection and bilateral pulmonary embolism after anterior shoulder dislocation: case report

    Directory of Open Access Journals (Sweden)

    Leclerc Betty

    2017-01-01

    Full Text Available Introduction: Anterior shoulder dislocation can be associated with vascular and neurological complications. However, axillary artery injury associated with shoulder dislocation is rare and extremely rare without bone fracture. An early diagnosis of these complications allows predicting long-term functional outcomes. Methods: This article reports the case of a 66-year-old patient who presented an anterior shoulder dislocation after a ski fall without any neurological dysfunction or pulse deficit. Results: The first reduction attempts were unsuccessful and during the new attempt, we observed a hematoma. A CT scan showed a disruption of the axillary artery and a bilateral pulmonary embolism. Conclusion: Neurovascular injury must be systematically sought before and after reduction, and a multidisciplinary approach is always necessary.

  11. Salvage intraosseous thrombolysis and extracorporeal membrane oxygenation for massive pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Luke Cameron Northey

    2015-01-01

    Full Text Available Intraosseous access is an alternative route of pharmacotherapy during cardiopulmonary resuscitation. Extracorporeal membrane oxygenation (ECMO provides cardiac and respiratory support when conventional therapies fail. This case reports the use of intraosseous thrombolysis and ECMO in a patient with acute massive pulmonary embolism (PE. A 34-year-old female presented to the emergency department with sudden onset severe shortness of breath. Due to difficulty establishing intravenous access, an intraosseous needle was inserted into the left tibia. Echocardiography identified severe right ventricular dilatation with global systolic impairment and failure, indicative of PE. Due to the patient′s hemodynamic compromise a recombinant tissue plasminogen activator (Alteplase bolus was administered through the intraosseous route. After transfer to the intensive care unit, venous-arterial ECMO was initiated as further therapy. The patient recovered and was discharged 36 days after admission. This is the first report of combination intraosseous thrombolysis and ECMO as salvage therapy for massive PE.

  12. Endomyocardial fibrosis as a cause of Budd-Chiari syndrome and fatal pulmonary embolism.

    Science.gov (United States)

    Bestetti, Reinaldo B; Silva, Carolina M P D C; Ardito, Sabrina Q; Theodoropoulos, Tatiana A D; Cury, Patrícia M; Corbucci, Hélio A R

    2010-01-01

    A 24-year-old-man had right-sided heart failure of 3 months' duration. A Doppler echocardiogram revealed atrium and right ventricular enlargement, obliteration of the right ventricular apex, and a mass with an echolucent center measuring 20x21 mm in the right ventricular outlet. He died of pulmonary embolism. At autopsy, a huge organized thrombus obliterating the right ventricular apex passing through the tricuspid valve to the right atrium and then extending to the inferior vena cava up to the suprahepatic veins was seen. Histologically, an intense fibrotic thickening of the endomyocardium extending into the myocardium was observed. Cardiac thrombosis associated with endomyocardial fibrosis should be added to the list of causes of Budd-Chiari syndrome.

  13. Quantitative evaluation of cardiopulmonary functional reserve in treated patients with pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    YAN Wen-wen; WANG Le-min; CHE Lin; SONG Hao-ming; JIANG Jin-fa; XU Jia-hong; SHEN Yu-qin; ZHANG Qi-ping

    2012-01-01

    Background There is no research,either at home or abroad,focusing on assessing the cardiopulmonary functional reserve and exercise tolerance in patients with pulmonary embolism (PE),but the benefits of early exercise are well recognized.The goals of this study were to assess cardiopulmonary functional reserve in treated PE patients using the inert gas rebreathing method of the cardiopulmonary exercise test (CPET),and to compare it with traditional methods.Methods CPET on the bicycle ergometer were performed in 40 patients with age,gender,body mass index,systolic blood pressure,and pulmonary function matched.The first group was the PE group composed of 16 PE patients (5 male,11 female) who were given the standard antithrombotic therapy for two weeks.The second group was composed of 24 normal individuals (10 male,14 female).Both groups were evaluated by cardiac ultrasound examination,6-minute walking test (6MVVT),and CPET.Results (1) Right ventricular systolic pressure (RVSP) in the PE group increased significantly compared to the control group,(34.81±8.15) mmHg to (19.75±3.47) mmHg (P <0.01).But neither right atrial end-systolic diameter (RASD) nor right ventricular end-diastolic diameter (RVDD) in the PE patients had changed when compared with the controls.The 6-minute walk distance was significantly reduced in the PE patients compared with normal subjects,(447.81±79.20) m vs.(513.75±31.45) m (P <0.01).Both anaerobic threshold oxygen consumption (VO2AT) and peak oxygen consumption (VO2peak) were significantly lower in patients with PE,while CO2 equivalent ventilation (VE/VCO2 slope) was higher;VO2AT (9.44±3.82) ml·kg1.min-1 vs.(14.62±2.93) ml.kg-1.min-1 (P <0.01) and VO2peak (12.26±4.06) ml.kg-1.min-1 vs.(23.46±6.15) ml.kg-1.min-1 (P <0.01) and VE/VCO2 slope 35.47±6.66 vs.26.94±3.16 (P <0.01).There was no significant difference in resting cardiac output (CO) between the PE and normal groups,whereas peak cardiac output (peak CO)and the

  14. Pulmonary embolism as a cause of cardiac arrest: Hypothermia in post-resuscitation period (cooling therapy

    Directory of Open Access Journals (Sweden)

    Niković Vuk

    2013-01-01

    Full Text Available Introduction. Pulmonary embolism as a possible cause of acute heart failure is a potentially fatal condition that can cause death in all age groups. Patients successfully resuscitated after cardiac arrest have a high risk of increased mortality and their poor long­term outcome is often associated with severe neurological complications. Case Outline. This is a case report of a 67­year­old man after a successful cardiopulmonary resuscitation (CPR which was followed by therapeutic hypothermia (TH. The patient visited the dermatological outpatients’ department with clinical presentation of pain and swelling of the right leg, shortness of breath and chest pain. During examination the patient lost consciousness, stopped breathing and had cardiac arrest. ECG was done which registered asystole. We began CPR. After 59 minutes of resuscitation return of heartbeat was achieved. The patient was transported to the Emergency Department. On admission, after computerized tomography (CT of the chest confirmed massive pulmonary embolism (PE, the patient was administered thrombolytic therapy with Metalyse (tenecteplase and anti­coagulation therapy (heparin. After stabilization, therapeutic hypothermia was applied. Combination of EMCOOLSpad on the chest and abdomen and cold Ringer lactate 500 ml at 4°C was flushed. Temperature was decreased to 33°C and kept stabile for 24 hours. After eight days the patient was conscious with a minimal neurological deficit. Conclusion. As shown in this case report, and according to the rich experience elsewhere, cooling therapy after out­of­hospital cardiac arrest and successful CRP may be useful in preventing neurological complications.

  15. Venous thromboembolism: Additional diagnostic value and radiation dose of pelvic CT venography in patients with suspected pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Reichert, Miriam, E-mail: Miriam.Reichert@umm.de [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Henzler, Thomas; Krissak, Radko; Apfaltrer, Paul [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Huck, Kurt [1st Department of Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim (Germany); Buesing, Karen [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Sueselbeck, Tim [1st Department of Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim (Germany); Schoenberg, Stefan O.; Fink, Christian [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany)

    2011-10-15

    Purpose: To assess the additional diagnostic value of indirect CT venography (CTV) of the pelvis and upper thighs performed after pulmonary CT angiography (CTA) for the diagnosis of venous thromboembolism (VTE). Materials and methods: In a retrospective analysis, the radiology information system entries between January 2003 and December 2007 were searched for patients who received pulmonary CTA and additional CTV of the pelvis and upper thighs. Of those patients, the radiology reports were reviewed for the diagnosis of pulmonary embolism (PE) and deep venous thrombosis (DVT) in the pelvic veins and veins of the upper thighs. In cases with an isolated pelvic thrombosis at CTV (i.e. which only had a thrombosis in the pelvic veins but not in the veins of the upper thigh) ultrasound reports were reviewed for the presence of DVT of the legs. The estimated radiation dose was calculated for pulmonary CTA and for CTV of the pelvis. Results: In the defined period 3670 patients were referred to our institution for exclusion of PE. Of those, 642 patients (353 men, 289 women; mean age, 65 {+-} 15 years, age range 18-98 years) underwent combined pulmonary CTA and CTV. Among them, PE was found in 227 patients (35.4%). In patients without PE CTV was negative in all cases. In patients with PE, CTV demonstrated pelvic thrombosis in 24 patients (3.7%) and thrombosis of the upper thighs in 43 patients (6.6%). Of those patients 14 (2.1%) had DVT in the pelvis and upper thighs. In 10 patients (1.5%) CTV showed an isolated pelvic thrombosis. Of those patients ultrasound reports were available in 7 patients, which revealed DVT of the leg veins in 5 cases (1%). Thus, the estimated prevalence of isolated pelvic thrombosis detected only by pelvic CTV ranges between 1-5/642 patients (0.1-0.7%). Radiation dose ranges between 4.8 and 9.7 mSv for additional CTV of the pelvis. Conclusion: CTV of the pelvis performed after pulmonary CTA is of neglectable additional diagnostic value for the

  16. Pulmonary Hemorrhagic Infarction due to Fat Embolism and Thromboembolism after Maxillofacial Plastic Surgery: a Rare Case Report

    Institute of Scientific and Technical Information of China (English)

    ZOU Dong-hua; SHAO Yu; ZHANG Jian-hua; QIN Zhi-qiang; LIU Ning-guo; HUANG Ping; CHEN Yi-jiu

    2012-01-01

    Pulmonary fat embolism (PFE) and pulmonary thromboembolism (PTE) are common post-operative complications of orthopedic surgical procedures,but are reported less often following maxillofacial plastic surgical procedures,especially with respect to PFE.Thrombi,or together with fat emboli in pulmonary vessels can induce hemorrhagic infarction and cause death.Herein this report introduced a death due to pulmonary hemorrhagic infarction following maxillofacial plastic surgery.The female patient underwent several osteotomies of the mandible,zygomas and autologous bone grafting within a single operation.The operative time was longer than normal and no preventive strategies for pulmonary embolism were implemented.The patient died 20 days after hospital discharge.The autopsy confirmed pulmonary hemorrhagic infarction.The fat emboli and thrombi were also noted in the pulmonary vessels,which were thought to have resulted from the maxillofacial osteotomy.Suggestions were offered to forensic pathologists that risk factors of PFE and PTE,such as the type and length of surgery,the surgical sites,and the preventive strategies,should be considered when handling deaths after maxillofacial operations.

  17. Pig model of pulmonary embolism: where is the hemodynamic break point?

    Science.gov (United States)

    Kudlička, J; Mlček, M; Hála, P; Lacko, S; Janák, D; Hrachovina, M; Malík, J; Bělohlávek, J; Neužil, P; Kittnar, O

    2013-01-01

    Early recognition of collapsing hemodynamics in pulmonary embolism is necessary to avoid cardiac arrest using aggressive medical therapy or mechanical cardiac support. The aim of the study was to identify the maximal acute hemodynamic compensatory steady state. Overall, 40 dynamic obstructions of pulmonary artery were performed and hemodynamic data were collected. Occlusion of only left or right pulmonary artery did not lead to the hemodynamic collapse. When gradually obstructing the bifurcation, the right ventricle end-diastolic area expanded proportionally to pulmonary artery mean pressure from 11.6 (10.1, 14.1) to 17.8 (16.1, 18.8) cm(2) (ppoint of maximal hemodynamic compensatory steady state. Similarly, mean arterial pressure decreased from 96 (87, 101) to 60 (53, 78) mmHg (p<0.0001), central venous pressure increased from 4 (4, 5) to 7 (6, 8) mmHg (p<0.0001), heart rate increased from 92 (88, 97) to 147 (122, 165) /min (p<0.0001), continuous cardiac output dropped from 5.2 (4.7, 5.8) to 4.3 (3.7, 5.0) l/min (p=0.0023), modified shock index increased from 0.99 (0.81, 1.10) to 2.31 (1.99, 2.72), p<0.0001. In conclusion, instead of continuous cardiac output all of the analyzed parameters can sensitively determine the individual maximal compensatory response to obstructive shock. We assume their monitoring can be used to predict the critical phase of the hemodynamic status in routine practice.

  18. Concurrent acute interstitial pneumonia and pulmonary embolism during treatment with peginterferon alpha-2a and ribavirin in a patient with hepatitis C

    Directory of Open Access Journals (Sweden)

    Hikmet Coban

    2014-01-01

    Full Text Available The case presented is the first patient with concurrent acute interstitial pneumonia and pulmonary embolism associated with combined treatment of peginterferon and ribavirin for hepatitis C.

  19. A nationwide, retrospective analysis of symptoms, comorbidities, medical care and autopsy findings in cases of fatal pulmonary embolism in younger patients

    DEFF Research Database (Denmark)

    Haunsø, S; Theilade, J; Winkel, B G

    2010-01-01

    Our objective was to provide a comprehensive description of fatal pulmonary embolism (PE) in younger persons. Specifically, we recorded information on symptoms, comorbidity, medical contact, if this had been required, and subsequent autopsy findings.......Our objective was to provide a comprehensive description of fatal pulmonary embolism (PE) in younger persons. Specifically, we recorded information on symptoms, comorbidity, medical contact, if this had been required, and subsequent autopsy findings....

  20. Pulmonary embolism in pregnancy: is nuclear medicine imaging still a valid option?

    LENUS (Irish Health Repository)

    Ezwawah, O

    2008-10-01

    In this study we demonstrate our Radiology Department\\'s experience in utilizing low dose (half the normal dose) lung perfusion radionuclide scanning for pregnant patients as the initial investigation for suspected pulmonary embolism (PE). Secondly; we highlight the radiation dose reduction advantages of nuclear medicine imaging over multi-detector computed tomography in this group. We performed a retrospective study of 21 consecutive pregnant women who presented with suspected PE. These patients underwent either lung perfusion scanning or CT pulmonary angiography (CTPA), over a two-year period (May 2005 to July 2007). 19 patients of the cohort studied underwent low dose perfusion-only scintigraphy, with half the usual dose of radionuclide activity. All scans were considered of diagnostic quality. No patient in our study required a ventilation scan. No patient with a negative perfusion scan represented during the 3 month follow up period with PE. We conclude, nuclear medicine imaging is an effective initial investigation for pregnant patients with suspected PE. While scinitigraphy is associated with a greater fetal radiation dose than CTPA, it imparts a lower maternal dose and significantly lower dose to radiosensitive tissues such as breast.

  1. An unusual presentation of massive pulmonary embolism mimicking septal acute myocardial infarction treated with tenecteplase.

    Science.gov (United States)

    Fasullo, Sergio; Paterna, Salvatore; Di Pasquale, Pietro

    2009-02-01

    A 31-year-old man (175 cm, 82 kg) was referred to the emergency department 2 h after the sudden onset of acute dyspnea. Immediate ECG showed sinus tachycardia with ST elevations from V1 through V2 and a diagnosis of septal acute myocardial infarction was made. ECG on admission to the cardiology department showed the same results plus the S1-Q3-T3 pattern. Echocardiogram revealed a normally contracting left ventricle, a distended right ventricle with free wall hypokinesia and displacement of the interventricular septum towards the left ventricle. Thrombolytic therapy with tenecteplase 8000 IU and heparin 5000 IU was administered 5-10 min after hospitalisation and the patient was haemodynamically stable 30 min later. Echocardiogram performed 12 h after thrombolysis showed a normal left ventricle and a less distended right ventricle. Lung spiral computed tomography (CT) and lower abdominal CT on the fourth day showed large emboli in the inferior pulmonary arteries of the right and left lung. Rarely, massive pulmonary embolism may mimic anteroseptal acute myocardial infarction on ECG and this case demonstrates the utility of echocardiography for a differential diagnosis, as well as the efficacy of tenecteplase for thrombolytic therapy.

  2. Mandatory adherence to diagnostic protocol increases the yield of CTPA for pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Stefan Walen

    2016-07-01

    Full Text Available Abstract Objectives To determine if mandatory adherence to a diagnostic protocol increases the rate of computed tomography pulmonary angiographies (CTPAs positive for pulmonary embolism (PE—the so-called diagnostic yield. Further, we aim to identify factors associated with this diagnostic yield. Methods We included all patients with suspected PE requiring CTPA from 9 January 2014 t0 3 June 2014. The requesting physicians were forced to follow diagnostic workup for PE by calculating a Wells score and, if necessary, determining D-dimer level. The percentage of positive CTPA scans was calculated and compared with our previous cohort (Walen et al. Insights Imaging 2014;5(2:231–236. Odds ratios were calculated as a measure of association between dichotomous variables and CTPA findings. Results Of 250 scans, 74 were positive (29.6 % [95 % CI, 24.3-35.5 %] and 175 were negative (70 %. The percentage positive scans increased with 6.6 % and the percentage negative scans decreased with 3.1 %. This change was statistically significant (p = 0.001. Independent clinical predictors of diagnostic yield were previous deep venous thrombosis (DVT (OR, 3.22; p = 0.013 and clinical signs of DVT (OR, 2.71; p = 0.012. Chronic obstructive pulmonary disease (COPD was negatively associated with PE (OR, 0.33; p = 0.045. Conclusions This study shows that mandatory adherence to a diagnostic protocol increases the yield of CTPA for PE in our centre. Main Messages • Mandatory adherence to diagnostic protocol increases the yield of CTPA for PE • Previous DVT and signs of DVT were associated with a higher yield • No patients with a low Wells score and a low D-dimer had PE

  3. [Venoarterial extracorporeal membrane oxygenation in an awake patient : Use of the mobile ECMO team for fulminant pulmonary embolism].

    Science.gov (United States)

    Keller, D; Lotz, C; Kippnich, M; Adami, P; Kranke, P; Roewer, N; Kredel, M; Schimmer, C; Leyh, R; Muellenbach, R M

    2015-05-01

    The current report highlights the use of venoarterial extracorporeal membrane oxygenation (va-ECMO) in a case of pulmonary embolism complicated by right ventricular failure. A 38-year-old woman was admitted to a secondary care hospital with dyspnea and systemic hypotension. Diagnostic testing revealed a massive pulmonary embolism. Thrombolytic therapy was unsuccessful necessitating thromboendarterectomy in the presence of cardiogenic shock. To allow the necessary transport of the highly unstable patient to a tertiary care center a mobile ECMO team was called in. The team immediately initiated awake va-ECMO as a bridge to therapy. Extracorporeal support subsequently allowed a safe transportation and successful completion of the surgical procedure with complete recovery.

  4. A Case of Antiphospholipid Syndrome Refractory to Secondary Anticoagulating Prophylaxis after Deep Vein Thrombosis-Pulmonary Embolism

    OpenAIRE

    Gu, Kang Mo; Shin,Jong Wook; Park, In Won

    2014-01-01

    Antiphospholipid syndrome (APS) is an acquired systemic autoimmune disorder characterized by a combination of clinical criteria, including vascular thrombosis or pregnancy morbidity and elevated antiphospholipid antibody titers. It is one of the causes of deep vein thrombosis and pulmonary embolism that can be critical due to the mortality risk. Overall recurrence of thromboembolism is very low with adequate anticoagulation prophylaxis. The most effective treatment to prevent recurrent thromb...

  5. Deep venous thrombosis and pulmonary embolism detected by FDG PET/CT in a patient with bacteremia

    DEFF Research Database (Denmark)

    Nielsen, Anne Lerberg; Thomassen, Anders; Hess, Søren;

    2013-01-01

    We report incidental FDG PET/CT findings of deep venous thrombosis and pulmonary embolism in a patient with bacteremia. In this patient, diagnosis of thromboembolism was not considered until FDG PET/CT imaging was performed, and the findings prompted immediate anticoagulant therapy. The role of FDG...... PET/CT in venous thromboembolism is not yet well established, but the potential benefit must be kept in mind when interpreting FDG PET/CT images regardless of the underlying disease....

  6. Detection of Acute Pulmonary Embolism by Bedside Ultrasound in a Patient Presenting in PEA Arrest: A Case Report

    Directory of Open Access Journals (Sweden)

    Hangyul Chung-Esaki

    2012-01-01

    Full Text Available Optimal management of the critically ill patient in shock requires rapid identification of its etiology. We describe a successful application of an emergency physician performed bedside ultrasound in a patient presenting with shock and subsequent cardiac arrest. Pulmonary embolus was diagnosed using bedside echocardiogram and confirmed with CTA of the thorax. Further validation and real-time implementation of this low-cost modality could facilitate the decision to implement thrombolytics for unstable patients with massive pulmonary embolism who cannot undergo formal radiographic evaluation.

  7. Life-Threatening Contraceptive-Related Pulmonary Embolism in a 14-Year-Old Girl with Hereditary Thrombophilia

    DEFF Research Database (Denmark)

    Hellfritzsch, Maja; Grove, Erik Lerkevang

    2015-01-01

    in patients with thrombophilia. CASE REPORT: A 14-year-old girl presented with acute onset of chest pain and dyspnea followed by syncope. She was hypoxic and hemodynamically compromised at admission. Computed tomography pulmonary angiography revealed a large central "saddle" pulmonary embolism causing nearly...... found heterozygote for the prothrombin G20210A mutation, and 9 months before admission she had initiated use of second-generation COCs. CONCLUSIONS: Hereditary thrombophilia and a family history of early-onset venous thromboembolism (VTE) each pose an increased risk of VTE and should be considered...

  8. Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2008-06-01

    Full Text Available Luca Masotti1,8, Patrick Ray2, Marc Righini3, Gregoire Le Gal4, Fabio Antonelli5, Giancarlo Landini1, Roberto Cappelli6, Domenico Prisco7, Paola Rottoli81Internal Medicine, Cecina Hospital, Cecina, Italy; 2Department of Emergency Medicine, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Université Pierre et Marie Curie-Paris 6, Paris, France; 3Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland; 4Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France; 5Clinical Chemistry, Cecina Hospital, Cecina, Italy; 6Department of Internal, Cardiovascular and Geriatric Medicine, University of Siena, Siena, Italy; 7Department of Critical Care Medicine, Thrombosis Centre, Careggi Hospital, Florence, Italy; 8Departiment of Clinical Medicine and Immunological Sciences, Division of Respiratory Diseases, University of Siena, Siena, ItalyObjective: Diagnosis of pulmonary embolism (PE remains difficult and is often missed in the elderly due to nonspecific and atypical presentation. Diagnostic algorithms able to rule out PE and validated in young adult patients may have reduced applicability in elderly patients, which increases the number of diagnostic tools use and costs. The aim of the present study was to analyze the reported clinical presentation of PE in patients aged 65 and more.Materials and Methods: Prospective and retrospective English language studies dealing with the clinical, instrumental and laboratory aspects of PE in patients more than 65 and published after January 1987 and indexed in MEDLINE using keywords as pulmonary embolism, elderly, old, venous thromboembolism (VTE in the title, abstract or text, were reviewed.Results: Dyspnea (range 59%–91.5%, tachypnea (46%–74%, tachycardia (29%–76%, and chest pain (26%–57% represented the most common clinical symptoms and signs. Bed rest was the most frequent risk factor for VTE (15%–67%; deep vein

  9. Pulmonary embolism in intensive care unit: Predictive factors, clinical manifestations and outcome

    Directory of Open Access Journals (Sweden)

    Bahloul Mabrouk

    2010-01-01

    Full Text Available Objective : To determine predictive factors, clinical and demographics characteristics of patients with pulmonary embolism (PE in ICU, and to identify factors associated with poor outcome in the hospital and in the ICU. Methods : During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study periods, all patients admitted to our ICU were classified into four groups. The first group includes all patients with confirmed PE; the second group includes some patients without clinical manifestations of PE; the third group includes patients with suspected and not confirmed PE and the fourth group includes all patients with only deep vein thromboses (DVTs without suspicion of PE. The diagnosis of PE was confirmed either by a high-probability ventilation/perfusion (V/Q scan or by a spiral computed tomography (CT scan showing one or more filling defects in the pulmonary artery or in its branches. The diagnosis was also confirmed by echocardiography when a thrombus in the pulmonary artery was observed. Results : During the study periods, 4408 patients were admitted in our ICU. The diagnosis of PE was confirmed in 87 patients (1.9%. The mean delay of development of PE was 7.8 ± 9.5 days. On the day of PE diagnosis, clinical examination showed that 50 patients (57.5% were hypotensive, 63 (72.4% have SIRS, 15 (17.2% have clinical manifestations of DVT and 71 (81.6% have respiratory distress requiring mechanical ventilation. In our study, intravenous unfractionated heparin was used in 81 cases (93.1% and low molecular weight heparins were used in 4 cases (4.6%. The mean ICU stay was 20.2 ± 25.3 days and the mean hospital stay was 25.5 ± 25 days. The mortality rate in ICU was 47.1% and the in-hospital mortality rate was 52.9%. Multivariate analysis showed that

  10. Computed tomography for the detection of free-floating thrombi in the right heart in acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Mansencal, Nicolas [Universite de Versailles-Saint Quentin (UVSQ), Ambroise Pare Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Centre de Reference des Maladies Cardiaques Hereditaires, Department of Cardiology, Boulogne (France); AP-HP, Hopital Universitaire Ambroise Pare, Service de Cardiologie et des Maladies Vasculaires, Centre de Reference des Maladies Cardiaques Hereditaires, Boulogne (France); Attias, David; Guiader, Julie; Abi Nasr, Imad; Dubourg, Olivier [Universite de Versailles-Saint Quentin (UVSQ), Ambroise Pare Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Centre de Reference des Maladies Cardiaques Hereditaires, Department of Cardiology, Boulogne (France); Caille, Vincent; Jardin, Francois; Vieillard-Baron, Antoine [Universite de Versailles-Saint Quentin (UVSQ), Ambroise Pare Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Intensive Care Unit, Boulogne (France); Desperramons, Julien; El Hajjam, Mostafa; Lacombe, Pascal [Universite de Versailles-Saint Quentin (UVSQ), Ambroise Pare Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), Department of Radiology, Boulogne (France)

    2011-02-15

    The aim of this study was to assess the prevalence of free-floating thrombi in the right heart (FFT) and the accuracy of computed tomography (CT) for their detection in pulmonary embolism (PE). We studied 340 consecutive patients presenting with PE. All patients underwent CT and echocardiography. The prevalence of FFT was 3.5% in the global population of PE and 22% in high-risk PE. Dyspnoea, cardiogenic shock, cardiac arrest and tachycardia were more frequently found in patients with FFT (p = 0.04, p < 0.0001, p = 0.0003 and p = 0.01, respectively). Sensitivity and specificity of CT for the detection of FFT were 100% (95% confidence interval: 74%-100%) and 97% (95%-99%), whereas positive and negative predictive values were 57% (34%-78%) and 100% (99%-100%). Among patients with FFT, right ventricular dilation was always detected by CT, whereas no right ventricular dilation was found among patients with a false diagnosis of FFT performed by CT (p < 0.0001). Prevalence of FFT is 3.5% and differs according to the clinical presentation. Detection of FFT by CT is feasible and should lead to echocardiography being promptly performed for the confirmation of FFT. (orig.)

  11. Comparison of automated 4-chamber cardiac views versus axial views for measuring right ventricular enlargement in patients with suspected pulmonary embolism.

    NARCIS (Netherlands)

    Wittenberg, R.; Vliet, J.W. van; Ghaye, B.; Peters, J.F.; Schaefer-Prokop, C.M.; Coche, E.

    2012-01-01

    PURPOSE: Compare the right ventricle to left ventricle (RV/LV) diameter ratio obtained from axial pulmonary CT angiograms (CTPA) with those derived from automatically generated 4-chamber (4-CH) reformats in patients with suspected pulmonary embolism (PE). METHODS: In this institutional review board-

  12. Clinical Analysis of Pulmonary Lipiodol Embolism in Patients with Hepatic Carcinoma after Transcatheter Arterial Chemoembolization

    Directory of Open Access Journals (Sweden)

    Wen-jin JIANG

    2015-03-01

    Full Text Available Objective:To explore the clinical manifestations, therapeutic methods and preventive measures of pulmonary lipiodol embolism (PLE induced by transcatheter arterial chemoembolization (TACE so as to improve the cognition and management of PLE. Methods:A total of 2 613 patients with hepatic cancer without history of pulmonary disease who were treated with TACE in our hospital from Sept., 2004 to Mar., 2013 were selected. The clinical manifestations, therapeutic methods and preventing measures of the 9 patients who were accompanied with PLE were observed to analyze the pre-operative hepatic computed tomography (CT and chest X-ray, intra-operative contrast examination, dosage of lipiodol and chemotherapeutic drugs, clinical manifestation and therapeutic progression as well as the postoperative follow-up.Results: Nine patients accompanied by PLE had different-severity cough, hemoptysis and progressive dyspnea, and chest X-ray and/or CT showed flaky high-density radiography. After treated with oxygen inhalation, bronchus expansion and inflammation alleviation, 8 patients were improved but 1 died. Of the 8 patients, 2 were given ventilator to assist breath, and the clinical symptoms of 8 patients disappeared within 3-15 d. The re-examined chest X-ray showed normal after 20-60 d follow-up observation. Additionally, 6 patients were with nidus diameter ≥10 cm, 6 with hepatic artery-vein fistula and 7 with lipiodol dosage ≥20 mL.Conclusion: PLE often occurs in patients with giant hepatic carcinoma accompanied by hepatic artery-vein fistula, whose lipiodol dosage is ≥20 mL. Accurate and correct management during operation can effectively reduce the development of PLE.

  13. Depression, anxiety and influencing factors in patients with acute pulmonary embolism

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    LIU Chun-ping; LI Xiao-mei; CHEN Hang-wei; CUI Jun-yu; NIU Li-li; HE Yu-bin; TIAN Xin-li

    2011-01-01

    Background Psychological distress has been widely studied in many cardiovascular and pulmonary diseases, but the condition in acute pulmonary embolism (APE) is unknown. The purpose of this study was to investigate levels of depression and anxiety and their influencing factors in APE patients.Methods Sixty consecutive patients with APE were subjected to investigation of depression and anxiety by the Beck Depression Inventory and State-Trait Anxiety Inventory, and 60 community-based subjects were enrolled as controls.APE patients were stratified as high-risk, intermediate-risk and low-risk according to the disease severity. Scores of depression and anxiety were compared by statistical analysis using paired t tests between APE patients and controls,and by analysis of variance within the APE patients with the three risk stratification. Factors influencing depression and anxiety were evaluated.Results The mean age of the patients (38 males and 22 females) was (52+12) years. APE patients displayed higher scores of depression (P=0.04) and anxiety (P=0.001) compared with controls. Patients in the high-risk group displayed higher scores of depression (P=0.004) and anxiety (P=0.001) compared with those in the intermediate- and low-risk groups. Depression scores were highly correlated with anxiety scores (r=0.60, P <0.001). Both depression and anxiety inversely related to risk stratification (P <0.01), age (P <0.05), and arterial blood oxygen pressure (PaO2) (P <0.05).Linear regression analysis showed that PaO2 was independently inversely related to both depression (P <0.01) and anxiety (P <0.05); risk stratification and age were independently inversely related to anxiety (P <0.05).Conclusions Patients of APE suffered high levels of depression and anxiety, which were negatively influenced by PaO2,risk stratification and age.

  14. Obstructive Sleep Apnea Hypopnea Syndrome as a Reason for Active Management of Pulmonary Embolism

    Institute of Scientific and Technical Information of China (English)

    Jiang Xie; Yong-Xiang Wei; Shuang Liu; Wei Zhang; Xiang-Feng Zhang; Jie Li

    2015-01-01

    Background:Obstructive sleep apnea hypopnea syndrome (OSAHS) constitutes an independent factor for high warfarin dose for patients with pulmonary embolism (PE).The aim of this study was to investigate whether the 6-month anticoagulation treatment by warfarin is enough for patients with PE complicated by OSAHS.Methods:We investigated 97 PE patients,32 of them had OSAHS and 65 non-OSAHS.Warfarin was administered for 6-month if no abnormal circumstances occurred.All patients were followed up for 18 months.Adverse events (AE) included death,major bleeding,hospitalization due to heart failure or pulmonary hypertension,and recurrence or aggravation of PE (including deep vein thrombosis).Recurrence rate of PE after warfarin cessation was compared between the two groups.Results:OSAHS patients required a significantly higher dose of warfarin than their non-OSAHS counterparts (4.73 mg vs.3.61 mg,P < 0.001).During warfarin treatment,no major bleeding and aggravation of PE occurred among OSAHS patients,and the rates of various AE were not significantly different between the OSAHS and non-OSAHS groups.PE recurrence was higher in OSAHS than non-OSAHS groups after withdrawal of warfarin (21.43% vs.6.78%,P =0.047).Compared with non-OSAHS patients,OSAHS group had lower international normalized ratio (INR) value but higher plasminogen on baseline and INR resumed to a relatively low level after warfarin discontinuation.Conclusions:OSAHS patients may present with hypercoagulation and relatively high-risk of recurrence of PE after cessation of 6-month warfarin treatment.

  15. Evaluation of pulmonary embolism in a pediatric population with high clinical suspicion

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    Victoria, Teresa; Mong, Andrew; Altes, Talissa; Hernandez, Andrea; Gonzalez, Leonardo; Kramer, Sandra S. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Jawad, Abbas F. [Children' s Hospital of Philadelphia, Department of Biostatistics and Epidemiology, Philadelphia, PA (United States); Raffini, Leslie [Children' s Hospital of Philadelphia, Department of Pediatrics, Division of Hematology, Philadelphia, PA (United States)

    2009-01-15

    Pulmonary embolism (PE) is an underdiagnosed entity in the pediatric population in part because of the low level of suspicion and awareness in the clinical world. To examine its relative prevalence, associated risk factors and imaging features in our pediatric population. A total of 92 patients age 21 years and younger with a high clinical suspicion of PE and who had available radiographic studies were identified from January 2003 to September 2006. Patients with a positive CT scan or a high probability ventilation/perfusion scan formed the case group; patients with a high clinical suspicion of PE and no radiographic evidence of PE or deep venous thrombosis (DVT), randomly matched in age and sex, became the matched control group. We reviewed the charts of both groups and analyzed the imaging studies. In our hospital, the prevalence of PE in patients with a strong suspicion of PE was 14%. The overall prevalence of thromboembolic disease (PE and/or DVT) was 25%. Recent surgery or orthopedic procedure, blood dyscrasias and contraceptive use were more common in patients with PE. No child died of PE in our study. The youngest child with PE in our study was 13 years. Girls were twice as likely to develop PE as boys. PE is a relatively common diagnosis in our tertiary care pediatric population when the clinical suspicion is high. We suggest increased awareness and index of suspicion in order to initiate prompt diagnostic imaging and treatment. (orig.)

  16. Paroxysmal Atrial Fibrillation in the Course of Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis

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    Agnieszka Krajewska

    2017-01-01

    Full Text Available The relationship and clinical implications of atrial fibrillation (AF in acute pulmonary embolism (PE are poorly investigated. We aimed to analyze clinical characteristics and prognosis in PE patients with paroxysmal AF episode. Methods. From the 391 patients with PE 31 subjects with paroxysmal AF were selected. This group was compared with patients with PE and sinus rhythm (SR and 32 patients with PE and permanent AF. Results. Paroxysmal AF patients were the oldest. Concomitant DVT varies between groups: paroxysmal AF 32.3%, SR 49.5%, and permanent AF 28.1% (p=0.02. The stroke history frequency was 4.6% SR, 12.9% paroxysmal AF, and 21.9% permanent AF (p<0.001. Paroxysmal AF comparing to permanent AF and SR individuals had higher estimated SPAP (56 versus 48 versus 47 mmHg, p=0.01 and shorter ACT (58 versus 65 versus 70 ms, p=0.04. Patients with AF were more often classified into high-risk group according to revised Geneva score and sPESI than SR patients. In-hospital mortality was lower in SR (5% and paroxysmal AF (6.5% compared to permanent AF group (25% (p<0.001. Conclusions. Patients with PE-associated paroxysmal AF constitute a separate population. More severe impairment of the parameters reflecting RV afterload may indicate relation between PE severity and paroxysmal AF episode. Paroxysmal AF has no impact on short-term mortality.

  17. Anticoagulant Treatment of Deep Vein Thrombosis and Pulmonary Embolism: The Present State of the Art.

    Science.gov (United States)

    Thaler, Johannes; Pabinger, Ingrid; Ay, Cihan

    2015-01-01

    Venous thromboembolism (VTE), a disease entity comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a frequent and potentially life-threatening event. To date different agents are available for the effective treatment of acute VTE and the prevention of recurrence. For several years, the standard of care was the subcutaneous application of a low molecular weight heparin (LMWH) or fondaparinux, followed by a vitamin K antagonist (VKA). The so-called direct oral anticoagulants (DOAC) were introduced rather recently in clinical practice for the treatment of VTE. DOAC seem to have a favorable risk-benefit profile compared to VKA. Moreover, DOAC significantly simplify VTE treatment because they are administered in fixed doses and no routine monitoring is needed. Patients with objectively diagnosed DVT or PE should receive therapeutic anticoagulation for a minimum of 3 months. Whether a patient ought to receive extended treatment needs to be evaluated on an individual basis, depending mainly on risk factors determined by characteristics of the thrombotic event and patient-related factors. In specific patient groups (e.g., pregnant women, cancer patients, and elderly patients), treatment of VTE is more challenging than that in the general population and additional issues need to be considered in those patients. The aim of this review is to give an overview of the currently available treatment modalities of acute VTE and secondary prophylaxis. In particular, specific aspects regarding the initiation of VTE treatment, duration of anticoagulation, and specific patient groups will be discussed.

  18. Gene expression of ANP, BNP and ET-1 in the heart of rats during pulmonary embolism.

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    Henrik Gutte

    Full Text Available AIMS: Atrial natriuretic petide (ANP, brain natriuretic peptide (BNP and endothelin-1 (ET-1 may reflect the severity of right ventricular dysfunction (RVD in patients with pulmonary embolism (PE. The exact nature and source of BNP, ANP and ET-1 expression and secretion following PE has not previously been studied. METHODS AND RESULTS: Polystyrene microparticles were injected to induce PE in rats. Gene expression of BNP, ANP and ET-1 were determined in the 4 cardiac chambers by quantitative real time polymerase chain reaction (QPCR. Plasma levels of ANP, BNP, ET-1 and cardiac troponin I (TNI were measured in plasma. PE dose-dependently increased gene expression of ANP and BNP in the right ventricle (RV and increased gene expression of ANP in the right atrium (RA. In contrast PE dose-dependently decreased BNP gene expression in both the left ventricle (LV and the left atrium (LA. Plasma levels of BNP, TNI and ET-1 levels dose-dependently increased with the degree of PE. CONCLUSION: We found a close correlation between PE degree and gene-expression of ANP, and BNP in the cardiac chambers with a selective increase in the right chambers of the heart. The present data supports the idea of natriuretic peptides as valuable biomarkers of RVD in PE.

  19. Role of Survival Time and Injury Severity in Fatal Pulmonary Fat Embolism.

    Science.gov (United States)

    Jarmer, Juliane; Ampanozi, Garyfalia; Thali, Michael J; Bolliger, Stephan A

    2017-03-01

    Pulmonary fat embolism (PFE) is frequent in blunt trauma and may occasionally lead to death. A correlation between fracture grade and severity and PFE grade has been described before, but no correlation between PFE and survival time, fat crushing extent, fat crush grade, or number of body regions with fractures could be noted in this small study. To further examine this, we decided to examine the aforementioned points in a far larger study group.Autopsy protocols of 188 nonresuscitated fatalities with blunt trauma and without right heart injury, which underwent whole body dissection, were retrospectively reviewed concerning the presence and the severity of PFE, injuries, survival time, age, sex, and the body mass index.The fracture grade, the fracture severity, and the number of the fractured regions correlated very well with the grade of PFE, but the crushed regions, crush grade, and crush severity did not. We observed a time correlation between survival time and PFE only in the sense that very rapid deaths were often PFE negative. High-grade PFE was observed most often in patients having died less than 6 hours after the incident, and PFE grades of 2 or more were occasionally noted even after 48 hours.

  20. Treatment of deep vein thrombosis and pulmonary embolism: The present state of the art

    Directory of Open Access Journals (Sweden)

    Johannes eThaler

    2015-07-01

    Full Text Available AbstractVenous thromboembolism (VTE, a disease entity comprising deep vein thrombosis (DVT and pulmonary embolism (PE, is a frequent and potentially life-threatening event. To date different agents are available for the effective treatment of acute VTE and the prevention of recurrence. For several years the standard of care was the subcutaneous application of a low molecular weight heparin (LMWH or fondaparinux, followed by a vitamin K antagonist (VKA. The so-called direct oral anticoagulants (DOACs were introduced rather recently in clinical practice for the treatment of VTE. DOACs seem to have a favourable risk-benefit profile compared to VKAs. Moreover, DOACs significantly simplify VTE treatment, because they are administered in fixed doses and no routine monitoring is needed.Patients with objectively diagnosed DVT or PE should receive therapeutic anticoagulation for a minimum of 3 months. Whether a patient ought to receive extended treatment needs to be evaluated on an individual basis, depending mainly on risk factors determined by characteristics of the thrombotic event and patient-related factors. In specific patients groups (e.g. pregnant women, cancer patients and elderly patients treatment of VTE is more challenging than in the general population and additional issues need to be considered in those patients.The aim of this review is to give an overview of the currently available treatment modalities of acute VTE and secondary prophylaxis. In particular, specific aspects regarding the initiation of VTE treatment, duration of anticoagulation and specific patient groups will be discussed.

  1. PULMONARY EMBOLISM DURING PREGNANCY AND THE POSTPARTUM PERIOD: REPORT OF 2 CASES

    Institute of Scientific and Technical Information of China (English)

    冯凤芝; 杨剑秋; 盖铭英

    2002-01-01

    Objective. To investigate the high risk factors, clinical features, diagnosis and treatment of pulmonary embolism (PE) during pregnancy and the postpartum period.Methods. Two cases of PE during pregnancy and postpartum period were reported retrospectively.Results. The first case was a pregnant woman with congenital heart disease at 39-week gestation. She underwent a successful cesarean section (CS) because of heart disease, but she manifested tachycardia, tachypnea,cyanosis, and dyspnea suddenly on the 10th day after CS and died soon after the onset of these symptoms. The diagnosis of PE was highly suspected clinically. The second case was a twin-pregnancy woman at 35-week gestation. Because of severe perinatal myocardiopathy, cesarean section was performed. Unfortunately, the patient died abruptly on the operation table. The diagnosis of PE was confirmed by autopsy.Conclusions. The maternal mortality of PE during pregnancy and postpartum period is quite high. Whenever there is any doubt, objective examinations for PE should be started early in order to strive for the chances of the anticoagulant therapy.

  2. Triage for suspected acute Pulmonary Embolism: Think before opening Pandora's Box

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    Levin, David [Department of Radiology, Mayo Clinic, Rochester, MN (United States); Seo, Joon Beom [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kiely, David G. [Sheffield Pulmonary Vascular Disease Unit, M-15, M-Floor, Royal Hallamshire Hospital, Sheffield (United Kingdom); Hatabu, Hiroto [Department of Radiology, Brigham and Women' s Hospital and Harvard Medical School Boston, MA (United States); Gefter, Warren [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA (United States); Beek, Edwin J.R. van [Clinical Research Imaging Centre, University of Edinburgh, Scotland (United Kingdom); Schiebler, Mark L., E-mail: mschiebler@uwhealth.org [Department of Radiology, UW-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252 (United States)

    2015-06-15

    This is a review of the current strengths and weaknesses of the various imaging modalities available for the diagnosis of suspected non-massive Pulmonary Embolism (PE). Without careful consideration for the clinical presentation, and the timely application of clinical decision support (CDS) methodology, the current overutilization of imaging resources for this disease will continue. For a patient with a low clinical risk profile and a negative D-dimer there is no reason to consider further workup with imaging; as the negative predictive value in this scenario is the same as imaging. While the current efficacy and effectiveness data support the continued use of Computed Tomographic angiography (CTA) as the imaging golden standard for the diagnosis of PE; this test does have the unintended consequences of radiation exposure, possible overdiagnosis and overuse. There is a persistent lack of appreciation on the part of ordering physicians for the effectiveness of the alternatives to CTA (ventilation–perfusion imaging and contrast enhanced magnetic resonance angiography) in these patients. Careful use of standardized protocols for patient triage and the application of CDS will allow for a better use of imaging resources.

  3. Multislice CT perfusion imaging of the lung in detection of pulmonary embolism

    Science.gov (United States)

    Hong, Helen; Lee, Jeongjin

    2006-03-01

    We propose a new subtraction technique for accurately imaging lung perfusion and efficiently detecting pulmonary embolism in chest MDCT angiography. Our method is composed of five stages. First, optimal segmentation technique is performed for extracting same volume of the lungs, major airway and vascular structures from pre- and post-contrast images with different lung density. Second, initial registration based on apex, hilar point and center of inertia (COI) of each unilateral lung is proposed to correct the gross translational mismatch. Third, initial alignment is refined by iterative surface registration. For fast and robust convergence of the distance measure to the optimal value, a 3D distance map is generated by the narrow-band distance propagation. Fourth, 3D nonlinear filter is applied to the lung parenchyma to compensate for residual spiral artifacts and artifacts caused by heart motion. Fifth, enhanced vessels are visualized by subtracting registered pre-contrast images from post-contrast images. To facilitate visualization of parenchyma enhancement, color-coded mapping and image fusion is used. Our method has been successfully applied to ten patients of pre- and post-contrast images in chest MDCT angiography. Experimental results show that the performance of our method is very promising compared with conventional methods with the aspects of its visual inspection, accuracy and processing time.

  4. Clinical applicability of D-dimer assay in the diagnosis of pulmonary embolism reduces with aging

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    Luca Masotti

    2007-12-01

    Full Text Available Despite modern algorithms have been proposed for diagnosis of pulmonary embolism (PE, it remains understimed and often missed in clinical practice, especially in elderly patients, resulting in high morbidity and mortality when early and correctly untreated. One of the main controversial issue is represented by the role and applicability of D-dimer in the diagnostic work up of geriatric patients. Most recent guidelines in young-adult patients suggest to perform D-dimer assay by ELISA or immunoturbidimetric methods only in non high pre-test clinical probability (PTP patients; in these patients negative D-dimer can safely rule out the diagnosis of PE. This strategy is safe also in elderly patients; however the percentage of patients with non high PTP and negative D-dimer reduces progressively with age, making difficult its clinical applicability. The Authors, starting from two case reports, up date the diagnostic management of PE underling the limitations of D-dimer assay in elderly patients.

  5. Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study

    Science.gov (United States)

    Besculides, Melanie C.; Gaber, Licia; Liu, Spencer; González Della Valle, Alejandro

    2008-01-01

    Pulmonary embolism (PE) is a cause of death after total hip and knee arthroplasty (THA, TKA). We characterised the patient population suffering from in-hospital PE and identified perioperative risk factors associated with PE using nationally representative data. Data from the National Hospital Discharge Survey between 1990 and 2004 on patients who underwent primary or revision THA/TKA in the United States were analysed. Multivariate regression analysis was performed to determine if perioperative factors were associated with increased risk of in-hospital PE. An estimated 6,901,324 procedures were identified. The incidence of in-hospital PE was 0.36%. Factors associated with an increased risk for the diagnosis of PE included: revision THA, female gender, dementia, obesity, renal and cerebrovascular disease. An increased association with PE was found among patients with diagnosis of Adult Respiratory Distress Syndrome (ARDS), psychosis (confusion), and peripheral thrombotic events. Our findings may be useful in stratifying the individual patient’s risk of PE after surgery. PMID:18925395

  6. Low-dose tenecteplase during cardiopulmonary resuscitation due to massive pulmonary embolism: a case report and review of previously reported cases.

    Science.gov (United States)

    Hefer, David Václav Fred; Munir, Aman; Khouli, Hassan

    2007-10-01

    The case of a 29 year-old man who suffered a cardiac arrest due to a massive pulmonary embolism while he was undergoing surgical repair of a complex tibial plateau fracture is presented. After 70 min of unsuccessful cardiopulmonary resuscitation a bolus of 20 mg tenecteplase was given, with a return of spontaneous circulation 2 min after administration of the drug. Pulmonary embolism was subsequently demonstrated on a pulmonary angiogram. To our knowledge this is the first report to show that the use of a low dose of tenecteplase might be useful to achieve the return of spontaneous circulation in the resuscitation of patients with cardiac arrest secondary to massive pulmonary embolism. Previously reported cases are reviewed.

  7. Pulmonary embolism in a wounded with mine blast injury against the background of anticoagulant prophylaxis (case report

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    K. N. Nikolaev

    2015-01-01

    Full Text Available Venous thrombosis and pulmonary embolism in healthy military are rare. Fighting surgical trauma is the trigger of a cascade of defense reactions of the body and the blood coagulation system, leading to stop bleeding. Hemostatic disorders, shifting the equilibrium toward hypercoagulable state, the emergence of the risk factors associated with the injury, lead to uncontrolled thrombosis with subsequent development of venous thromboembolic complications. We present the case of the left pulmonary artery thromboembolism in 41 year old wounded with a gunshot fracture of the right femur, obtained by blowing an unknown explosive device. Medical assistance was provided in three stages of evacuation. In order to stabilize a femur fracture the external fixation device was used. According coagulogram thrombinemia persisted for more than 30 days. Prevention of thrombosis carried LMWH (Clexane, with 9 days after injury. 31 day angiography was performed computer, identified thrombus by 70% ceiling clearance left pulmonary artery; by ultrasound scanning of the veins of the lower limbs was diagnosed asymptomatic thrombosis of the right iliofemoral. Against the background of complex treatment for 67 hours after the injury occurred recanalization. This case shows that the injured limb wound clinical symptoms of the disease symptoms negate venous thrombosis, which becomes the only manifestation of pulmonary embolism. Prevention of venous thromboembolic events, as well as monitoring of its effectiveness, should be carried out at all stages of the evacuation of the wounded and for the entire period of the presence of risk factors for their development.

  8. Application of labeled radioimmunoimaging tracing in detecting pulmonary embolism in rabbits after bone cement perfusion and relevant treatment effects

    Institute of Scientific and Technical Information of China (English)

    QI Xiang-bei; ZHANG Ying-ze; PAN Jin-she; MA Li-jie; WANG Jian-zhao; WANG Lin

    2011-01-01

    Background During the process of bone cement joint replacement,some patients show a series of complications,such as a sudden drop in blood pressure or dyspnea.The cause of the complication is considered to be due to emboli caused by the femur prosthesis insertion.The purpose of the present study was to detect the pulmonary embolism in rabbits after bone cement perfusion by radioimmunoimaging,and to explore its protective measures.Methods Forty rabbits,2.5-3.0 kg weight,were randomly assigned to four groups,with ten rabbits in each group.Group Ⅰ (no intervention):Bone cement perfusion was done after medullary cavity reaming and pressurizing.Group Ⅱ (epinephrine hydrochloride intervention):The medullary cavity was rinsed with a 1:10000 normal saline-diluted epinephrine hydrochloride solution followed by bone cement perfusion after medullary cavity reaming and pressurizing.Group Ⅲ (fibrin sealant intervention):The medullary cavity was precoated with fibrin sealant followed by bone cement perfusion after medullary cavity reaming and pressurizing.Group Ⅳ (blank control group):The medullary cavity was not perfused with bone cement after reaming.In each group,the rabbits underwent femoral head resection and medullary cavity reaming.Before bone cement perfusion,2 ml of developing tracer was injected through the ear vein.Radionuclide imaging was performed at 60,120,and 180 minutes after bone cement perfusion,and the pulmonary radioactivity in vivo was measured.The rabbits were immediately sacrificed,and the pulmonary tissue was removed and its radioactivity was measured in vitro.Pulmonary tissue was then fixed and the pulmonary embolism and the associated pathological changes were observed.Results The pulmonary radioactivity in vivo was measured at 60,120,and 180 minutes after bone cement perfusion.The radioactivities of the four groups were 11.67±2.16,14.59±2.92 and 18.43±4.83 in group Ⅰ; 8.37±3.05,10.35±2.24 and 11.48±2.96 in group Ⅱ; 3.91±1.19,5.53±2

  9. Relative risk of pulmonary embolism in the very elderly compared with the elderly

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    Yayan J

    2013-07-01

    Full Text Available Josef Yayan Department of Internal Medicine, University Hospital of Saarland, Homburg/Saar, Germany Background: Pulmonary embolism (PE can be an acute, life-threatening emergency, and studies suggest that advanced age is a risk factor for this condition. However, the literature is scarce regarding PE in patients above the age of 90 years. This study examined the relative risk for PE in the very elderly (>90 years compared with that in the elderly (80–89 years. Methods: A retrospective study was performed examining very elderly patients diagnosed with PE in the Department of Internal Medicine at the University Hospital Homburg/Saar in Germany between 2004 and 2012. Elderly patients (aged 80–89 years diagnosed with PE served as controls. PE was confirmed by contrast-enhanced chest computed tomography or ventilation perfusion scintigraphy in both groups. A total of 2230 patients were examined for PE in this study. Of these, 15 (0.67% in the study group and 197 (8.83% in the control group underwent further evaluation for PE. Results: After performing a radiological examination, 11 (73.3%, including six [54.55%] women of the 15 study patients (mean age 91.6 ± 1.67 years and 148 (75.1%, including 93 [62.84%] women of the 197 controls (mean age 84.0 ± 2.59 years were confirmed to have PE. There was a significantly lower proportion of the very elderly enrolled in the study (P < 0.001. There were no significant differences in clinical presentation, cardiovascular risk factors, electrocardiograms, blood gas analyses, radiological diagnoses, or acute comorbidities between the groups. However, the very elderly were more likely to experience minor bleeding in the extremities (P = 0.016 and to have more chronic diseases (P < 0.001. An increased relative risk of PE was not detected in the very elderly (relative risk 0.98, P = 0.88. Furthermore, d-dimer, troponin T, and high-sensitive troponin T levels had limited predictive value for PE in the very

  10. Successful Off-Label Use of Recombinant Factor VIIa and Coil Embolization in an Adolescent with Massive Hemoptysis Due to Invasive Pulmonary Aspergillosis

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    Dilek Gürlek Gökçebay

    2015-03-01

    Full Text Available Invasive fungal infections have turned out to be a significant cause of morbidity and mortality in pediatric patients with malignant disorders. Massive hemoptysis, a rare complication of invasive pulmonary aspergillosis, may threaten the lives of patients, usually during the resolution of neutropenia. In this report, we describe a patient with massive hemoptysis due to invasive pulmonary aspergillosis whose bleeding was controlled successfully with off-label use of recombinant factor VIIa and subsequent coil embolization of the right pulmonary artery.

  11. Progress in the study of the pulmonary embolism in congestive heart failure%心力衰竭并发肺动脉栓塞研究进展

    Institute of Scientific and Technical Information of China (English)

    陈远刚

    2014-01-01

    Many clinical manifestations of congestive heart failure are similar to that of pulmonary embolism. Pulmonary embolism is a common complication of heart failure. The prognosis will be worse when a heart failure patient was complicated with pulmonary embolism. Here we briefly review the progress in the study of the pulmonary embolism in congestive heart failure from the aspects of etiopathogenisis,risk factor,clinical manifestation,diagnosis and prognosis,precaution and treatment. We hope that it may provide some informa-tion and study strategies for the diagnosis and precaution of the pulmonary embolism in congestive heart failure.%充血性心力衰竭(CHF)在许多临床表现上与肺动脉栓塞相似,而前者易并发后者,两者一旦合并存在,即提示患者预后更为恶劣。该文从发病原因、危险因素、临床表现、诊断与预后、预防及治疗等方面复习近年心力衰竭并发肺动脉栓塞研究进展,以期能在诊断及预防CHF并发肺动脉栓塞等方面提供相关的信息和思路。

  12. Therapeutic Dilemmas Regarding Anticoagulation: An Experience in a Patient with Nephrotic Syndrome, Pulmonary Embolism, and Traumatic Brain Injury

    Science.gov (United States)

    Akimoto, Tetsu; Yamazaki, Tomoyuki; Kusano, Eiji; Nagata, Daisuke

    2016-01-01

    Patients with active bleeding complications who concomitantly develop overt pulmonary embolism (PE) present distinct therapeutic dilemmas, since they are perceived to be at substantial risk for the progression of the embolism in the absence of treatment and for aggravation of the hemorrhagic lesions if treated with anticoagulants. A 76-year-old patient with nephrotic syndrome, which is associated with an increased risk of thromboembolism, concurrently developed acute PE and intracranial bleeding because of traumatic brain injury. In this case, we prioritized the treatment for PE with the intravenous unfractionated heparin followed by warfarinization. Despite the transient hemorrhagic progression of the brain contusion after the institution of anticoagulation, our patient recovered favorably from the disease without any signs of neurological compromise. Several conundrums regarding anticoagulation that emerged in this case are also discussed. PMID:27840582

  13. Cerebral air embolism as a complication of computed tomography-guided marking of the lung: depiction of air inflow route from a pulmonary vein to the left atrium.

    Science.gov (United States)

    Higashino, Takanori; Noma, Satoshi; Nishimoto, Yuko; Endo, Junki; Taguchi, Yoshio; Shindo, Toru

    2011-02-01

    Air embolism in the arterial system is a very rare but potentially fatal complication of percutaneous transthoracic needle biopsy or marking. We report a case of a patient with interstitial pneumonia associated with Sjögren syndrome, who presented with systemic arterial air embolism as a complication of computed tomography-guided marking of the lung. The air inflow route was depicted clearly on computed tomography from the peripheral pulmonary vein that crossed the needle pathway to the left atrium.

  14. Lung infarction following pulmonary embolism. A comparative study on clinical conditions and CT findings to identify predisposing factors

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    Kirchner, J.; Obermann, A.; Stueckradt, S.; Tueshaus, C. [General Hospital Hagen (Germany). Radiology; Goltz, J.; Kickuth, R. [University Hospital Wuerzburg (Germany). Radiology; Liermann, D. [University Hospital Marienhospital Herne (Germany). Radiology

    2015-06-15

    The aim of this study was to identify factors predisposing to lung infarction in patients with pulmonary embolism (PE). We performed a retrospective analysis on 154 patients with the final diagnosis of PE being examined between January 2009 and December 2012 by means of a Toshiba Aquilion 64 CT scanner. The severity of clinical symptoms was defined by means of a clinical index with 4 classes. The pulmonary clot load was quantified using a modified severity index of PE as proposed by Miller. We correlated several potential predictors of pulmonary infarction such as demographic data, pulmonary clot burden, distance of total vascular obstruction and pleura, the presence of cardiac congestion, signs of chronic bronchitis or emphysema with the occurrence of pulmonary infarction. Computed tomography revealed 78 areas of pulmonary infarction in 45/154 (29.2%) patients. The presence of infarction was significantly higher in the right lung than in the left lung (p < 0.001). We found no correlation between pulmonary infarction and the presence of accompanying malignant diseases (r=-0.069), signs of chronic bronchitis (r=-0.109), cardiac congestion (r=-0.076), the quantified clot burden score (r=0.176), and the severity of symptoms (r=-0.024). Only a very weak negative correlation between the presence of infarction and age (r=-0.199) was seen. However, we could demonstrate a moderate negative correlation between the distance of total vascular occlusion and the occurrence of infarction (r=-0.504). Neither cardiac congestion nor the degree of pulmonary vascular obstruction are main factors predisposing to pulmonary infarction in patients with PE. It seems that a peripheral total vascular obstruction more often results in infarction than even massive central clot burden.

  15. Preliminary investigation of diagnosis and treatment of pulmonary embolism in Chongqing in recent ten years%重庆市近10年肺栓塞诊治情况初步调查

    Institute of Scientific and Technical Information of China (English)

    古正凤; 韩晓黎; 陈虹; 重庆市PTE-DVT防治协作组

    2015-01-01

    Objective To investigate the status of diagnosis and treatment of pulmonary embolism in hospitals of Chongqing in recent ten years in order to provide evidences for the rational organization of pulmonary embolism training and improvement of the level of pulmonary embolism diagnosis and treatment.Methods Samples from 30 hospitals in Chongqing (15 tertiary hospitals,15 second-class hospitals) by convenience sampling method were investigated.The investigation included number of patients with pulmonary embolism from 2003 to 2012,medical conditions,prevention and screening of pulmonary embolism.Results ①The total number of pulmonary embolism diagnosis cases in nearly ten years was 703 (512 cases in tertiary hospitals,191 cases in second-class hospitals),of whom 581 cases were diagnosed in clinic,122 cases were confirmed.The definite diagnosis rate was 17.35%.②With the time,pulmonary embolism diagnosis cases increased gradually,dramatically increased in 2009-2012.③ The unmber of hospitals in which pulmonary embolism could be diagnosed had increased year by year except six hospitals.④ All of the investigated hospitals could carry out biochemical and imaging examinations such as D-dimer,blood gas analysis,myocardial injury markers,activated partial thromboplastin time,international normalized ratio,lower limb vascular ultrasound,cardiac ultrasound,and enhancement CT.All the investigated hospitals had the essential medicines,such as heparin,low molecular heparin,warfarin,and urokinase.⑤17 hospitals could conduct CT pulmonary angiography,including eight hospitals for clinical diagnosis.⑥The eight investigated hospitals conducted pulmonary embolism risk assessment with relevant scale table in some departments.Conclusions The consciousness of pulmonary embolism diagnosis has been gradually improved for the most hospital medical staffs from 2003 to 2012 in Chongqing,but the consciousness of prevention and screening high-risk patients with pulmonary embolism is

  16. Different risk of deep vein thrombosis and pulmonary embolism in carriers with factor V Leiden compared with non-carriers, but not in other thrombophilic defects. Results from a large retrospective family cohort study

    NARCIS (Netherlands)

    Makelburg, Anja B. U.; Veeger, Nic J. G. M.; Middeldorp, Saskia; Hamulyak, Karly; Prins, Martin H.; Buller, Harry R.; Lijfering, Willem M.

    2010-01-01

    The term factor V Leiden (FVL) paradox is used to describe the different risk of deep vein thrombosis and pulmonary embolism that has been found in carriers of FVL. In a thrombophilic family-cohort, we estimated differences in absolute risks of deep vein thrombosis and pulmonary embolism for various

  17. Pulmonary embolism excluded acute coronary syndrome by coronarography: a retrospective analysis

    Institute of Scientific and Technical Information of China (English)

    LIU Chun-ping; LI Jun-xia; NIU Li-li; CHEN Hang-wei; TAN Bo; WANG Ya-ping

    2012-01-01

    Background Pulmonary embolism (PE) is often mistaken as acute coronary syndromes (ACS) because of the considerable overlap in their clinical features.We evaluated the factors causing misdiagnosis of PE as ACS and factors that differentiate PE from ACS to improve the diagnosis efficacy of PE.Methods The medical records of 22 consecutive PE patients,between 2001 and 2010,who were initially suspected of ACS were retrieved.ACS was ruled out by coronary artery angiography before a definite diagnosis of PE was given.Twenty-two contemporary cases of ACS matched by age and sex were recruited as controls.Clinical manifestations,electrocardiograms (ECG),and biomarkers of these patients were reviewed retrospectively.The factors causing misdiagnosis of PE as ACS and factors differentiating PE from ACS were evaluated.Results We found two leading causes of misdiagnosis of PE as ACS.One is that PE can resemble ACS in several clinical aspects (symptoms and signs,ECG findings,plasma cardiac troponin I,and D-dimer).The other is the insufficient recognition of PE by clinicians.Risk factors for venous thromboembolism (VTE),especially deep venous thrombosis (DVT),together with signs of PE,such as unexplained dyspnea or hypoxemia,and right ventricular pressure overload on ECGs are valuable in differentiating the two diseases.Conclusions Differentiation between PE and ACS is sometimes challenging.Adequate awareness of the risk factors for VTE and the signs of PE are crucial in the diagnosis of PE.

  18. Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism

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    Wolfe Rory

    2006-06-01

    Full Text Available Abstract Background The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. Methods A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002 were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. Results The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. Conclusion Extrapolating the observed cost-savings of $59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to $3.7 million.

  19. An Independent Risk of Gout on the Development of Deep Vein Thrombosis and Pulmonary Embolism

    Science.gov (United States)

    Huang, Chien-Chung; Huang, Po-Hao; Chen, Jiunn-Horng; Lan, Joung-Liang; Tsay, Gregory J.; Lin, Hsiao-Yi; Tseng, Chun-Hung; Lin, Cheng-Li; Hsu, Chung-Yi

    2015-01-01

    Abstract Previous studies indicated that gout is a risk factor of cardiovascular diseases. This study aimed to determine if patients with gout have an increased risk of deep vein thrombosis (DVT) or pulmonary embolism (PE). We used the Longitudinal Health Insurance Database, a subset of the national insurance claim dataset, which enrolled 1 million Taiwanese to identify 57,981 patients with gout and 115,961 reference subjects matched by sex, age, and entry date of diagnosis. The risk of DVT and PE was analyzed using the Cox proportional hazards model. In this Taiwanese dataset observed from 2000 to 2010, we found the incidence of DVT was 5.26 per 104 person-years in the gout cohort, which was twofold higher than the incidence of 2.63 per 104 person-years in the reference cohort. After adjusting for age, sex, and 9 comorbidities, the hazard ratio (HR) of developing DVT was 1.66 (95% confidence interval [CI] = 1.37–2.01). Among patients with gout, the youngest age group had the highest increase in the risk of developing DVT (HR [95% CI] = 2.04 [1.24–3.37] for ages 20 to 49 years, 1.80 [1.28–2.51] for ages 50 to 64 years, and 1.45 [1.11–1.91] for ages ≥65 years). The incidence of PE was about one-fifth that of DVT in gout patients, but the effect of gout on the risk was similar (HR [95% CI] = 1.53 [1.01–2.29]). Our analysis confirmed that gout increased the risk of DVT and PE. Further exploration is needed in the future. PMID:26705202

  20. Fibrinolysis for Acute Care of Pulmonary Embolism in the Intermediate Risk Patient.

    Science.gov (United States)

    Meyer, Guy; Planquette, Benjamin; Sanchez, Olivier

    2015-12-01

    Controversy over the role of fibrinolysis in patients with intermediate-risk pulmonary embolism (PE) has persisted because of the lack of adequately sized trials. The PEITHO study now allows a more precise estimate of the risk to benefit ratio of fibrinolysis in these patients. This trial enrolled patients with intermediate-risk PE who were randomized to receive heparin with either tenecteplase or placebo. Fibrinolysis was associated with a significant reduction in the combined end-point of death or hemodynamic decompensation, but also with a significant increase in the risk of major bleeding. The primary efficacy end-point occurred in 2.6 % of the patients in the tenecteplase group and in 5.6 % of the patients in the placebo group (OR, 0.44; 95 % CI, 0.23 to 0.87), conversely, major extracranial bleeding occurred in 6.3 % and 1.2 % in the tenecteplase and placebo groups, respectively (OR, 5.55; 95 % CI, 2.3 to 13.39) and stroke occurred in 2.4 % and in 0.2 % of the patients in the tenecteplase group and in the placebo group, respectively (OR, 12.10; 95 % CI, 1.57 to 93.39). No difference was observed for the risk of death alone and the risk of full-dose thrombolytic therapy outweighs its benefit in patients with intermediate-risk PE. Recent meta-analyses suggest that fibrinolysis may be associated with a slight reduction in overall mortality offset by an increase in major bleeding. Two pilot studies suggest that a reduced dose of fibrinolysis may produce significant hemodynamic improvement with a low risk of major bleeding. These options need to be evaluated in larger studies including patients with a higher risk of adverse outcome than those included in the PEITHO study.

  1. Pulmonary Embolism Mortality in Brazil from 1989 to 2010: Gender and Regional Disparities

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    Eduardo Sahade Darze

    2015-01-01

    Full Text Available AbstractBackground:A significant variation in pulmonary embolism (PE mortality trends have been documented around the world. We investigated the trends in mortality rate from PE in Brazil over a period of 21 years and its regional and gender differences.Methods:Using a nationwide database of death certificate information we searched for all cases with PE as the underlying cause of death between 1989 and 2010. Population data were obtained from the Brazilian Institute of Geography and Statistics (IBGE. We calculated age-, gender- and region-specific mortality rates for each year, using the 2000 Brazilian population for direct standardization.Results:Over 21 years the age-standardized mortality rate (ASMR fell 31% from 3.04/100,000 to 2.09/100,000. In every year between 1989 and 2010, the ASMR was higher in women than in men, but both showed a significant declining trend, from 3.10/100,000 to 2.36/100,000 and from 2.94/100,000 to 1.80/100,000, respectively. Although all country regions showed a decline in their ASMR, the largest fall in death rates was concentrated in the highest income regions of the South and Southeast Brazil. The North and Northeast regions, the lowest income areas, showed a less marked fall in death rates and no distinct change in the PE mortality rate in women.Conclusions:Our study showed a reduction in the PE mortality rate over two decades in Brazil. However, significant variation in this trend was observed amongst the five country regions and between genders, pointing to possible disparities in health care access and quality in these groups.

  2. Comparative proteome analysis of serum from acute pulmonary embolism rat model for biomarker discovery.

    Science.gov (United States)

    Li, Sheng-qing; Yun, Jun; Xue, Fu-bo; Bai, Chang-qing; Yang, Shu-guang; Que, Hai-ping; Zhao, Xin; Wu, Zhe; Wang, Yu; Liu, Shao-jun

    2007-01-01

    Pulmonary embolism (PE) is a common, potentially fatal disease and its diagnosis is challenging because clinical signs and symptoms are nonspecific. In this study, to investigate protein alterations of a rat PE model, total serum proteins collected at different time points were separated by two-dimensional electrophoresis (2-DE) and identified using matrix assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Bioinformatics analysis of 24 differentially expressed proteins showed that 20 had corresponding protein candidates in the database. According to their properties and obvious alterations after PE, changes of serum concentrations of Hp, Fn, DBP, RBP, and TTR were selected to be reidentified by western blot analysis. Semiquantitative RT-PCR showed DBP, RBP, and TTR to be down-regulated at mRNA levels in livers but not in lung tissues. The low serum concentrations of DBP, RBP, and TTR resulted in the up-regulation of 25(OH)D3, vitamin A, and FT4 (ligands of DBP, RBP, and TTR) after acute PE in rat models. The serum levels of Hp and Fn were detected in patients with DVT/PE and controls to explore their diagnostic prospects in acute PE because the mRNA levels of Hp and Fn were found to be up-regulated both in lung tissues and in livers after acute PE. Our data suggested that the concentration of serum Fn in controls was 79.42 +/- 31.57 microg/L, whereas that of PE/DVT patients was 554.43 +/- 136.18 microg/L (P PE/DVT patients was 2063.48 +/- 425.38 mg/L (P diagnosis of acute PE, but diagnostic tests are still needed to evaluate the sensitivity and specificity of these markers and also the number of false positives and false negatives.

  3. MicroRNA-134 as a potential plasma biomarker for the diagnosis of acute pulmonary embolism

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    Liu Yi

    2011-09-01

    Full Text Available Abstract Background Acute pulmonary embolism (APE remains a diagnostic challenge due to a variable clinical presentation and the lack of a reliable screening tool. MicroRNAs (miRNAs regulate gene expression in a wide range of pathophysiologic processes. Circulating miRNAs are emerging biomarkers in heart failure, type 2 diabetes and other disease states; however, using plasma miRNAs as biomarkers for the diagnosis of APE is still unknown. Methods Thirty-two APE patients, 32 healthy controls, and 22 non-APE patients (reported dyspnea, chest pain, or cough were enrolled in this study. The TaqMan miRNA microarray was used to identify dysregulated miRNAs in the plasma of APE patients. The TaqMan-based miRNA quantitative real-time reverse transcription polymerase chain reactions were used to validate the dysregulated miRNAs. The receiver-operator characteristic (ROC curve analysis was conducted to evaluate the diagnostic accuracy of the miRNA identified as the candidate biomarker. Results Plasma miRNA-134 (miR-134 level was significantly higher in the APE patients than in the healthy controls or non-APE patients. The ROC curve showed that plasma miR-134 was a specific diagnostic predictor of APE with an area under the curve of 0.833 (95% confidence interval, 0.737 to 0.929; P Conclusions Our findings indicated that plasma miR-134 could be an important biomarker for the diagnosis of APE. Because of this finding, large-scale investigations are urgently needed to pave the way from basic research to clinical utilization.

  4. Efficacy and safety of 2-hour urokinase regime in acute pulmonary embolism: a randomized controlled trial

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    Huang Kewu

    2009-12-01

    Full Text Available Abstract Backgrounds Urokinase (UK 2 200 U/kg·h for 12 hours infusion(UK-12 his an ACCP recommended regimen in treating acute pulmonary embolism (PE. It is unclear whether this dose and time can be reduced further. We compared the efficacy and safety of 20, 000 U/kg for 2 hours (UK-2 h with the UK-12 h regime in selected PE patients. Methods A randomized trial involving 129 patients was conducted. Patients with acute PE were randomly assigned to receive either UK-12 h (n = 70, or UK-2 h (n = 59. The efficacy was determined by the improvement of right heart dysfunction and perfusion defect at 24 h and 14 d post UK treatment. The bleeding incidence, death rate and PE recurrence were also evaluated. Results Similarly significant improvements in right heart dysfunction and lung perfusion defects were observed in both groups. Overall bleeding incidents were low in both groups. Major bleeding directly associated with UK infusion occurred in one patient in the UK-2 h group and one in the UK-12 h group. Mortality rates were low, with one reported fatal recurrent in the UK-12 h group and none in the UK-2 h group. When the rate of bleeding, death and PE recurrence were compared separately in the hemodynamic instability and the massive anatomic obstruction subgroups, no significant difference was found. Conclusions The UK-2 h regimen exhibits similar efficacy and safety as the UK-12 h regimen for acute PE. Trial Registration Clinical trial registered with http://clinicaltrials.gov/ct2/show/NCT00799968 (Identifier: NCT 00799968

  5. Electrocardiogram Changes and Significance of Acute Pulmonary Embolism%急性肺栓塞心电图的改变及意义

    Institute of Scientific and Technical Information of China (English)

    黄玉江(综述); 徐俊波; 胡咏梅(审校)

    2015-01-01

    急性肺栓塞心电图常有QRS波异常、心律失常、ST-T异常和肺型P波等表现,心电图虽缺乏特异性,但在入院早期及时可行,可作为急性肺栓塞患者的筛查工具,提高肺栓塞的诊断率,有利于早期发现肺栓塞并及时采取正确的处理以改善患者预后。%Acute pulmonary embolism’s electrocardiogram changes include QRS extraordinary wave,arrhythmia,ST-T extraordinary, changes of pulmonary P-wave,etc.Although the electrocardiogram changes of acute pulmonary embolism lack of specificity,but it is a timely manner in the early admission and can be used as a screening tool in patients with acute pulmonary embolism.In order to improve the diagno-sis rate of pulmonary embolism, it conducive to early detection of pulmonary embolism and take timely and correct processing to improve the prognosis of patients.

  6. Efficacy and Safety of Thrombolytic Therapy in Acute Submassive Pulmonary Embolism: Follow-Up Study

    Science.gov (United States)

    Sinha, Santosh Kumar; Sachan, Mohit; Goel, Amit; Singh, Karandeep; Mishra, Vikas; Jha, Mukesh Jitendra; Kumar, Ashutosh; Abdali, Nasar; Asif, Mohammad; Razi, Mahamdula; Pandey, Umeshwar; Thakur, Ramesh; Varma, Chandra Mohan; Krishna, Vinay

    2017-01-01

    Background Thrombolysis in acute submassive pulmonary embolism (PE) remains controversial. So we studied impact of thrombolytic therapy in acute submassive PE in terms of mortality, hemodynamic status, improvement in right ventricular function, and safety in terms of major and minor bleeding. Method A single-center, prospective, randomized study of 86 patients was conducted at LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, India. Patients received thrombolysis (single bolus of tenecteplase) with unfractionated heparin (UFH, group I) or placebo with UFH (group II). Result Mean age of patients was 54.35 ± 12.8 years with male dominance (M:F = 70%:30%). Smoking was the most common risk factor seen in 29% of all patients, followed by recent history of immobilization (25%), history of surgery or major trauma within past 1 month (15%), dyslipidemia (10%) and diabetes mellitus (10%). Dyspnea was the most common symptom in 80% of all patients, followed by chest pain in 55% and syncope in 6%. Primary efficacy outcome occurred significantly better in group I vs. group II (4.5% vs. 20%; P = 0.04), and significant difference was also found in hemodynamic decompensation (4.5% vs. 20%; P = 0.04), the fall in mean pulmonary artery systolic pressure (PASP) (28.8% vs. 22.5%; P = 0.03), improvement in right ventricular (RV) function (70% vs. 40%; P = 0.001) and mean hospital stay (8.1 ± 2.5 vs. 11.1 ± 2.14 days; P = 0.001). There was no difference in mortality and major bleeding as safety outcome but increased minor bleeding occurred in group I patients (16% vs. 12%; P = 0.04). Conclusion Patients with acute submassive PE do not derive overall mortality benefit, recurrent PE and rehospitalization with thrombolytic therapy but had improved clinical outcome in form of decrease in hemodynamic decompensation, mean hospital stay, PASP and improvement of RV function with similar risk of major bleed but at cost of increased minor bleeding. PMID:28090232

  7. Venous Fragment Embolism to the Pulmonary Artery: A Rare Occurrence - Case Report and Literature Review of Venous Fragment Embolization to the Pulmonary Artery

    Science.gov (United States)

    2009-09-01

    approx 8x9mm. Angiography revealed a left popliteal artery aneurysm and left popliteal vein disruption. Whether the fragment originated from the...complications such as hemorrhage at insertion site, cardiac dysrhythmias, and ruptured aortic aneurysm . Technique failure requiring venotomy can occur...embolization in childhood: report of a case, literature review, and recommendations for management. J Pediatr Surg. 1990 Dec;25(12):1292-4. 28 Shannon FL

  8. Concurrent administration of heparin and activated protein C in a patient with pulmonary embolism and severe sepsis with positive outcome

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    Juneja Deven

    2009-01-01

    Full Text Available Results of the PROWESS trial suggested that heparin may reduce the efficacy of recombinant human activated protein C (rhAPC and the XPRESS study also showed increased bleeding complications in patients receiving heparin with rhAPC. Although it has been shown that heparin prophylaxis may be used along with rhAPC, no study has shown the interaction between continuous heparin infusion and rhAPC. Here, we report a case of severe sepsis with pulmonary embolism who was concurrently administered heparin and rhAPC infusions, with positive results and no bleeding complications.

  9. Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet.

    Science.gov (United States)

    Noly, Pierre-Emmanuel; Guihaire, Julien; Coblence, Matthieu; Dorfmüller, Peter; Fadel, Elie; Mercier, Olaf

    2015-11-04

    An original piglet model of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) associated with chronic Right Ventricular (RV) dysfunction is described. Pulmonary Hypertension (PH) was induced in 3-week-old piglets by a progressive obstruction of the pulmonary vascular bed. A ligation of the left Pulmonary Artery (PA) was performed first through a mini-thoracotomy. Second, weekly embolizations of the right lower pulmonary lobe were done under fluoroscopic guidance with n-butyl-2-cyanoacrylate during 5 weeks. Mean Pulmonary Arterial Pressure (mPAP) measured by ritght heart catheterism, increased progressively, as well as Right Atrial pressure and Pulmonary Vascular Resistances (PVR) after 5 weeks compared to sham animals. Right Ventricular (RV) structural and functional remodeling were assessed by transthoracic echocardiography (RV diameters, RV wall thickness, RV systolic function). RV elastance and RV-pulmonary coupling were assessed by Pressure-Volume Loops (PVL) analysis with conductance method. Histologic study of the lung and the right ventricle were also performed. Molecular analyses on RV fresh tissues could be performed through repeated transcutaneous endomyocardial biopsies. Pulmonary microvascular disease in obstructed and unobstructed territories was studied from lung biopsies using molecular analyses and pathology. Furthermore, the reliability and the reproducibility was associated with a range of PH severity in animals. Most aspects of the human CTEPH disease were reproduced in this model, which allows new perspectives for the understanding of the underlying mechanisms (mitochondria, inflammation) and new therapeutic approaches (targeted, cellular or gene therapies) of the overloaded right ventricle but also pulmonary microvascular disease.

  10. Fontan's circulation with dextrocardia, recent pulmonary embolism, and inferior vena cava filter: Anesthetic challenges for urgent hysterectomy.

    Science.gov (United States)

    Singh, Preet Mohinder; Borle, Anuradha; Ramachandran, Rashmi; Trikha, Anjan; Goudra, Basavana Gouda

    2016-01-01

    Fontan's circulation is a unique challenge for the anesthesiologist. Venous pressure is the only source of blood flow for the pulmonary circulation. Patients with such circulation are extremely sensitive to progression of cyanosis (decreased pulmonary blood flow) or circulatory failure. Any major venous compression can compromise the pulmonary blood flow worsening cyanosis; simultaneously, an increased afterload can precipitate circulatory failure. We present a rare patient of surgically corrected Ivemark syndrome with Fontan's physiology with dextrocardia who developed a large uterine fibroid compressing inferior vena cava (IVC). As a result of compression, not only the pulmonary circulation was compromised but she also developed stasis-induced venous thrombosis in the lower limbs that lead to pulmonary embolism (PE) (increased afterload). In addition to oral anticoagulation an IVC filter was inserted to prevent ongoing recurrent PE. Further, to prevent both circulatory compromise and deep venous thrombosis an urgent myomectomy/hysterectomy was planned. In the present case, we discuss the issues involved in the anesthetic management of such patients and highlight the lacunae in the present guidelines for managing perioperative anticoagulation these situations.

  11. Fontan′s circulation with dextrocardia, recent pulmonary embolism, and inferior vena cava filter: Anesthetic challenges for urgent hysterectomy

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    Preet Mohinder Singh

    2016-01-01

    Full Text Available Fontan′s circulation is a unique challenge for the anesthesiologist. Venous pressure is the only source of blood flow for the pulmonary circulation. Patients with such circulation are extremely sensitive to progression of cyanosis (decreased pulmonary blood flow or circulatory failure. Any major venous compression can compromise the pulmonary blood flow worsening cyanosis; simultaneously, an increased afterload can precipitate circulatory failure. We present a rare patient of surgically corrected Ivemark syndrome with Fontan′s physiology with dextrocardia who developed a large uterine fibroid compressing inferior vena cava (IVC. As a result of compression, not only the pulmonary circulation was compromised but she also developed stasis-induced venous thrombosis in the lower limbs that lead to pulmonary embolism (PE (increased afterload. In addition to oral anticoagulation an IVC filter was inserted to prevent ongoing recurrent PE. Further, to prevent both circulatory compromise and deep venous thrombosis an urgent myomectomy/hysterectomy was planned. In the present case, we discuss the issues involved in the anesthetic management of such patients and highlight the lacunae in the present guidelines for managing perioperative anticoagulation these situations.

  12. Elevated d-dimer cut-off values for computed tomography pulmonary angiography—d-dimer correlates with location of embolism

    Science.gov (United States)

    Kubak, Mateuzs Piotr; Borthne, Arne; Ruud, Espen Asak; Ashraf, Haseem

    2016-01-01

    Background Acute pulmonary embolism (APE) is a potentially fatal condition, and making a timely diagnosis can be challenging. Computed tomography pulmonary angiography (CTPA) has become the modality of choice, and this contributes to the increasing load on emergency room CT scanners. Our purpose was to investigate whether an elevated d-dimer cut-off could reduce the demand for CTPA while maintaining a high sensitivity and negative predictive value (NPV). Methods We retrospectively reviewed all patients referred for CTPA with suspicion of APE in 2012, and collected d-dimer values and CTPA results. We investigated the diagnostic performance of d-dimer using a 0.5 mg/L cut-off and an age adjusted cut-off. We also evaluated a new and elevated cut-off. Cases were categorized according to their CTPA result into: no embolism, peripheral embolism, lobar embolism and central embolism. Finally we investigated a possible correlation between d-dimer values and location of embolism. Results We included 1,051 CTPAs, from which 216 (21%) showed pulmonary embolism. There were concomitant d-dimer analyses in 822 CTPA examinations. The current 0.5 mg/L cut-off achieved a sensitivity and NPV of 99%. The age-adjusted cut-off achieved a sensitivity and NPV of 98%, and our suggested cut-off of 0.9 mg/L achieved a sensitivity and NPV of 97%. Conclusions We conclude that the elevated d-dimer cut-off of 0.9 mg/L achieved a high sensitivity and NPV, while reducing the number of CTPA by 27%. The correlation between d-dimer values and location of embolisms supports the suggestion of an elevated d-dimer value. PMID:27386486

  13. Infective endocarditis and septic pulmonary embolism following scorpion sting envenoming in an 11-year-old child.

    Science.gov (United States)

    Prakash, Vellasamy; Krishnamurthy, Sriram; Mahadevan, Subramanian; Bethou, Adhisivam; Deepak Barathi, S

    2014-05-01

    Scorpion sting is one of the common paediatric toxicological problems encountered in southern India. This rural emergency often results in an autonomic storm causing peripheral circulatory failure and/or congestive cardiac failure, leading to pulmonary oedema. A rare case of scorpion sting envenoming in an 11-year-old boy that led to local cellulitis, dyspnoea and congestive heart failure is presented. This was followed by a persistent high-grade fever which lasted for more than 2 weeks and was complicated by fatal Staphylococcus aureus infective endocarditis and septic pulmonary embolism. Although infective endocarditis has been reported occasionally in adults following scorpion sting, this is the first case of infective endocarditis in a native valve in a child following scorpion sting. The literature is reviewed and the mechanisms for this association are discussed.

  14. Benefit of combining quantitative cardiac CT parameters with troponin I for predicting right ventricular dysfunction and adverse clinical events in patients with acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, Mathias, E-mail: mr.meyer.mathias@gmail.com [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Fink, Christian, E-mail: Christian.Fink@umm.de [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Roeger, Susanne, E-mail: susanne.roeger@umm.de [1st Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Apfaltrer, Paul, E-mail: Paul.Apfaltrer@umm.de [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Haghi, Dariush, E-mail: dariush.haghi@umm.de [1st Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Kaminski, Wolfgang E., E-mail: wolfgang.kaminski@umm.de [Department of Clinical Chemistry, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Neumaier, Michael, E-mail: michael.neumaier@medma.uni-heidelberg.de [Department of Clinical Chemistry, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Schoenberg, Stefan O., E-mail: Stefan.Schoenberg@umm.de [Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); and others

    2012-11-15

    Objective: To prospectively evaluate the diagnostic accuracy of quantitative cardiac CT parameters alone and in combination with troponin I for the assessment of right ventricular dysfunction (RVD) and adverse clinical events in patients with acute pulmonary embolism (PE). Materials and results: This prospective study had institutional review board approval and was HIPAA compliant. In total 83 patients with confirmed PE underwent echocardiography and troponin I serum level measurements within 24 h. Three established cardiac CT measurements for the assessment of RVD were obtained (RV/LV{sub axial}, RV/LV{sub 4-CH}, and RV/LV{sub volume}). CT measurements and troponin I serum levels were correlated with RVD found on echocardiography and adverse clinical events according to Management Strategies and Prognosis in Pulmonary Embolism Trial-3 (MAPPET-3 criteria. 31 of 83 patients with PE had RVD on echocardiography and 39 of 83 patients had adverse clinical events. A RV/LV{sub volume} ratio > 1.43 showed the highest area under the curve (AUC) (0.65) for the prediction of adverse clinical events when compared to RV/LV{sub axial}, RV/LV{sub 4Ch} and troponin I. The AUC for the detection of RVD of RV/LV{sub axial}, RV/LV{sub 4Ch}, RV/LV{sub volume}, and troponin I were 0.86, 0.86, 0.92, and 0.69, respectively. Combination of RV/LV{sub axial}, RV/LV{sub 4Ch}, RV/LV{sub volume} with troponin I increased the AUC to 0.87, 0.87 and 0.93, respectively. Conclusion: A combination of cardiac CT parameters and troponin I measurements improves the diagnostic accuracy for detecting RVD and predicting adverse clinical events if compared to either test alone.

  15. Tromboembolismo pulmonar: El valor de la clínica PULMONARY EMBOLISM: THE IMPORTANCE OF CLINICAL EVALUATION

    Directory of Open Access Journals (Sweden)

    MIGUEL ANTÚNEZ R.

    2002-04-01

    Full Text Available El tromboembolismo pulmonar constituye un problema clínico frecuente; sus síntomas y signos son inespecíficos y los exámenes habitualmente utilizados para su diagnóstico son a menudo poco sensibles y específicos. La Angiografía Pulmonar es el "Gold Standard", no obstante es de escasa disponibilidad en nuestro medio, de alto costo, constituye un método invasivo no exento de complicaciones y de difícil interpretación en algunas oportunidades. La tomografía helicoidal de tórax es una técnica nueva, de mayor accesibilidad, cuyo desarrollo tecnológico ha permitido lograr mejorías en su sensibilidad y especificidad diagnósticas y consecuentemente un cambio en nuestras decisiones terapéuticas. Presentamos el caso de un paciente con trombosis venosa de las extremidades inferiores y un cuadro clínico compatible con alta probabilidad para tromboembolismo pulmonar. Hubo desarrollo de infiltrados pulmonares bilaterales asociados a derrame pleural en ausencia de fiebre y leucocitosis. Se inició terapia anticoagulante con lo cual hubo mejoría clínica del cuadro. Sin embargo, la realización de una tomografía helicoidal de tórax no demostró presencia de émbolos en la vasculatura pulmonar. Es por ello que debemos ser cautos en el momento de tomar decisiones clínicas basadas en un solo test diagnóstico, sin importar cuan eficiente este seaPulmonary embolism is a common clinical problem. Its symptoms and signs are inespecific and the tests commonly used are either non sensitive or non specific. Pulmonary angiography is considered as the "gold standard" for pulmonary embolism diagnosis. However, it is usually unavailable, very expensive, invasive and sometimes of complex interpretation. Thoracic helical computed tomography is a new technique, available in our clinical setting. It has become the most sensitive and specific test for pulmonary embolism detection and whose results can change our therapy. We report a clinical case with a leg

  16. Role of heart-type fatty acid-binding protein in assessing the prognosis of acute pulmonary embolism%心肌型脂肪酸结合蛋白在急性肺栓塞预后中的作用

    Institute of Scientific and Technical Information of China (English)

    李宾公; 郑泽琪; 王梦洪; 彭景添; 颜琼; 肖坚

    2011-01-01

    Objective To study the role of heart - type fatty acid - binding protein ( H - FABP) in assessing the prognosis of acute pulmonary embolism (APE).Methods The levels of plasma H - FABP, cTnI and D - dimer were determined in 72 patients with APE and 30 healthy controls.The associations between the biomarkers and severe complications were determined by Logistic regression model.Results The levels of D - dimer in the patients with APE were significantly higher than that in healthy controls (P < 0.01).The incidence of severe complications was higher in the H FABP positive group of APE than in the H - FABP negative group (66.7% vs 3.5%, P < 0.05).By Logistic regression analysis, elevated H -FABP was associated with a 50.44 -fold increase in the death or complication risk (95% CI 7.40 ~ 342.38, P < 0.001).Conclusion The H - FABP might be a useful biomarker for prediction prognosis of patients with APE.%目的 探讨心肌型脂肪酸结合蛋白(H-FABP)在急性肺栓塞(APE)预后中的作用.方法 检测72例确诊为急性肺栓塞(APE)患者及对照组30例健康受试者血浆H-FABP、心肌肌钙蛋白I(cTnI)、D-二聚体水平.应用Logistic回归模型分析各生化标志物与APE预后的关系.结果 APE组血浆D-二聚体水平较对照组明显增高(P<0.01).APE组中H-FABP阳性组30 d内不良事件发生率高于H-FABP阴性组(66.7% vs 3.5%,P<0.05).Logistic回归分析显示,H-FABP为APE预后的独立危险因素,H-FABP阳性者发生不良事件的危险性是H-FABP阴性者的50.44倍(95%CI 7.40~342.38,P<0.001).结论 H-FABP阳性APE者预后较差,H-FABP可用于APE的危险分层.

  17. Assessment of pulmonary parenchyma perfusion with FAIR in comparison with DCE-MRI-Initial results

    Energy Technology Data Exchange (ETDEWEB)

    Fan Li [Department of Radiology, ChangZheng Hospital Affiliated to Second Military Medical University, No. 415 Fengyang Road, Shanghai 200003 (China)], E-mail: fanli0930@163.com; Liu Shiyuan [Department of Radiology, ChangZheng Hospital Affiliated to Second Military Medical University, No. 415 Fengyang Road, Shanghai 200003 (China); Sun Fei [GE Healthcare China (China)], E-mail: Fei.sun@med.ge.com; Xiao Xiangsheng [Department of Radiology, ChangZheng Hospital Affiliated to Second Military Medical University, No. 415 Fengyang Road, Shanghai 200003 (China)], E-mail: lizhaobin79@163.com

    2009-04-15

    Objective: The aim of this study was to assess pulmonary parenchyma perfusion with flow-sensitive alternating inversion recovery (FAIR) in comparison with 3D dynamic contrast-enhanced (DCE) imaging in healthy volunteers and in patients with pulmonary embolism or lung cancer. Materials and methods: Sixteen healthy volunteers and 16 patients with pulmonary embolism (5 cases) or lung cancer (11 cases) were included in this study. Firstly, the optimized inversion time of FAIR (TI) was determined in 12 healthy volunteers. Then, FAIR imaging with the optimized TI was performed followed by DCE-MRI on the other 4 healthy volunteers and 16 patients. Tagging efficiency of lung and SNR of perfusion images were calculated with different TI values. In the comparison of FAIR with DCE-MRI, the homogeneity of FAIR and DCE-MRI perfusion was assessed. In the cases of perfusion abnormality, the contrast between normal lung and perfusion defects was quantified by calculating a normalized signal intensity ratio. Results: One thousand milliseconds was the optimal TI, which generated the highest lung tagging efficiency and second highest PBF SNR. In the volunteers, the signal intensity of perfusion images acquired with both FAIR and DCE-MRI was homogeneous. Wedged-shaped or triangle perfusion defects were visualized in five pulmonary embolisms and three lung cancer cases. There was no significant statistical difference in signal intensity ratio between FAIR and DCE-MRI (P > 0.05). In the rest of eight lung cancers, all the lesions showed low perfusion against the higher perfused pulmonary parenchyma in both FAIR and DCE-MRI. Conclusion: Pulmonary parenchyma perfusion imaging with FAIR was feasible, consistent and could obtain similar functional information to that from DCE-MRI.

  18. Homocysteine lowering by B vitamins and the secondary prevention of deep vein thrombosis and pulmonary embolism: A randomized, placebo-controlled, double-blind trial.

    NARCIS (Netherlands)

    Heijer, M. den; Willems, H.P.J.; Blom, H.J.; Gerrits, W.B.J.; Cattaneo, M.; Eichinger, S.; Rosendaal, F.R.; Bos, G.M.

    2007-01-01

    The Vitamins and Thrombosis (VITRO) study investigated the effect of homocysteine lowering by daily supplementation of B vitamins on the risk reduction of deep vein thrombosis (DVT) and pulmonary embolism (PE). Patients between 20 to 80 years old with a first objectively confirmed proximal DVT or PE

  19. Bacteria-associated haemophagocytic syndrome and septic pulmonary embolism caused by Burkholderia cepacia complex in a woman with chronic granulomatous disease.

    Science.gov (United States)

    Hisano, Michi; Sugawara, Kana; Tatsuzawa, Osamu; Kitagawa, Michihiro; Murashima, Atsuko; Yamaguchi, Koushi

    2007-05-01

    Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by recurrent infections with certain types of bacteria and fungi. Presented herein is the case of a 29 year old woman with CGD who suffered from bacteria-associated haemophagocytic syndrome and a septic pulmonary embolism following a uterine infection and sepsis, caused by Burkholderia cepacia complex.

  20. Selective D-dimer thresholds in the diagnostic management for symptomatic pulmonary embolism does not lead to acceptable 3 months venous thromboembolism recurrence rates

    NARCIS (Netherlands)

    Van Der Hulle, T.; Den Exter, P.L.; Klok, F.A.; Erkens, P.G.M.; Van Es, J.; Kamphuisen, P.W.; Huisman, M.V.; Mos, I.C.M.; Ten Cate, H.

    2013-01-01

    Background: With current diagnostic algorithms for pulmonary embolism (PE) CT-scan imaging is still frequently necessary. For deep vein thrombosis it was very recently shown (Linkins et al. Ann Intern Med 2013; 158:93-100) that doubling the D-dimer threshold in patients with low clinical probability

  1. Contrast enhanced chest-MDCT in oncologic patients. Prospective evaluation of the prevalence of incidental pulmonary embolism and added value of thin reconstructions

    Energy Technology Data Exchange (ETDEWEB)

    Tresoldi, Silvia; Flor, Nicola [Azienda Ospedaliera San Paolo, Dipartimento di Radiologia Diagnostica ed Interventistica, Milano (Italy); Luciani, Andrea [Azienda Ospedaliera San Paolo, Oncologia, Dipartimento di Medicina, Milano (Italy); Lombardi, Maria Antonietta; Colombo, Bernardo [Universita degli Studi di Milano, Scuola di Specializzazione in Radiodiagnostica, Facolta di Medicina e Chirurgia, Milano (Italy); Cornalba, Gianpaolo [Azienda Ospedaliera San Paolo, Dipartimento di Radiologia Diagnostica ed Interventistica, Milano (Italy); Universita degli Studi di Milano, Dipartimento di Scienze della Salute, Milano (Italy)

    2015-11-15

    To prospectively assess prevalence/characteristics of clinically unsuspected pulmonary embolism (PE) in cancer patients undergoing follow-up chest MDCT and investigate MDCT protocol. We evaluated 1013 oncologic patients. MDCT images at 5 and 1.25 mm thickness were independently evaluated. Pulmonary artery opacification degree was assessed. Presence, level, and site of PE were reported. Type of malignancy and metastases were reported for PE-positive patients. After excluding 1.4 % (14/1013) of examinations due to inadequate vessel opacification, 999 patients (572 male; mean age:68 ± 12 years; range:26-93 years) entered the study. Prevalence of PE was 5 %. There was significant improvement in the sensitivity for both readers in the evaluation of 1.25 mm compared to 5 mm images (46-50 % to 82-92 %). 30 % (15/51) PE were not described by the radiologist in the prospectively issued report; 53 % (27/51) of PE were segmental, 72.5 % (37/51) unilateral. The right lower lobe was the most involved (59 %). 27 % patients had colon cancer, 18 % lung cancer. Among PE-positive patients (25 male; mean age 70 ± 10 years; range:44-87 years), 25 % (13/51) had lung cancer, 15 % (8/51) colon cancer. Thin reconstructions are essential for PE diagnosis, regardless of reader experience. Regarding oncologic patients, incidental PE diagnosis influences anticoagulation therapy. (orig.)

  2. Embolia pulmonar séptica de origen cutáneo Septic pulmonary embolism of cutaneous origin

    Directory of Open Access Journals (Sweden)

    Agustina Sosa Beláustegui

    2012-08-01

    Full Text Available La embolia pulmonar séptica es una enfermedad grave y poco frecuente que se caracteriza por presentar infiltrados pulmonares bilaterales asociados a un foco infeccioso extrapulmonar. Se relaciona principalmente a endocarditis derecha, tromboflebitis pelviana, accesos vasculares y menos frecuentemente a infecciones profundas como osteomielitis, artritis séptica o piomiositis. El Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-AC es un patógeno emergente, con alta virulencia y de rápida propagación, que afecta a sujetos sin enfermedades previas relacionadas o factores de riesgo conocidos. Causa infecciones de piel y partes blandas y con menor frecuencia infecciones graves como fascitis necrotizante, artritis séptica, osteomielitis, piomiositis y neumonía necrotizante. Su epidemiología, patogenia y manifestaciones clínicas difieren de las causadas por el SAMR adquirido en el hospital. Presentamos el caso de un varón de 67 años con embolias pulmonares sépticas causadas por SAMR-AC con origen en una infección cutánea.Septic pulmonary embolism is a serious and rare illness characterized by pulmonary infiltrates associated with an extrapulmonary infectious focus. It is mainly related to right-sided endocarditis, pelvic thrombophlebitis, vascular access and less frequently to deep infections such as osteomyelitis, septic arthritis and pyomyositis. The community-acquired methicillin-resistant Staphylococcus aureus (MRSA is an emerging pathogen with high virulence and rapid spread involving subjects without previous related diseases or known risk factors. It causes infections of skin and soft tissue and less frequently other serious infections such as necrotizing fascitits, septic arthritis, osteomyelitis, pyomyositis and necrotizing pneumonia. Epidemiologically, pathogenesis and clinical manifestations differ from those caused by MRSA acquired in the hospital. We present the case of a 67 year-old male with septic

  3. Late outcomes after acute pulmonary embolism: rationale and design of FOCUS, a prospective observational multicenter cohort study.

    Science.gov (United States)

    Konstantinides, Stavros V; Barco, Stefano; Rosenkranz, Stephan; Lankeit, Mareike; Held, Matthias; Gerhardt, Felix; Bruch, Leonard; Ewert, Ralf; Faehling, Martin; Freise, Julia; Ghofrani, Hossein-Ardeschir; Grünig, Ekkehard; Halank, Michael; Heydenreich, Nadine; Hoeper, Marius M; Leuchte, Hanno H; Mayer, Eckhard; Meyer, F Joachim; Neurohr, Claus; Opitz, Christian; Pinto, Antonio; Seyfarth, Hans-Jürgen; Wachter, Rolf; Zäpf, Bianca; Wilkens, Heinrike; Binder, Harald; Wild, Philipp S

    2016-11-01

    Acute pulmonary embolism (PE) is a frequent cause of death and serious disability. The risk of PE-associated mortality and morbidity extends far beyond the acute phase of the disease. In earlier follow-up studies, as many as 30 % of the patients died during a follow-up period of up to 3 years, and up to 50 % of patients continued to complain of dyspnea and/or poor physical performance 6 months to 3 years after the index event. The most feared 'late sequela' of PE is chronic thromboembolic pulmonary hypertension (CTEPH), the true incidence of which remains obscure due to the large margin of error in the rates reported by mostly small, single-center studies. Moreover, the functional and hemodynamic changes corresponding to early, possibly reversible stages of CTEPH, have not been systematically investigated. The ongoing Follow-Up after acute pulmonary embolism (FOCUS) study will prospectively enroll and systematically follow, over a 2-year period and with a standardized comprehensive program of clinical, echocardiographic, functional and laboratory testing, a large multicenter prospective cohort of 1000 unselected patients (all-comers) with acute symptomatic PE. FOCUS will possess adequate power to provide answers to relevant remaining questions regarding the patients' long-term morbidity and mortality, and the temporal pattern of post-PE abnormalities. It will hopefully provide evidence for future guideline recommendations regarding the selection of patients for long-term follow-up after PE, the modalities which this follow-up should include, and the findings that should be interpreted as indicating progressive functional and hemodynamic post-PE impairment, or the development of CTEPH.

  4. Diagnostic Value of MRI for Pulmonary Embolism: A Meta-Analysis%磁共振成像诊断肺栓塞价值的Meta分析

    Institute of Scientific and Technical Information of China (English)

    卢星如; 张皓; 王浩; 王刚; 包海荣; 王文辉; 郭奇宏

    2013-01-01

    目的 系统评价磁共振成像(MRI)诊断肺栓塞的价值,以期为临床决策提供依据.方法 计算机检索PubMed、EMbase、Cochrane图书馆、CBM、CNKI和VIP等数据库,查找MRI与金标准(CT肺血管造影)比较诊断肺栓塞的诊断性试验,对纳入研究进行资料提取并应用QUADAS条目进行方法学质量评估后,采用Meta-Disc1.4软件进行Meta分析,计算合并敏感度和特异度,并绘制汇总受试者工作特征曲线(SROC曲线)和计算曲线下面积,以评价MRI诊断肺栓塞的价值.结果 共纳入6篇英文文献,595例患者.异质性检验结果显示各纳入研究结果间存在统计学异质性,采用随机效应模型进行Meta分析,结果显示其合并敏感度、特异度分别为0.87[95%CI(0.80,0.91)]和0.98[95%CI (0.96,0.99)],SROC曲线下面积(AUC)为0.988 7.结论 MRI是一种比较好的评价肺栓塞的无创性检查方法,有较高的敏感度和特异度,具有很好的临床应用价值.%Objective To study the diagnostic value of MRI for pulmonary embolism, so as to provide information for clinical decision. Methods The trials about MRI in the diagnosis of pulmonary embolism were searched in the following databases such as PubMed, EMbase, The Cochrane Library, CBM, CNKI and VIP. The data of the included trials were extracted, the methodological quality was evaluated in accordance with the quality assessment of diagnostic accuracy studies (QUADAS), and then meta-analysis was conducted using Meta-Disc 1.4 software. The weighted sensitivity and specificity were aggregated, as well as the summary receiver operating characteristic (SROC) curve. Further, the area under the curve (AUC) was calculated to evaluate the value of MRI in the diagnosis of pulmonary embolism. Results A total of 6 English articles involing 595 patients were included. The results of heterogeneity test revealed that there was statistical heterogeneity among the results of studies. According to the random effects

  5. [Thrombo-embolic pulmonary hypertension--do not spoil a chance for effective surgery!].

    Science.gov (United States)

    Kurzyna, Marcin; Torbicki, Adam; Poloński, Lech; Skoczylas, Ilona; Przybylski, Roman; Wieteska, Maria; Dyk, Wojciech; Biederman, Andrzej; Zembala, Marian

    2011-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as pulmonary hypertension with persistent pulmonary perfusion defects causes by unresolved thrombi. All symptomatic CTEPH patients with documented pulmonary vascular resistance > 300 dyn*sec*cm(-5) and proximal lesions should be considered for surgical treatment--pulmonary endarterectomy. The role of pharmacological treatment remains controversial and should be restricted to inoperable cases and persistent pulmonary hypertension after pulmonary endarterectomy. Every year about 30 procedures is performed in two specialised centers in Poland with 1 year mortality at 8-9%. Number of procedures done gives the frequency of pulmonary endarterectomy at 0.7/million of population/year. Current data from UK indicate the actual ratio of surgical treatment of CTPH at 2/million/year. The article discusses reasons for CTEPH is underdiagnosed and why rate of surgical therapy in Poland is too low.

  6. Association of pulmonary embolism recurrence with increased plasma fibrinogen level%肺栓塞再发与血浆纤维蛋白原升高相关性研究

    Institute of Scientific and Technical Information of China (English)

    何成; 江兴堂

    2012-01-01

    Objective To observe and evaluate the relationship between different plasma fibrinogen levels and pulmonary embolism recurrence.Methods The plasma fibrinogen levels of 77 cases of remission in patients with initial pulmonary embolism and 24 cases of pulmonary embolism recurrence were retrospectively analyzed to observe whether there was a dominant difference plasma fibrinogen between the pulmonary embolism recurrence in patients and not recurrent pulmonary embolism in patients,to observe whether there was a dominant difference plasma fibrinogen level between pulmonary embolism recurrence of patients with initial onset of remission and pulmonary embolism recurrence with treatment,to analysis the relationship between pulmonary embolism recurrence and embolism stove distribution in patients.Results There were significant differences in plasma fibrinogen level between pulmonary embolism recurrence and not recurrence of pulmonary embolism in patients ( P <0.05).The plasma fibrinogen level of pulmonary embolism recurrence with pre-treatment was higher than the level of plasma fibrinogen after the initial pulmonary embolism in patients with remission ( P <0.05).There was no significant correlation between pulmonary embolism recurrence and embolism stove distribution ( P >0.05).Conclusions Elevated plasma fibrinogen is related to pulmonary embolism recurrence,fibrinogen is an important risk factor for pulmonary embolism events,can predict recurrence of pulmonary embolism.%目的 观察并评价不同血浆纤维蛋白原水平与肺栓塞再发的关系.方法 回顾性分析77例初次肺栓塞患者治疗缓解后及24例肺栓塞再发患者的血浆纤维蛋白原水平,比较再发肺栓塞患者及未再发肺栓塞患者血浆纤维蛋白原水平是否存在显著差异,比较肺栓塞再发患者初次发病治疗缓解后及肺栓塞再发治疗前血浆纤维蛋白原水平之间的差异,同时分析肺栓塞再发患者栓塞灶分布与血浆纤维蛋

  7. Pulmonary fat embolism--a prospective study within the forensic autopsy collective of the Republic of Iceland.

    Science.gov (United States)

    Voisard, Matthias X; Schweitzer, Wolf; Jackowski, Christian

    2013-01-01

    In the last century, studies established the origin of pulmonary fat embolism (PFE) and identified mechanical trauma as main source for PFE. This prospective study focused on determining a possible influence of cardiopulmonary resuscitation (CPR), in the context of an aging population, on the occurrence of PFE. Lung tissue samples from 256 bodies were examined using the twin-edged knife technique without preliminary fixation but after staining with Sudan III. PFE grading was determined according to Falzi and performed at a 10× magnification. For statistical analysis, bodies were grouped by age, gender, and putrefaction and categorized following whether they had experienced trauma, CPR, the combination of both, or no mechanical impact. There was a significant correlation of trauma, CPR, and the combination of both to PFE but no noticeable influence of gender or putrefaction. An age over 70 years promotes a PFE due to resuscitation.

  8. Fatal pulmonary embolism subsequent to the use of Esmarch bandage and tourniquet: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Sameer Desai

    2013-01-01

    Full Text Available We report a case of fatal pulmonary embolism (PE following exsanguinations of lower limb in orthopedic surgery. A 30-year-old man was posted for fixation of a tibial plateau fracture on the seventh day after injury. Subarchnoid block was performed. Esmarch bandage was used for exsanguination of the limb and tourniquet was inflated. Within three minutes after tourniquet inflation, the patient became unconscious hypotensive, and collapsed. Resuscitation was instituted and spontaneous circulation restored. Right ventricular strain pattern on transthoracic echocardiography, increased levels of D-dimer, and Doppler examination of the lowerlimb confirmed deep venous thrombosis of right femoral vessels and PE. In spite of thrombolytic therapy with streptokinase and heparin, the patient died on the ninth day after the event. Cases of PE secondary to the use of Esmarch bandage and tourniquet are reviewed here to identify the risk groups and management of PE.

  9. Deep venous thrombosis and pulmonary embolism caused by an intravascular synovial sarcoma of the common femoral vein.

    Science.gov (United States)

    Schoneveld, J M; Debing, E; Verfaillie, G; Geers, C; Van den Brande, P

    2012-11-01

    Malignant tumors arising in deep veins of the lower extremities are very uncommon. To our best knowledge, this is the seventh case of a primary venous intravascular synovial sarcoma (SS) reported in literature. A 32-year-old woman was admitted with a second episode of deep venous thrombosis of the right lower limb and pulmonary embolism. Physical and radiological examinations showed besides the thrombosis a tumor arising from the right common femoral vein involving the bifurcation of the common femoral artery. At surgery, en block resection of the tumor including the deep femoral vein and arterial bifurcation was done with an arterial reconstruction using a synthetic graft. Histopathological examination revealed an intravascular SS of the common femoral vein. The mainstay of curative therapy is complete surgical resection of all tumor manifestations with negative histological margins.

  10. Follow-Up of 6 Patients with Permanent ; Vena Cava Filters in the Prevention of Pulmonary Embolism

    Directory of Open Access Journals (Sweden)

    M. Vahedian

    2011-10-01

    Full Text Available Introduction & Objective: Venous thromboembolic disease is a significant cause of morbidity and mortality in the United States. Deep venous thrombosis (DVT and pulmonary embolism (PE are a spectrum of a single disease entity. In most clinical situations, anticoagulation is the preferred form of therapy .IVC filter placement when using anticoagulation therapy is contraindicated or proves ineffective. The placement of an IVC filter is considered standard preventive treatment for PE. The aim of this study was follow up of patients with permanent vena cava filters in the prevention of pulmonary embolism after six months. Materials & Methods: In this cross sectional study 6 patients with IVC filter were followed up after 6 months. They were examined about having emboli, reccurent DVT, edema, varicosis, bleeding, misplacement, and fracture of filter. Data were analyzed with SPSSV17. Results: 6 patients having a mean age of 58.6 years were evaluated. There was no difference in sex . The reason of admission in all cases was DVT. Doppler sonography was done for all the patients. In 66.66% anticoagulation therapy was done before surgery. The filter was placed percutaneously in all cases. After 6 months in 5 cases there were no signs of DVT, PE, edema, and varicosis. In addition one patient died because of respiratory arrest due to encephalopathy. No complications were seen during admission period. Conclusion: Although IVC filter increases the risk of recurrent DVT in the long term ,it remarkablely decreases the risk of PE.IVC filter is a useful and effective treatment in patients with contraindication of using anticoagulation therapy especially in patients with cancer. (Sci J Hamadan Univ Med Sci 2011;18(2:29-32

  11. Selective Embolization of Systemic Collaterals for the Treatment of Recurrent Hemoptysis Secondary to the Unilateral Absence of a Pulmonary Artery in a Child

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Yin, E-mail: zhouyin502@163.com [West China Hospital, Sichuan University, Department of Pediatric Surgery (China); Tsauo, Jiaywei, E-mail: 80732059@qq.com [West China Hospital, Sichuan University, Institute of Interventional Radiology (China); Li, Yuan, E-mail: liyuanletters@163.com [West China Hospital, Sichuan University, Department of Pediatric Surgery (China); Li, Xiao, E-mail: simonlixiao@gmail.com [West China Hospital, Sichuan University, Institute of Interventional Radiology (China)

    2015-10-15

    The unilateral absence of the pulmonary artery (UAPA) is a rare anomaly. Hemoptysis due to systemic collaterals is one of the most common complications of UAPA. To the best of the authors’ knowledge, the utility of selective embolization for the treatment of this condition in children has not been reported previously. This report describes a 6-year-old girl with isolated UAPA (IUAPA) admitted for a 10-month history of recurrent hemoptysis that had worsened during the previous 2 months. Selective embolization of the bronchial systemic collaterals was performed. The patient remained asymptomatic with no recurrence of hemoptysis 8 months after the procedure.

  12. Isquemia pulmonar embólica: aspectos clínicos e experimentais Pulmonary embolic ischemia: clinical and experimental aspects

    Directory of Open Access Journals (Sweden)

    Fabio Biscegli Jatene

    2003-09-01

    Full Text Available A isquemia está freqüentemente relacionada a mecanismos embólicos e esta oclusão arterial mecânica não é sempre seguida de conseqüências isquêmicas severas porque mudanças na circulação brônquica suprem as áreas sem fluxo sangüíneo. No entanto, ocorre o fenômeno de remodelação vascular, também relacionado a níveis elevados de pressão arterial pulmonar, principalmente no tromboembolismo pulmonar crônico. Modelos experimentais têm sido produzidos para estudar a relação entre a oclusão arterial mecânica, a hipertensão pulmonar e a remodelação vascular, entretanto mais avaliações sistemáticas são necessárias para se entender esta relação no parênquima pulmonar isquêmico e não isquêmico.Pulmonary ischemia is usually related with embolics mechanisms, and this mechanic artery occlusion is not always followed by severe ischemic consequences, because the bronchial circulation changes supply the areas without blood flow. However, small artery vascular remodeling occurs, related to persistent high pulmonary pressure levels, mainly in the chronic pulmonary thromboembolism. Experimental models have been produced to study the relation-ship between mechanic artery occlusion, pulmonary hypertension and vascular remodeling, however, more systematic evaluation is necessary to understand such a these relation-ship, in the ischemic and not ischemic lung parenchyma.

  13. Prophylaxis of venous and pulmonary thrombo-embolism. Profilaxis del tromboembolismo venoso y pulmonar. Conceptos actuales.

    OpenAIRE

    Hugo Jiménez Vázquez; José Julio Requeiro Molina; Yusimí Isaguirre Martínez

    2004-01-01

    This bibliographical revision stands out the importance of the vein thromboembolism prevention in patients under different surgical and injuries procedures, wicked illnesses and medical conditions. The epidemiology, etiopatogenia and factors of risk of the deep vein thrombosis and the lung embolism are exposed in different categories of patient. Up to dates prophylactic methods are taken into account and compared their effectiveness and cautions according to the last studies on the topic.<...

  14. Chronic post-embolic pulmonary hypertension: a new target for medical therapies?

    Directory of Open Access Journals (Sweden)

    Marion Delcroix

    2013-09-01

    Full Text Available The rationale for the use of pulmonary arterial hypertension-targeted drugs in chronic thromboembolic pulmonary hypertension is based on four bundles of evidence, as follows: 1 the pathobiology of the disease, with a distal component of pre-capillary arteriopathy that is very similar to pulmonary arterial hypertension; 2 the inoperability of some patients, and the persistence or recurrence of pulmonary hypertension after pulmonary endarterectomy in others; 3 the short-term efficacy and safety of pulmonary arterial hypertension-targeted drugs in these patients; and 4 their potential effect on survival. Chronic thromboembolic pulmonary hypertension is essentially a surgical disease, curable by pulmonary endarterectomy, with acceptable procedural mortality in experienced centres. Patient selection for surgery is extremely complex and results in 30–50% of patients considered inoperable. A large clinical experience has been built up with endothelin receptor antagonists and phosphodiesterase-5 inhibitors, while evidence from controlled trials is running far behind schedule. More recently, a randomised controlled trial with the guanylate cyclase stimulator, riociguat, achieved its target and showed haemodynamic, as well as functional, improvements within 4 months of therapy. The place of this therapy in the therapeutic arsenal needs to be further defined, but should be strictly limited to inoperable patients.

  15. Contribution of fibrinolysis to the physical component summary of the SF-36 after acute submassive pulmonary embolism

    Science.gov (United States)

    Stewart, Lauren K.; Peitz, Geoffrey W.; Nordenholz, Kristen E.; Courtney, D. Mark; Kabrhel, Christopher; Jones, Alan E.; Rondina, Matthew T.; Diercks, Deborah B.; Klinger, James R.

    2015-01-01

    Acute pulmonary embolism (PE) can diminish patient quality of life (QoL). The objective was to test whether treatment with tenecteplase has an independent effect on a measurement that reflects QoL in patients with submassive PE. This was a secondary analysis of an 8-center, prospective randomized controlled trial, utilizing multivariate regression to control for predefined predictors of worsened QoL including: age, active malignancy, history of PE or deep venous thrombosis (DVT), recurrent PE or DVT, chronic obstructive pulmonary disease and heart failure. QoL was measured with the physical component summary (PCS) of the SF-36. Analysis included 76 patients (37 randomized to tenecteplase, 39 to placebo). Multivariate regression yielded an equation f(8, 67), Ptenecteplase second (β = 4.73, P = 0.056). After controlling for all interactions, tenecteplase increased the PCS by +5.37 points (P = 0.027). In patients without any of the defined comorbidities, the coefficient on the tenecteplase variable was not significant (−0.835, P = 0.777). In patients with submassive PE, obesity had the greatest influence on QoL, followed by use of fibrinolysis. Fibrinolysis had a marginal independent effect on patient QoL after controlling for comorbidities, but was not significant in patients without comorbid conditions. PMID:25433511

  16. Characteristics and clinical management of acute pulmonary embolism in real world: findings from TUSCAN-PE study

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2014-06-01

    Full Text Available Acute pulmonary embolism (PE remains one of the leading causes of mortality and morbidity in cardiovascular setting. Despite much information about clinical aspects and recommendations or clinical guidelines is available from literature, few data exist about the management of PE in real world of internal medicine scenario. Therefore the aim of the present study was to report on characteristics and management of PE patients admitted in this setting. TUSCAN-PE study was a multicenter, observational, retrospective, cohort study aimed to analyze data of PE patients admitted in Internal Medicine wards of Tuscany. Each center was invited to submit anonymously data of at least ten patients consecutively discharged for acute PE in 2012. Data were referred to demographic, clinical, instrumental, prognostic and therapeutic characteristics. A total of 452 patients from 28 Tuscan centers (60.2% F, with mean age 76.01±12.34 years, were enrolled. A total of 87% of patients was admitted from Emergency Department, but only 65.2% of patients with diagnosis of PE. Around one third of diagnoses of PE was performed by internists. In 14.8% of diagnoses was incidental. In 86% of patients, diagnosis was performed by computer tomography pulmonary angiography. Overall mortality was 9.5%, 5.75% being PE-related. Main risk factors enclosed recent respiratory tract infections (55.3%, immobility (42.25%, recent hospital admissions (33.6% and cancer (30.3%. In 65.8% of patients, PE was associated with deep vein thrombosis. 16.6% of patients had a shock index ≥1 and 84.75% simplified pulmonary embolism severity index (PESI score ≥1. A number of 51.5% of patients presented echocardiographic right heart dysfunction, 50.6% and 55.9% of patients presented increased values of troponins and natriuretic peptides, respectively. The following percentage, 6.5%, 71.1% and 22.4%, were defined as high, intermediate and low risk according to the European Society of Cardiology (ESC

  17. Handbook of pulmonary emergencies

    Energy Technology Data Exchange (ETDEWEB)

    Spaquolo, S.V.; Medinger, A

    1986-01-01

    This book presents information on the following topics: clinical assessment of the patient with pulmonary disease; interpretation of arterial blood gases in the emergency patient; life-threatening pneumonia; extrapulmonic ventilatory failure; acute inhalation lung disease; pulmonary edema; near drowning; chest trauma; upper airway emergencies; chronic lung disease with acute respiratory decompensation; acute respiratory failure in the patient with chronic airflow obstruction; asthma; hemoptysis; embolic pulmonary disease; superior vena cava syndrome; catastrophic pleural disease; ventilatory assistance and its complications; and ventilator emergencies.

  18. Catastrophic antiphospholipid syndrome and pulmonary embolism in a 3-year-old child

    Energy Technology Data Exchange (ETDEWEB)

    Olivier, Carine; Blondiaux, Eleonore; Dacher, Jean-Nicolas [University Hospital of Rouen, Department of Radiology, Rouen (France); Blanc, Thierry [University Hospital of Rouen, Department of Neonatal Medicine, Rouen (France); Borg, Jeanne-Yvonne [University Hospital of Rouen, Haematology Laboratory, Rouen (France)

    2006-08-15

    We report a rare example of catastrophic antiphospholipid syndrome (CAPS) in a young child. A 3-year-old girl with no previous medical history presented with extensive and recurrent thromboses. The diagnosis of CAPS was based on the occurrence of cardiopulmonary embolism in the child with a high titre of autoantibodies directed against phospholipids and beta-2-glycoprotein 1. In spite of a relatively rapid diagnosis and multiple treatments, the outcome was unfavourable. Multimodality imaging, including both ultrasonography and spiral CT, allowed close follow-up of the thromboses. (orig.)

  19. Study of new dual-source dual-energy CT pulmonary angiography for pulmonary embolism diagnosis%第二代双源CT双能量成像对肺栓塞的诊断价值研究

    Institute of Scientific and Technical Information of China (English)

    吴山; 武志峰; 鄂林宁; 江小鹏

    2012-01-01

    目的:探讨西门子第二代双源CT(Somatom Definition Flash)双能量成像对肺动脉栓塞的诊断价值.方法:回顾性研究42位临床疑诊肺栓塞行双能量肺血管成像(DE-CTPA)扫描的患者的资料,利用工作站双能量软件Lung PBV(肺灌注)、Lung Vessels(肺血管)进行彩色编码成像.2名胸部影像医师结合DE-CTPA与软件提供的信息做出诊断.结果:根据临床及CT结果,其中32例(76.2%,32/42)存在肺动脉栓塞,28例在CTPA上表现为肺动脉充盈缺损,4例在CTPA上未见异常征象,而双能量成像上表现为亚段或以下水平灌注或充盈缺损.双能量Lung PBV测得32例48个栓塞肺区CT强化值(35.6±12.1)HU,低于非栓塞区域所测得的CT强化值(44.5±10.6) HU,t=-2.336,P=0.027.结论:双能量Lung PBV与Lung Vessels软件能显示肺栓塞所致的灌注及充盈缺损,结合CTPA能提高肺栓塞的检出率,特别是外周性肺动脉栓塞.%Objective: To investigate the diagnostic value of the second-generation Siemens dual-source CT(Somatom Definition Flash) dual-energy imaging of pulmonary embolism. Methods: Dual-energy pulmonary angiography (CTPA) data of 42 patients with clinically suspected pulmonary embolism were retrospectively studied by dual—energy software on the workstation. Lung PBV (lung perfusion), Lung Vessels (pulmonary vasculature) and color-coded imaging were analyzed. Two chest-imaging physicians combined information provided by both the DE-CTPA and software to make a diagnosis. Results: According to clinical and CT findings, 32 cases(76.2%, 32/42) had pulmonary embolism, with pulmonary filling defects on CTPA in 28 cases, normal CTPA but perfusion defects in sub-segments or below on DE-CTPA in four cases. Lung PBV measured 32 cases with 48 embolism pulmonary, with a CT enhancement value of (35.6+12.1) HU, lower than the non-embolism region with a CT enhancement value of (44.5±10.6) HU(t=-2.336, P=0.027). Conclusion: Dual-energy lung perfusion(Lung PBV

  20. The original and simplified Wells rules and age-adjusted D-dimer testing to rule out pulmonary embolism: an individual patient data meta-analysis.

    Science.gov (United States)

    van Es, N; Kraaijpoel, N; Klok, F A; Huisman, M V; Den Exter, P L; Mos, I C M; Galipienzo, J; Büller, H R; Bossuyt, P M

    2017-04-01

    Essentials Evidence for the simplified Wells rule in ruling out acute pulmonary embolism (PE) is scarce. This was a post-hoc analysis on data from 6 studies comprising 7268 patients with suspected PE. The simplified Wells rule combined with age-adjusted D-dimer testing may safely rule out PE. Given its ease of use, the simplified Wells rule is to be preferred over the original Wells rule.

  1. An unexpected case of venous and pulmonary thrombo-embolism in a patient treated with thalidomide for refractory erythema nodosum leprosum: a case report

    Directory of Open Access Journals (Sweden)

    Chamara Ratnayake

    2011-01-01

    Full Text Available Abstract Recent literature reports an increased incidence of venous thrombosis following thalidomide use in the treatment of diseases with disease-related thrombotic risks such as malignancy, as well as concomitant use with chemotherapy and/or systemic corticosteroids. We report a case of deep vein thrombosis (DVT and pulmonary embolism (PE following thalidomide use in a patient with erythema nodosum leprosum (ENL reaction who was concurrently treated with prednisolone, as well as a review of relevant literature.

  2. Clinical Analysis of the Diagnosis and Treatment of Patients with Acute Pulmonary Embolism%急性肺栓塞患者临床诊治分析

    Institute of Scientific and Technical Information of China (English)

    乔云峰; 王冬梅

    2014-01-01

    目的:研究并分析急性肺栓塞的诊断、临床表现以及治疗方法。方法统计我院近两年来收治的61例急性肺栓塞患者,详细记录这些患者的临床资料,包括临床表现、辅助检查、治疗方法以及临床疗效等。结果61名患者中,有6例患者由于误诊、漏诊错过了宝贵的治疗急救时间导致最终死亡,本组患者存活率为90.2%。结论急性肺栓塞临床诊治辅助检查工具推荐肺增强螺旋CT,对早期急性肺栓塞患者用以抗凝联合栓治疗具有良好疗效。%ObjectiveTo study and analyze the diagnosis, clinical manifestations and treatment of acute pulmonary embolism.Methods The statistics I admitted to hospital in the past two years, 61 cases of acute pulmonary embolism in patients with documented clinical data of these patients, including clinical manifestations, laboratory examinations, treatment and clinical curative effect.Results 61 patients, 6 patients due to misdiagnosis and missed valuable time lead to the eventual death of first-aid treatment, the survival rate in this group of patients was 90.2%. Conclusion The clinical diagnosis of acute pulmonary embolism secondary inspection tool recommended lung enhanced helical CT, early anticoagulation for patients with acute pulmonary embolism suppository therapy combined with good effect.

  3. 临床药师对肺栓塞患者的药学监护%Pharmaceutical care of clinical pharmacist for patients with pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    王来成; 韩强; 吕冬梅

    2011-01-01

    Objective: To ensure the safety and efficacy in pulmonary embolism patients taking drugs by pharmaceutical care of clinical pharmacists. Methods: The clinical pharmacists carried out the close observation,the revisit and medication proposal to a pulmonary embolism patient with pharmaceutical care measure. Results:Through pharmaceutical care, the efficacy and the safety of the patient taking drugs were obviously enhanced, and events of responding adverse drug reactions were avoided. Conclusion: The pharmaceutical care of clinical pharmacist can coordinate the optimization of medicine plan, and is advantageous for the safety and efficacy in pulmonary embolism patients taking drugs.%目的:通过临床药师对患者实施药学监护,保障肺栓塞患者用药的安全有效.方法:临床药师对1例肺栓塞患者进行密切观察与随访,制订相应的药学监护措施,针对性提出用药建议.结果:通过药学监护,明显提高了肺栓塞患者用药的安全性、有效性,尽量避免了不良反应事件的发生.结论:临床药师积极开展药学监护,协同临床医师优化给药方案,有利于患者的用药安全有效.

  4. A fatal case of acute pulmonary embolism caused by right ventricular masses of acute lymphoblastic lymphoma-leukemia in a 13 year old girl

    Directory of Open Access Journals (Sweden)

    Yu Mi Ko Ko

    2012-07-01

    Full Text Available We report a case of a 13-year-old girl with acute lymphoblastic lymphoma- leukemia, who presented with a cardiac metastasis in the right ventricle, resulting in a pulmonary embolism. At the time of her leukemia diagnosis, a cardiac mass was incidentally found. The differential diagnosis for this unusual cardiac mass included cardiac tumor, metastasis, vegetation, and thrombus. Empirical treatment was initiated, including anticoagulation and antibiotics. She underwent plasmapheresis and was administered oral prednisolone for her leukemia. Five days later, she experienced sudden hemodynamic collapse and required extracorporeal membrane oxygenation insertion and emergency surgery. These interventions proved futile, and the patient died. Pathology revealed that the cardiac mass comprised an aggregation of small, round, necrotic cells consistent with leukemia. This is the first known case of acute lymphoblastic leukemia presenting as a right ventricular mass, with consequent fatal acute pulmonary embolism. A cardiac mass in a child with acute leukemia merits investigation to rule out every possible etiology, including vegetation, thrombus, and even a mass of leukemic cells, which could result in the fatal complication of pulmonary embolism.

  5. Clinical Treatment Analysis of 27 Cases of Patients with Pulmonary Embolism%27例肺栓塞临床分析

    Institute of Scientific and Technical Information of China (English)

    张成军

    2014-01-01

    目的:探讨肺栓塞(PE)的抗凝溶栓治疗。方法选取临床27例肺栓塞患者临床抗凝治疗、溶栓治疗资料方法进行分析。结果26例患者在综合治疗基础上抗凝治疗、溶栓治疗治愈出院,1例主动出院。结论诊断确立后立即进行抗凝治疗,防止新的血栓形成及新的肺栓塞的发生。早期的治疗可明显改善预后。%Objective The anticoagulant and thrombolytic treatment of pulmonary embolism (PE) to be investigated.Methods Analyzing the clinical anticoagulant and thrombolytic treatment data selected from 27 cases of patients with pulmonary embolism (PE).ResultsAl 27 cases of patients, there are 26 cases of patients cured and discharged from hospital with utilizing anticoagulant and thrombolytic treatment bases on comprehensive attendance, and the rest one case of patient is discharged from hospital on his own will.ConclusionTake anticoagulant and thrombolytic treatment immediately once the disease is diagnosed to prevent from new thrombosis as wel as the pulmonary embolism. The early-phase treatment can ameliorate the prognosis obviously.

  6. Presenting features and clinical course of 34 patients with septic pulmonary embolism caused by right-sided infective endocarditis

    Institute of Scientific and Technical Information of China (English)

    Liu Shuang; Xie Jiang; Chen Yong; Yang Jinghua; Zhang Jianqun; Meng Xu; Liu Yinglong

    2014-01-01

    Backgroud Misdiagnosis and missed diagnosis of septic pulmonary embolism (SPE),a rare disease,occurs among the patients with right heart infective endocarditis.The purpose of this study was to analyze the characteristics of SPE and improve the early diagnosis and treatment.Methods We retrospectively studied 34 patients with septic pulmonary embolism caused by right-sided infective endocarditis who were seen from June 1,2002 to June 1,2013.We reviewed the medical records and radiological images of these cases and extracted the following information:age,gender,and symptoms,physical examination,laboratory findings,transthoracic echocardiography (TTE) results,treatment information,comorbid medical conditions,and outcomes.Microbiological samples were collected and processed according to well-established and published guidelines.Results We identified basic heart disease in 97.1% of the patients.A high proportion of the right-sided infective endocarditis patients had congenital heart defects (82.4%); predominantly,ventricular septal defects.Clinical symptoms were fever (97.1%),cardiac murmurs (94.1%) and fatigue (88.2%).Respiratory symptoms included cough (58.8%),pleuritic chest pain (47.1%) and hyoxemia (52.9%).Positive blood cultures were grown from 35.2% of patients and 50.0% were caused by staphylococcal species.Chest X-rays or CT examinations detected patchy infiltrates and/or nodules in all cases.Transthoracic echocardiography demonstrated infectious foci of the right-side heart in all cases.Parenteral antibiotics were administered for all,and cardiac surgery was carried out for 76.5% of patients with an effective rate of 82.3%.Conclusions SPE lacks characteristic clinical manifestation.Congenital heart disease is a common risk of SPE.Most patients with SPE have a good prognosis as long as early diagnosis and proper treatment can be provided.

  7. D-Dimer Use and Pulmonary Embolism Diagnosis in Emergency Units: Why Is There Such a Difference in Pulmonary Embolism Prevalence between the United States of America and Countries Outside USA?

    Science.gov (United States)

    Pernod, Gilles; Caterino, Jeffrey; Maignan, Maxime; Tissier, Cindy; Kassis, Jeannine; Lazarchick, John

    2017-01-01

    Objective Although diagnostic guidelines are similar, there is a huge difference in pulmonary embolism (PE) prevalence between the United States of America (US) and countries outside the USA (OUS) in the emergency care setting. In this study, we prospectively analyze patients’ characteristics and differences in clinical care that may influence PE prevalence in different countries. Methods An international multicenter prospective diagnostic study was conducted in a standard-of-care setting. Consecutive outpatients presenting to the emergency unit and suspected for PE were managed using the Wells score, STA-Liatest® D-Dimers and imaging. Results The prevalence of PE in the study was 7.9% in low and moderate risk patients. Among the 1060 patients with low or moderate pre-test probability (PTP), PE prevalence was four times higher in OUS (10.7%) than in the US (2.5%) (P < 0.0001). The mean number of imaging procedures performed for one new PE diagnosis was 3.3 in OUS vs 17 in the US (P < 0.001). Stopping investigation in the case of negative D-dimers (DD combined) with low/moderate PTP was more frequent in OUS (92.7%) than in the US (75.7%) (P < 0.01). Moreover, the use of imaging was much higher in the US (44.4% vs 19.2% in OUS) in the case of moderate PTP combined with negative DD. Conclusion Differences between US and OUS PE prevalence in emergency setting might be explained by differences in patients' characteristics and mostly in care patterns. US physicians performed computed tomographic pulmonary angiography more often than in Europe in cases of low/moderate PTP combined with negative DD. Trial Registration ClinicalTrials.gov NCT01221805 PMID:28085911

  8. [Successful surgical treatment of a massive pulmonary embolism in the organized thromboembolic phase].

    Science.gov (United States)

    Mandarić, V; Todorić, M; Ilić, R; Tisma, S; Trifunović, Z; Nikolić, G; Stojnić, B

    2000-01-01

    A patient, male, aged 36, clinically presented as an unstable angina pectoris following myocardial infarction, who came from general hospital of Banja Luka for further examination is presented. According to the medical report, he was treated for acute myocardial infarction in 1994 at Banja Luka's general hospital, when he was resusciated due to of cardiac arrest. The anginous pain was still present regardless of prescribed therapy. Following the clinical examination at the Military Medical Academy we have established a diagnosis of thromboembolism of the main pulmonary artery with a high pressure in the right ventricle. He underwent surgery under the extracorporeal circulation, when an organized old thrombus the main pulmonary artery and partially in arterial branches. The main pulmonary artery was almost completely obliterated. Thrombectomy was done. Following the operation, the patient was in a good condition and the repeated echocardiographic examinations showed no signs of recurrent thrombosis while the pressure in the right ventricle was significantly decreased. Afterwards, he was treated by heparine and oral anticoagulants and then by antiagregants. This case is very instructive because the massive pulmonary thromboembolism which was wrongly recognized and treated as an acute myocardial infarction.

  9. Eighty-peak kilovoltage 16-channel multidetector computed tomography and reduced contrast-medium doses tailored to body weight to diagnose pulmonary embolism in azotaemic patients

    Energy Technology Data Exchange (ETDEWEB)

    Holmquist, Fredrik [Lund University, Department of Radiology, Malmoe University Hospital, 205 02, Malmoe (Sweden); Nyman, Ulf [Lund University, Department of Radiology, Lasarettet Trelleborg, 23185, Trelleborg (Sweden)

    2006-05-15

    The aim of this study was to assess the feasibility of minimising contrast-medium (CM) doses using 80-peak kilovoltage (kVp) 16-channel multidetector computed tomography (MDCT) with CM dose tailored to body weight, when diagnosing pulmonary embolism (PE) in azotaemic patients. Twenty-nine patients (68-93 years; 38-79 kg) with an estimated glomerular filtration rate of 12-49 ml/min underwent 80 kVp MDCT at a median dose of 200 mg iodine (I)/kg and 15 s injection time. Pulmonary artery (PA) enhancement where compared with our own reference material using 320 mg I/kg at 120 kVp and with reported figures in the literature at 120-140 kVp and a 42 g iodine CM dose. Median (1st and 3rd quartiles) values regarding CM dose were 12.2 (9.9-12.8) g iodine; density of left main and lower lobe segmental PA 339 (275-395) Hounsfield units (HU) and 354 (321-442) HU, respectively. Those enhancement values were similar to those obtained from the reference population at 120 kVp and those reported in the literature at 120-140 kVp. One patient had a transient increase in plasma creatinine. Three months' follow-up revealed deep venous thrombosis among 1/18 patients with negative results from computed tomography (CT). We conclude that 80 kVp 16-channel MDCT to diagnose PE in azotaemic patients may be performed with markedly reduced CM doses, implying a lesser risk for CM-induced nephropathy. (orig.)

  10. Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Shazia Awan

    2017-03-01

    Full Text Available Objectives: Pulmonary embolism (PE is seven times more common in cancer patients than non-cancer patients. Since the existing clinical prediction rules (CPRs were validated predominantly in a non-cancer population, we decided to look at the utility of arterial blood gas (ABG analysis and D-dimer in predicting PE in cancer patients. Methods: Electronic medical records were reviewed between December 2005 and November 2010. A total of 177 computed tomography pulmonary angiograms (CTPAs were performed. We selected 104 individuals based on completeness of laboratory and clinical data. Patients were divided into two groups, CTPA positive (patients with PE and CTPA negative (PE excluded. Wells score, Geneva score, and modified Geneva score were calculated for each patient. Primary outcomes of interest were the sensitivities, specificities, positive, and negative predictive values for all three CPRs. Results: Of the total of 104 individuals who had CTPAs, 33 (31.7% were positive for PE and 71 (68.3% were negative. There was no difference in basic demographics between the two groups. Laboratory parameters were compared and partial pressure of oxygen was significantly lower in patients with PE (68.1 mmHg vs. 71 mmHg, p = 0.030. Clinical prediction rules showed good sensitivities (88−100% and negative predictive values (93−100%. An alveolar-arterial (A-a gradient > 20 had 100% sensitivity and negative predictive values. Conclusions: CPRs and a low A-a gradient were useful in excluding PE in cancer patients. There is a need for prospective trials to validate these results.

  11. 探讨宝石能谱成像在肺栓塞患者诊断中的临床应用%To Explore Gem Spectral Imaging in Diagnosis of Pulmonary Embolism in Patients With Clinical Application

    Institute of Scientific and Technical Information of China (English)

    金晓霞

    2016-01-01

    目的:研究宝石能谱成像技术应用于肺栓塞临床诊断工作中发挥的作用。方法选择本院44例肺栓塞患者,经GE Discorvery能谱CT对患者实施扫描检查,分析扫描诊断结果。结果44例肺栓塞患者中42例均能实现清晰显影;44例研究对象的肺动脉CTPA发现肺栓塞共计248处。结论针对肺栓塞患者,选择宝石能谱成像技术进行检查,能够获得良好的显影效果,确定肺栓塞发生部位以及栓塞数量。%Objective To study the gemstone spectral imaging technology is applied in clinical diagnosis of pulmonary embolism work role.Methods Selected 44 patients with pulmonary embolism in our hospital, the GEDiscorvery energy spectrum CT scans for patients, scanning diagnosis. Results44 cases in 42 patients with pulmonary embolism can achieve a clear development, The research object of pulmonary artery CTPA 44 cases pulmonary embolism a total of 248.Conclusion For patients with pulmonary embolism, choose gem spectral imaging technology to inspect, can obtain good enhancement effect, determine the location and number of embolism pulmonary embolism.

  12. Electrocardiographic differentiation between acute coronary syndrome and acute pulmonary embolism associated with inverted T waves in precordial leads

    Institute of Scientific and Technical Information of China (English)

    ZHAN Zhong-qun; WANG Chong-quan; HE Chao-rong; WANG Zhi-xiao; MAO Shan

    2010-01-01

    Background Inverted T waves in precordial leads are often seen in patients with acute pulmonary embolism (APE) and acute coronary syndrome (ACS). The purpose of this study was to analyze the electrocardiogram (ECG) difference between APE and ACS related inverted T waves in precordial leads. Methods The ECG difference among 62 patients with APE and 125 patients with ACS related inverted T waves in precordial leads were compared. Results Compared with ACS, Patients with APE were more frequently associated with incomplete or complete RBBB or slurred S wave in lead V1, the sum of the depth of inverted T waves in leads V1 and V2 not less than in lead V3 and V4 (inverted TV1 + V2 ≥ inverted TV3 + V4), and inverted T waves in leads V1 and Ⅲ. Conclusions Complete or incomplete RBBB or slurred S wave in lead V1, inverted T waves in leads V1 and III, and inverted TV1 + V2 ≥ inverted TV3 + V4 are useful criteria for predicting APE.

  13. Pulmonary Embolism in Pneumonia: Still a Diagnostic Challenge? Results of a Case-Control Study in 100 Patients

    Directory of Open Access Journals (Sweden)

    Maria Paparoupa

    2016-01-01

    Full Text Available This study evaluated the diagnostic value of D-dimer, CRP, and leucocytes count to detect an underlying pulmonary embolism (PE in patients with pneumonia. A predictive model of an underlying PE, based on laboratory markers and clinical symptoms, was our ultimate objective. Overall 100 patients underwent a computed tomography angiography (CTA of the lung: 54 with coexistence of PE and pneumonia (cases and 46 with pneumonia without PE (controls. Cases and controls were matched 1 : 1. Symptoms and paraclinical findings were registered on admission. Receiver operating characteristic (ROC curves, search for an optimal threshold, and conditional logistic regression analysis were conducted. D-dimer has a moderate ability to detect PE in pneumonia. Sensitivity of D-dimer was estimated at 97.78% and specificity at 11.11%. No optimal cut-point has acceptable diagnostic ability. After excluding patients with sepsis, sensitivity was reduced to 96.97%, whereas specificity increased to 16.13%. Consolidation in chest X-ray and positive D-dimer predict better an underlying PE as D-dimer itself. Thus, discriminatory power of the prediction model (AUC of 0.740 is not much greater than D-dimer (AUC of 0.703. No threshold that could increase the diagnostic value of D-dimer or a prediction model which is significantly better than D-dimer itself was identified.

  14. Diagnostic value of CT pulmonary angiography for right ventricular with pulmonary embolism in patients%MSCTPA对肺栓塞患者右心功能的诊断价值

    Institute of Scientific and Technical Information of China (English)

    王刚; 王浩; 卢星如; 包海荣; 张皓; 郭奇宏

    2012-01-01

    Objective The purpose of this study was to assess the diagnostic value of 64-slice CT pulmonary angiography (CTPA) with right heart function in patients with pulmonary embolism as the reference standard of echocardiography. Methods We prospectively collected 41 patients of clinically suspected pulmonary embolism with routine CTPA examination. Positive group according to right heart function, pulmonary embolism and pulmonary arterial pressure index of sites were grouped. Thinning data for maximum intensity projection (MIP), multiplanar reconstruction (MPR) and volume rendering (VRT) , were analysed for every group differences in right heart function parameters. Results In 24 of 41 patients with PE, 64-CTPA identified that 13 patients were positive for RVD. Meanwhile, 11 cases were diagnosed as positive by UCG. In comparison with UCG, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of CTPA were 76. 9% , 90.9%, 90.9% and 76. 9-%, respectively. Kappa value was 0. 669, which suggested moderate agreement between 64-CTPA and UCG in the whole level. Cardiovascular parameters including main pulmonary, ascending aorta, superior vena cava diameters, azygos vein diameters,coronary sinus diameters, PA / Aorta ratio, Right ventricular diameter (RVd) , left ventricular diameter (LVd) and RVd/LVd ratio were measured. For the first group, PA, PA/Aorta ratio, LVd, RVd and RVd/LVd, CS were significant; All of cardiovascular parameters for the second group were not significant; For the third group, only PA /Aorta ratio was significant. Conclusion These results suggest that MSCTPA and post-processing techniques are a practical and accurate means for evaluating RV function of pulmonary embolism in patients.%目的 以超声心动图作为诊断右心功能的标准,探讨64层CT肺血管造影(CTPA)对肺栓塞患者右心功能的诊断价值.方法 前瞻性收集了临床疑诊肺栓塞的41例行CTPA检查的患者,阳性组根据右

  15. Automated detection of pulmonary embolism (PE) in computed tomographic pulmonary angiographic (CTPA) images: multiscale hierachical expectation-maximization segmentation of vessels and PEs

    Science.gov (United States)

    Zhou, Chuan; Chan, Heang-Ping; Hadjiiski, Lubomir M.; Chughtai, Aamer; Patel, Smita; Cascade, Philip N.; Sahiner, Berkman; Wei, Jun; Ge, Jun; Kazerooni, Ella A.

    2007-03-01

    CT pulmonary angiography (CTPA) has been reported to be an effective means for clinical diagnosis of pulmonary embolism (PE). We are developing a computer-aided detection (CAD) system to assist radiologist in PE detection in CTPA images. 3D multiscale filters in combination with a newly designed response function derived from the eigenvalues of Hessian matrices is used to enhance vascular structures including the vessel bifurcations and suppress non-vessel structures such as the lymphoid tissues surrounding the vessels. A hierarchical EM estimation is then used to segment the vessels by extracting the high response voxels at each scale. The segmented vessels are pre-screened for suspicious PE areas using a second adaptive multiscale EM estimation. A rule-based false positive (FP) reduction method was designed to identify the true PEs based on the features of PE and vessels. 43 CTPA scans were used as an independent test set to evaluate the performance of PE detection. Experienced chest radiologists identified the PE locations which were used as "gold standard". 435 PEs were identified in the artery branches, of which 172 and 263 were subsegmental and proximal to the subsegmental, respectively. The computer-detected volume was considered true positive (TP) when it overlapped with 10% or more of the gold standard PE volume. Our preliminary test results show that, at an average of 33 and 24 FPs/case, the sensitivities of our PE detection method were 81% and 78%, respectively, for proximal PEs, and 79% and 73%, respectively, for subsegmental PEs. The study demonstrates the feasibility that the automated method can identify PE accurately on CTPA images. Further study is underway to improve the sensitivity and reduce the FPs.

  16. Heart-type fatty acid binding protein for the assessment of the short-term prognosis in acute pulmonary embolism patients with hemodynamic stability on admission%心脏型脂肪酸结合蛋白对人院时血流动力学稳定的急性肺栓塞患者短期预后的评估

    Institute of Scientific and Technical Information of China (English)

    陈勇; 刘双; 郭伟; 王增智

    2013-01-01

    目的 探讨心脏型脂肪酸结合蛋白(H-FABP)对入院时血流动力学稳定的急性肺栓塞患者短期预后评估的临床意义.方法 筛选2009年12月至2010年12月在北京安贞医院就诊并被确诊的入院时血流动力学稳定的急性肺栓塞患者156例,其中符合纳入标准90例,男37例,女53例,平均年龄(61.1±14.6)岁,留取溶栓或抗凝前的外周静脉血标本,应用双抗体夹心酶联免疫吸附法测定H-FABP浓度,非均相免疫法测定肌钙蛋白Ⅰ(cTnI)、N-末端脑钠肽前体(NT-proBNP)浓度,所有患者随访30 d,根据随访结果分为复杂临床过程组(7例)和简单临床过程组(83例),结果采用Mann-Whitney U检验、x2检验、x2检验的连续性校正及logistic回归进行分析.结果 复杂临床过程组H-FABP水平高于简单临床过程组(U =54.000,P<0.01);ROC曲线获得H-FABP的最佳预后截值为7 μg/L,H-FABP、cTnI和NT-proBNP三者之间AUC比较差异无统计学意义;单变量logistic回归分析发现H-FABP≥6 μg,/L、心率≥106次/min和晕厥(均P<0.01)可预测血流动力学稳定的急性肺栓塞患者短期不良预后;多变量logistic回归分析发现仅H-FABP≥6 μg/L和晕厥(均P<0.05)仍是独立预测因素;cTnI或NT-proBNP联合H-FABP可提高对血流动力学稳定的急性肺栓塞患者治疗30 d的预测价值.结论 单独应用H-FABP或H-FABP联合其他临床资料,可对入院时血流动力学稳定的急性肺栓塞患者治疗30 d的预后进行评估,H-FABP作为预后评估可能优于cTnI和NT-proBNP.%Objective To explore the clinical value of heart-type fatty acid binding protein (H-FABP)for the assessment of the short-term prognosis in acute pulmonary embolism (APE)patients with hemodynamic stability on admission.Method A total of 156 APE patients with hemodynamic stability on admission were hospitalized in Beijing Anzhen hospital from December 2009 to December 2010,and the final study population comprised 90

  17. Echocardiographic assessment of pulmonary vascular resistance in pulmonary arterial hypertension

    Directory of Open Access Journals (Sweden)

    Bergot Emmanuel

    2010-06-01

    Full Text Available Abstract Background Echocardiographic ratio of peak tricuspid regurgitant velocity to the right ventricular outflow tract time-velocity integral (TRV/TVI rvot was presented as a reliable non-invasive method of estimating pulmonary vascular resistance (PVR. Studies using this technique in patients with moderate to high PVR are scarce. Left ventricular outflow tract time-velocity integral (TVI lvot can be easier to measure than TVI rvot, especially in patients with severe pulmonary hypertension (PH with significant anatomical modifications of the right structures. Aims We wanted to determine whether the TRV/TVI rvot and TRV/TVI lvot ratios would form a reliable non-invasive tool to estimate PVR in a cohort of patients with moderate to severe pulmonary vascular disease. Methods Doppler echocardiographic examination and right heart catheterisation were performed in 37 patients. Invasive PVR was compared with TRV/TVI rvot and TRV/TVI lvot ratios using regression analysis. Two equations were modelled and the results compared with invasive measurements using the Bland-Altman analysis. Using receiver-operating characteristics curve analysis, a cut-off value for the two ratios was generated. Results Correlation coefficients between invasive PVR and TRV/TVI rvot then TRV/TVI lvot were respectively 0.76 and 0.74. Two new equations were found but the Bland-Altman analysis showed wide standard deviations (respectively 3.8 and 3.9 Wood units. A TRV/TVI rvot then TRV/TVI lvot ratio cut-off value of 0.14 had a sensitivity of 93% and a specificity of 57% for the first and a sensitivity of 87% and a specificity of 57% for the second to determine PVR > 2 Wood units. Conclusion Echocardiography is useful for the screening of patients with pulmonary hypertension and PVR > 2 WU. It remains disappointing for accurate assessment of high PVR. TVI lvot may be an alternative to TVI rvot for patients for whom accurate TVI rvot measurement is not possible.

  18. Prophylaxis of venous and pulmonary thrombo-embolism. Profilaxis del tromboembolismo venoso y pulmonar. Conceptos actuales.

    Directory of Open Access Journals (Sweden)

    Hugo Jiménez Vázquez

    2004-04-01

    Full Text Available This bibliographical revision stands out the importance of the vein thromboembolism prevention in patients under different surgical and injuries procedures, wicked illnesses and medical conditions. The epidemiology, etiopatogenia and factors of risk of the deep vein thrombosis and the lung embolism are exposed in different categories of patient. Up to dates prophylactic methods are taken into account and compared their effectiveness and cautions according to the last studies on the topic.
    En esta revisión se destaca la importancia de la prevención de tromboembolismo venoso en pacientes bajo diferentes procedimientos quirúrgicos y traumatológicos, enfermedades malignas y condiciones médicas. Se exponen la epidemiología, etiopatogenia y factores de riesgo de la trombosis venosa profunda y el embolismo pulmonar en diferentes categorías de pacientes. Se tratan también los métodos profilácticos actualmente existentes y se compara su efectividad y precauciones de acuerdo a los últimos estudios sobre el tema.

  19. Low-dose radiation with 80-kVp computed tomography to diagnose pulmonary embolism: a feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Nyman, Ulf [Dept. of Radiology, Univ. of Lund, Lasarettet Trelleborg, Trelleborg (Sweden)], E-mail: ulf.nyman@skane.se; Bjoerkdahl, Peter [Dept. of Radiology, Lasarettet Trelleborg, Trelleborg (Sweden); Olsson, Marie-Louise; Gunnarsson, Mikael [Medical Radiation Physics, Dept. of Clinical Sciences, Univ. of Lund, Skaane Univ. Hospital, Malmoe (Sweden); Goldman, Bitte [Dept. of Internal Medicine, Lasarettet Trelleborg, Trelleborg (Sweden)

    2012-11-15

    Background Mounting collective radiation doses from computed tomography (CT) implies an increased risk of radiation-induced cancer in exposed populations, especially in the young. Purpose To evaluate radiation dose and image quality at 80-kVp CT to diagnose acute pulmonary embolism (PE) compared with a previous study at 100 and 120 kVp with all other scanning parameters unchanged. Material and Methods A custom-made chest phantom with a 12 mg I/mL-syringe was scanned at 80/100/120 kVp to evaluate relative changes in computed tomographic dose index (CTDIvol), attenuation, image noise, and contrast-to-noise ratio (CNR). Fifty patients underwent 80 kVp 16-row detector CT at 100 'Quality reference' mAs. A total of 350 mg I/kg were injected to compensate for increased CNR at 80 kVp, while 300 mg I/kg had been used at 100/120 kVp. CTDI{sub vol}, dose-length product (DLP), and estimated effective dose were evaluated including Monte Carlo simulations. Pulmonary artery attenuation and noise were measured and CNR calculated. Two radiologists evaluated subjective image quality using a four-grade scale. Results Switching from 120 to 80 kVp in the phantom study decreased radiation dose by 67% while attenuation and noise increased 1.6 and 2.0 times, respectively, and CNR decreased by 16%. Switching from 120 to 80 kVp in the patient studies decreased estimated effective dose from 4.0 to 1.2 mSv (70% decrease) in median while pulmonary artery attenuation and noise roughly doubled from 332 to 653 HU and from 22 to 49 HU, respectively, resulting in similar CNR (13 vs. 12). At 80 kVp all examinations were regarded as adequate (8%) or excellent (92%). Conclusion Switching from 120 to 80 kVp CT without increased mAs but slightly increased iodine dose may be of special benefit to diagnose PE in younger individuals with preserved renal function where the primary aim is to minimize radiation dose and reaching levels below that of scintigraphy.

  20. Minimizing Contrast Medium Doses to Diagnose Pulmonary Embolism with 80-kVp Multidetector Computed Tomography in Azotemic Patients

    Energy Technology Data Exchange (ETDEWEB)

    Holmquist, F. (Dept. of Diagnostic Radiology, Malmoe Univ. Hospital, Univ. of Lund, Malmoe (Sweden)); Hansson, K.; Pasquariello, F. (Dept. of Internal Medicine, Lasarettet Trelleborg, Univ. of Lund, Trelleborg (Sweden)); Bjoerk, J. (Competence Center for Clinical Research, Univ. Hospital, Univ. of Lund, Lund (Sweden)); Nyman, U. (Dept. of Radiology, Lasarettet Trelleborg, Univ. of Lund, Trelleborg (Sweden))

    2009-02-15

    Background: In diagnosing acute pulmonary embolism (PE) in azotemic patients, scintigraphy and magnetic resonance imaging are frequently inconclusive or not available in many hospitals. Computed tomography is readily available, but relatively high doses (30-50 g I) of potentially nephrotoxic iodine contrast media (CM) are used. Purpose: To report on the diagnostic quality and possible contrast-induced nephropathy (CIN) after substantially reduced CM doses to diagnose PE in azotemic patients using 80-peak kilovoltage (kVp) 16-row multidetector computed tomography (MDCT) combined with CM doses tailored to body weight, fixed injection duration adapted to scan time, automatic bolus tracking, and saline chaser. Material and Methods: Patients with estimated glomerular filtration rate (eGFR) <50 ml/min were scheduled to undergo 80-kVp MDCT using 200 mg I/kg, and those with eGFR =50 ml/min, 120-kVp MDCT with 320 mg I/kg. Both protocols used an 80-kg maximum dose weight and a fixed 15-s injection time. Pulmonary artery density and contrast-to-noise ratio were measured assuming 70 Hounsfield units (HU) for a fresh clot. CIN was defined as a plasma creatinine rise >44.2 mumol/l from baseline. Results: 89/148 patients (63/68 females) underwent 80-/120-kVp protocols, respectively, with 95% of the examinations being subjectively excellent or adequate. Mean values in the 80-/120-kVp cohorts regarding age were 82/65 years, body weight 66/78 kg, effective mAs 277/117, CM dose 13/23 g I, pulmonary artery density 359/345 HU, image noise (1 standard deviation) 24/21 HU, contrast-to-noise ratio 13/13, and dose-length product 173/258 mGycm. Only 1/65 and 2/119 patients in the 80- and 120-kVp cohorts, respectively, with negative CT and no anticoagulation suffered non-fatal thromboembolism during 3-month follow-up. No patient developed CIN. Conclusion: 80-kVp 16-row MDCT with optimization of injection parameters may be performed with preserved diagnostic quality, using markedly reduced CM

  1. 双源CT肺动脉成像在肺动脉栓塞诊断中的应用价值%Application of dual-source CT pulmonary angiography in the diagnosis of pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    张谷青; 陈月芹; 孙新海; 史志涛; 张新东; 王皆欢

    2011-01-01

    Objective : To explore the value of dual-source CT angiography of pulmonary arteries in the diagnosis of pulmonary embolism. Methods: 58 patients suspected of having pulmonary embolism were examined with dual-source CT pulmonary angiography. The effects of imaging in displaying pulmonary embolism on MPR , MIP , VR and CTVE were compared. The direct signs, the indirect signs and types were analyzed. Results : 45 cases with pulmonary embolism were diagnosed. A total of 658 emboli were found by dual-source CT , 170 of which were central type, 208 were eccentric type , 74 were mural type,and 206 were complete occlusion type. Indirect signs included mosaic sign (13 cases) , pleural effusion (27 cases) ,pulmonary artery hypertension (7 cases) , and pulmonary infarct (18 cases). 658 emboli were found on MPR,584 on MIP.the effect of VR and CTVE were not good (249 and 75 emboli were found). MIP,VR and CTVE were obviously inferior to MPR (P<0.05). Conclusion : The dual-source CT pulmonary angiography is a convenient, fast and reliable method for demonstration of pulmonary embolism. MPR, MIP,VR and CTVE play an important role in the diagnosis of pulmonary embolism.and MPR is the best among them.%目的:探讨双源CT肺动脉成像对肺动脉栓塞(PE)的诊断价值.方法:对58例临床拟诊为PE的患者行双源CT肺动脉成像,总结PE的直接、间接征象及分型,并比较MPR、MIP、VR和CTVE对肺动脉栓子的显示效果.结果:直接征象:58例中45例诊断为PE,共发现栓子 658支(中心型170支,偏心型208支,附壁型74支,完全闭塞型206支).间接征象:马赛克征13例,胸腔积液27例,肺动脉高压7例,肺梗死18例.MPR检出栓子658支,MIP检出584支,VR及CTVE对栓子的显示效果较差,分别为249支和75支.MIP、VR及CTVE对栓子的显示效果低于MPR,差异有统计学意义(P<0.05).结论:双源CT肺动脉成像能够方便、快捷、清楚地显示肺动脉栓子,对诊断PE有重要价值;MPR、MIP、VR和CTVE是

  2. MR Diagnosis of a Pulmonary Embolism: Comparison of P792 and Gd-DOTA for First-Pass Perfusion MRI and Contrast-Enhanced 3D MRA in a Rabbit Model

    Energy Technology Data Exchange (ETDEWEB)

    Keilholz, Shella D. [Emory University and Georgia Institute of Technology, Atlanta (United States); Bozlar, Ugur; Fujiwara, Naomi; Mata, Jaime F.; Berr, Stuart S.; Hagspiel, Klaus D. [Gulhane Military Medical Academy, Ankara (Turkmenistan); Corot, Claire [Guerbet Research, Aulnay-sous-Bois (France)

    2009-10-15

    To compare P792 (gadomelitol, a rapid clearance blood pool MR contrast agent) with gadolinium-tetraazacyclododecanetetraacetic acid (Gd- DOTA), a standard extracellular agent, for their suitability to diagnose a pulmonary embolism (PE) during a first-pass perfusion MRI and 3D contrastenhanced (CE) MR angiography (MRA). A perfusion MRI or CE-MRA was performed in a rabbit PE model following the intravenous injection of a single dose of contrast agent. The time course of the pulmonary vascular and parenchymal enhancement was assessed by measuring the signal in the aorta, pulmonary artery, and lung parenchyma as a function of time to determine whether there is a significant difference between the techniques. CE-MRA studies were evaluated by their ability to depict the pulmonary vasculature and following defects between 3 seconds and 15 minutes after a triple dose intravenous injection of the contrast agents. The P792 and Gd-DOTA were equivalent in their ability to demonstrate PE as perfusion defects on first pass imaging. The signal from P792 was significantly higher in vasculature than that from Gd-DOTA between the first and the tenth minutes after injection. The results suggest that a CE-MRA PE could be reliably diagnosed up to 15 minutes after injection. P792 is superior to Gd-DOTA for the MR diagnosis of PE.

  3. Clinical analysis of 12patients of lung cancer with pulmonary thrombosis embolism%12例肺癌并发肺栓塞的临床分析

    Institute of Scientific and Technical Information of China (English)

    杨中飞; 邓芳

    2013-01-01

    objective To investigate the clinical characteristics and therapeutic methods of 12 patients of lung cancer with pulmonary embolism in order to improve early diagnosis and treatment of the disease.Methods:The clinical characteristics and therapeutic methods of 12patients of lung cancer with pulmonary embolism were reviewed retrospectively.Results:4 of 12patients of lung cancer with pulmonary embo1ism received thrmbolytic therapy in vein,7patients anti-coagulative therapy in vein, 1 patients normal therapy,8 patients recovered health,and the effective rate was 75% .Conclusions:Maintaining the vital sign and thrombolytic therapy, anti-coagulative therapy are the key to rescue patients of lung cancer with pulmonary embolism.%目的:探讨12例肺癌并发肺栓塞患者的临床特点、治疗方法,提高对该病的早期认识、治疗。方法:回顾性分析12例肺癌并发肺栓塞患者的临床特点和治疗方法。结果:12例肺癌并发肺栓塞患者中4例接受了静脉溶栓治疗,7例接受了静脉抗凝治疗,1例接受了对症治疗,抢救成功8例,有效率75%。结论:维持生命征的稳定,溶栓及抗凝治疗是治疗肺癌并发肺栓塞患者的重要手段

  4. Evaluation of biventricular ejection fraction with ECG-gated 16-slice CT: preliminary findings in acute pulmonary embolism in comparison with radionuclide ventriculography

    Energy Technology Data Exchange (ETDEWEB)

    Coche, Emmanuel; Goncette, Louis; Maldague, Baudouin [Universite Catholique de Louvain, Department of Medical Imaging, Cliniques Universitaires St-Luc, Brussels (Belgium); Vlassenbroek, Alain [Philips Medical Systems, Cleveland, OH (United States); Roelants, Veronique [Universite Catholique de Louvain, Department of Nuclear Medicine, Cliniques Universitaires St-Luc, Brussels (Belgium); D' Hoore, William [Catholic University of Louvain, Public Health, Brussels (Belgium); Verschuren, Franck [Universite Catholique de Louvain, Department of Emergency Medicine, Cliniques Universitaires St-Luc, Brussels (Belgium)

    2005-07-01

    This study aimed to assess the feasibility of cardiac global function evaluation during a whole-chest multi-slice CT (MSCT) acquisition in patients referred for suspicion of pulmonary embolism (PE), and to compare the results with planar equilibrium radionuclide ventriculography (ERNA). Ten consecutive haemodynamically stable patients (six female, four male; mean age 69.7 years; heart rate 65-99 bpm) with suspicion of PE underwent an MSCT and ERNA within a 6 h period. CT acquisition was performed after contrast medium injection by using 16 x 1.5 mm collimation and retrospective ECG gating. Left ventricular (LVEF) and right ventricular (RVEF) ejection fractions were calculated using dedicated three-dimensional software. Relationships between measurements obtained with MSCT and ERNA were assessed using linear regression analysis and reliability of MSCT was assessed with intra-class correlation coefficient. Bland-Altman analysis was performed to calculate limits of agreement between MSCT and ERNA. MSCT was performed successfully in ten patients with a mean acquisition time of 16.5{+-}2.8 s. Functional cardiac evaluation was possible on CT for all patients except for one due to poor opacification of right ventricle. Linear regression analysis showed a good correlation between MSCT and ERNA for the LVEF (R=0.91) and the RVEF (R=0.89) measurements. Intra-class correlation was superior for LVEF (0.92) than for the RVEF (0.68). Bland-Altman plots demonstrated that MSCT substantially overestimated the ERNA RVEF. Morphological CT data demonstrated PE in four of ten of patients and alternative diagnoses in five of ten patients. Our study reveals that MSCT with retrospective ECG gating may provide in one modality a morphological and a functional cardiopulmonary evaluation. Comparison with ERNA demonstrated a good correlation for both ventricular ejection fractions. (orig.)

  5. Evaluation of biventricular ejection fraction with ECG-gated 16-slice CT: preliminary findings in acute pulmonary embolism in comparison with radionuclide ventriculography.

    Science.gov (United States)

    Coche, Emmanuel; Vlassenbroek, Alain; Roelants, Véronique; D'Hoore, William; Verschuren, Franck; Goncette, Louis; Maldague, Baudouin

    2005-07-01

    This study aimed to assess the feasibility of cardiac global function evaluation during a whole-chest multi-slice CT (MSCT) acquisition in patients referred for suspicion of pulmonary embolism (PE), and to compare the results with planar equilibrium radionuclide ventriculography (ERNA). Ten consecutive haemodynamically stable patients (six female, four male; mean age 69.7 years; heart rate 65-99 bpm) with suspicion of PE underwent an MSCT and ERNA within a 6 h period. CT acquisition was performed after contrast medium injection by using 16x1.5 mm collimation and retrospective ECG gating. Left ventricular (LVEF) and right ventricular (RVEF) ejection fractions were calculated using dedicated three-dimensional software. Relationships between measurements obtained with MSCT and ERNA were assessed using linear regression analysis and reliability of MSCT was assessed with intra-class correlation coefficient. Bland-Altman analysis was performed to calculate limits of agreement between MSCT and ERNA. MSCT was performed successfully in ten patients with a mean acquisition time of 16.5+/-2.8 s. Functional cardiac evaluation was possible on CT for all patients except for one due to poor opacification of right ventricle. Linear regression analysis showed a good correlation between MSCT and ERNA for the LVEF (R=0.91) and the RVEF (R=0.89) measurements. Intra-class correlation was superior for LVEF (0.92) than for the RVEF (0.68). Bland-Altman plots demonstrated that MSCT substantially overestimated the ERNA RVEF. Morphological CT data demonstrated PE in four of ten of patients and alternative diagnoses in five of ten patients. Our study reveals that MSCT with retrospective ECG gating may provide in one modality a morphological and a functional cardiopulmonary evaluation. Comparison with ERNA demonstrated a good correlation for both ventricular ejection fractions.

  6. McConnell Sign in a Patient with Massive Acute Pulmonary Embolism

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    Qaiser Shafiq

    2011-01-01

    Full Text Available A 48-year-old female was admitted after experiencing a brief syncopal episode. Three weeks ago the patient sustained a right arm humerus bone fracture in a motor vehicle accident. Since the accident, her mobility has been limited. CT angiogram of the chest revealed massive bilateral pulmonary emboli. A 2D echocardiogram was performed, which demonstrated McConnell sign and severe right ventricle dysfunction. Considering potential of hemodynamic instability, the patient received fibrinolytic therapy with Alteplase. A subsequent 2D echocardiogram showed complete resolution of McConnell sign and right ventricle dysfunction.

  7. Assessing the Reliability and Quality of Online Uterine Fibroid Embolization Resources

    Energy Technology Data Exchange (ETDEWEB)

    Kaicker, Jatin; Wu Ke; Athreya, Sriharsha, E-mail: sathreya@stjoes.ca [Michael G. Degroote School of Medicine, Department of Medical Imaging (Canada)

    2013-04-15

    This study was designed to examine the best internet resources about uterine fibroid embolization (UFE) pertinent to medical trainees, radiologists, gynecologists, family physicians, and patients. The terms 'uterine fibroid embolization,' 'uterine fibroid embolization,' and 'uterine artery embolization' were entered into Google, Yahoo, and Bing search engines; the top 20 hits were assessed. The hits were categorized as organizational or nonorganizational. Additionally, 23 radiological and obstetrical organizations were assessed. The DISCERN instrument and Journal of the American Medical Association (JAMA) benchmarks (authorship, attribution, currency, disclosure) were used to assess the information critically. The scope, strength, weaknesses, and unique features were highlighted for the top five organizational and nonorganizational websites. A total of 203 websites were reviewed; 23 were removed in accordance with the exclusion criteria and 146 were duplicate websites, for a total of 34 unique sites. It was found that 35 % (12/34 websites) were organizational (family medicine, radiology, obstetrics/gynecology) and 65 % (22/34 websites) were nonorganizational (teaching or patient resources). The overall mean DISCERN score was 49.6 (10.7). Two-tailed, unpaired t test demonstrated no statistically significant difference between organizational and nonorganizational websites (p = 0.101). JAMA benchmarks revealed 44 % (15/34 websites) with authorship, 71 % (24/34 websites) with attribution, 68 % (23/34 websites) with disclosure, and 47 % (16/34 websites) with currency. The overall quality of websites for UFE is moderate, with important but not serious shortcomings. The best websites provided relevant information about the procedure, benefits/risks, and were interactive. DISCERN scores were compromised by sites failing to provide resources for shared decision-making, additional support, and discussing consequence of no treatment. JAMA

  8. Development and comparison of a minimally-invasive model of autologous clot pulmonary embolism in Sprague-Dawley and Copenhagen rats

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    Sanapareddy Nina

    2010-02-01

    Full Text Available Abstract Background Experimental models of pulmonary embolism (PE that produce pulmonary hypertension (PH employ many different methods of inducing acute pulmonary occlusion. Many of these models induce PE with intravenous injection of exogenous impervious objects that may not completely reproduce the physiological properties of autologous thromboembolism. Current literature lacks a simple, well-described rat model of autlogous PE. Objective: Test if moderate-severity autologous PE in Sprague-Dawley (SD and Copenhagen (Cop rats can produce persistent PH. Methods blood was withdrawn from the jugular vein, treated with thrombin-Ca++ and re-injected following pretreatment with tranexamic acid. Hemodynamic values, clot weights and biochemical measurements were performed at 1 and 5 days. Results Infusion of clot significantly increased the right ventricular peak systolic pressure to 45-55 mm Hg, followed by normalization within 24 hours in SD rats, and within 5 days in COP rats. Clot lysis was 95% (24 hours and 97% (5 days in SD rats and was significantly lower in COP rats (70%, 24 hours; 87% 5 days. Plasma D-dimer was elevated in surgical sham animals and was further increased 8 hours after pulmonary embolism. Neither strain showed a significant increase in bronchoalveolar chemotactic activity, myeloperoxidase activity, leukocyte infiltration, or chemokine accumulation, indicating that there was no significant pulmonary inflammation. Conclusions Both SD and COP rats exhibited near complete fibrinolysis of autologous clot PE within 5 days. Neither strain developed persistent PH. Experimental models of PE designed to induce sustained PH and a robust inflammatory response appear to require significant, persistent pulmonary vascular occlusion.

  9. Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hwa Yeon; Song, In Sup (Dept. of Diagnostic Radiology Chung-Ang Univ. College of Medicine, Seoul (Korea, Republic of)); Yoo, Seung Min; Rho, Ji Young (Dept. of Diagnostic Radiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)), email: smyoo68@hanmail.net; Moon, Jae Youn; Kim, In Jai; Lim, Sang Wook; Sung, Jung Hoon; Cha, Dong Hun (Dept. of Cardiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)); White, Charles S. (Dept. of Diagnostic Radiology Univ. of Maryland, Baltimore (United States))

    2011-05-15

    Background Although triple rule-out CT angiography (TRO) to simultaneously evaluate acute coronary syndrome (ACS), pulmonary embolism (PE), and acute aortic syndrome (AAS) is increasingly used in many institutions, TRO is inevitably associated with increased radiation exposure due to extended z-axis coverage compared with dedicated coronary CT angiography (DCTA). Purpose To determine the frequency of exclusion of findings of AAS, PE, and significant incidental non-cardiac pathology that may be the cause of acute chest pain when using a restricted DCTA field of view (FOV). Material and Methods We retrospectively reviewed CT images and charts of 103 patients with acute PE and 50 patients with AAS. Either non-ECG gated dedicated pulmonary or aortic CT angiography was performed using 16- or 64-slice multidetector CT (MDCT). We analyzed the incidence of isolated PE, AAS, or significant non-cardiac pathology outside of DCTA FOV (i.e. from tracheal carina to the base of heart). Results There were two cases of isolated PE (2/103, 1.9%) excluded from the FOV of DCTA. One case of PE was isolated to the subsegmental pulmonary artery in the posterior segment of the right upper lobe. In the second case, pulmonary embolism in the left main pulmonary artery was located out of the FOV of DCTA because the left main pulmonary artery was retracted upwardly by fibrotic scar in the left upper lobe due to prior tuberculosis. There was no case of AAS and significant non-cardiac pathology excluded from the FOV of DCTA. AAS (n = 50) consisted of penetrating atherosclerotic ulcer (n = 7), intramural hematoma (n = 5) and aortic dissection (n = 38). Conclusion As isolated PE, AAS, and significant non-cardiac pathology outside of the DCTA FOV rarely occur, DCTA may replace TRO in the evaluation of patients with non-specific acute chest pain and a low pre-test probability of PE or aortic dissection

  10. Catheter fragmentation and local lysis in two lung transplant patients with pulmonary embolism.

    Science.gov (United States)

    Suhling, H; Westerkamp, V; Dinh, Q T; Greer, M; Kempf, T; Simon, A; Gottlieb, J; Welte, T; Schieffer, B

    2010-11-01

    In conjunction with the rising number of lung transplant operations in the past decade, an increased predisposition to venous thrombosis (VT), particularly within the first year posttransplantation has been observed. Previous studies have revealed that between 8.6% and 12% of patients develop VT, which can ultimately result in pulmonary emboli (PE).Transplanted lungs pose a much greater infarction risk due to their lack of collateral vascularisation, relying entirely on the vasa publica--the pulmonary artery--in the absence of vasa privata. Such losses in viable lung parenchyma are always serious, but carry still greater risks for single-lung transplant recipients, an early diagnosis and treatment remain critical. Here we report on two cases of PE after lung transplantation, both of whom were managed with catheter fragmentation and local thrombolysis. In our opinion, this approach represents a viable treatment for symptomatic PE in lung transplant recipients. The benefits and risks of the alternative treatment options in these special cases will be reviewed and the definitive therapy was described. In the patients treated, catheter fragmentation with localized thrombolysis resulted in short term improvements in graft function, but could not prevent later lung infarction in one case.

  11. The Evaluation of Pulmonary Embolism Diagnosis Using SPECT V/Q Imaging Combined with D-Dimer Assay

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    LU Xia;MENG Jing-jing;XIE Xiao-fen;WANG Qian

    2016-11-01

    Full Text Available 全文: PDF (2692 KB HTML (1 KB 输出: BibTeX | EndNote (RIS 摘要 研究V/Q断层显像半定量分析联合测定血浆D-二聚体早期、准确诊断肺栓塞的价值,尤其在小面积肺栓塞诊断中的应用优势。疑诊肺栓塞来核医学科行V/Q断层显像患者共156例,以CT肺血管造影(computed tomographic pulmonary angiography, CTPA)检查及临床诊断为分组标准,肺栓塞组患者101例,非肺栓塞组患者55例。比较SPECT V/Q断层显像、血浆D-二聚体测定以及SPECT V/Q断层显像联合血浆D-二聚体测定三种方法对肺栓塞的诊断效能。应用Philips公司Oasis图像后处理软件对栓塞面积进行半定量分析,进一步评估对于肺栓塞面积占双肺容积≤15%的小面积肺栓塞的诊断价值。结果显示,血浆D-二聚体测定对于肺栓塞的诊断有较高的灵敏度(70.3%),但是特异性(61.8%)差;SPECT V/Q断层显像半定量分析对于肺栓塞的诊断具有较高的灵敏度和特异性,分别为85.1%、90.9%;而二者联合应用,诊断肺栓塞效能最高,灵敏度和特异性分别为91.1%、98.2%。 其中SPECT V/Q断层显像半定量分析对于肺栓塞面积小于15%的小面积肺栓塞诊断有优势。放射性核素SPECT V/Q断层显像联合测定血浆D-二聚体能显著提高肺栓塞的诊断效能,是临床实用、安全有效的肺栓塞疑诊患者诊断策略。 服务 把本文推荐给朋友 加入我的书架 加入引用管理器 E-mail Alert RSS 作者相关文章 卢霞 孟晶晶 解小芬 王蒨 关键词 : 肺栓塞, SPECT V/Q显像, 血浆D-二聚体测定, 诊断效能 Abstract: To evaluate the early and accurate diagnostic value of SPECT V/Q imaging combined with D-dimer assay,especially in non massive pulmonary embolism group. 156 patients with computed tomographic pulmonary angiography (CTPA, Geneva score, response of anticoagulation treatments, who was selected from 321

  12. Pulmonary embolism risk stratification by European Society of Cardiology is associated with recurrent venous thromboembolism: Findings from a long-term follow-up study.

    Science.gov (United States)

    Zhang, Shuai; Zhai, Zhenguo; Yang, Yuanhua; Zhu, Jianguo; Kuang, Tuguang; Xie, Wanmu; Yang, Suqiao; Liu, Fangfang; Gong, Juanni; Shen, Ying H; Wang, Chen

    2016-01-01

    Venous thromboembolism (VTE) recurrence carries significant mortality and morbidity. Accurate risk assessment and effective treatment for patients with acute pulmonary embolism (PE) is important for VTE recurrence prevention. We examined the association of VTE recurrence with risk stratification and PE treatment. We enrolled 627 patients with a first episode of confirmed PE. Baseline clinical information was collected. PE severity was assessed by the European Society of Cardiology's (ESC) risk stratification, the simplified PE Severity Index (sPESI) and the Qanadli score of clot burden. Patients were followed for 1-5 years. The cumulative recurrent VTE and all-cause death were documented. The association between recurrent VTE and risk factors was analyzed. The cumulative incidences of recurrent VTE were 4.5%, 7.3%, and 13.9% at 1, 2, and 5 years of follow-up, respectively. The VTE recurrence was associated with higher (high- and intermediate-) risk stratification predicted by ESC model (HR 1.838, 95% CI 1.318-2.571, P<0.001), as well as with unprovoked PE (HR 2.809, 95% CI 1.650-4.781, P b 0.001) and varicose veins (HR 4.747, 95% CI 2.634-8.557, P<0.001). The recurrence was negatively associated with longer (≥6 months) anticoagulation (HR 0.473, 95% CI 0.285-0.787, P=0.004), especially in patients with higher risk (HR 0.394, 95% CI 0.211-0.736, P=0.003) and unprovoked PE (HR 0.248, 95% CI 0.122-0.504, P<0.001). ESC high-risk and intermediate-risk PE, unprovoked PE and varicose veins increase recurrence risk. Longer anticoagulation treatment reduces recurrence, especially in higher risk and unprovoked PE patients.

  13. Bronchial Artery Embolization for Massive Hemoptysis: a Retrospective Study

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    Ali Fani

    2013-05-01

    Full Text Available   Introduction: To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis.   Materials and Methods: A retrospective study on 46 patients (26 males and 20 females who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. Results: The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure–related complication such as bronchial infarction was identified However none of the patientsexperienced neurological complications. Conclusion: Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition.

  14. Role of endovascular embolization in improving the quality of life in a patient suffering from complicated intralobar pulmonary sequestration – A case report

    Directory of Open Access Journals (Sweden)

    Vineeta Ojha

    2015-01-01

    Full Text Available Intralobar pulmonary sequestration is a rare congenital malformation characterized by the presence of nonfunctional parenchymal lung tissue, receiving systemic arterial blood supply and lacking normal communication with tracheobronchial tree. Recurrent pneumonia and massive hemoptysis are life threatening complications associated with it. Delay in the diagnosis and management can be fatal. We report here a case of intralobar pulmonary sequestration in a 18 year old female who presented with recurrent severe episodes of pneumonia and hemoptysis forcing her to drop out of school. The diagnosis was confirmed by CECT Thorax and CT Angiography. The patient was managed by minimally invasive endovascular treatment in the form of feeding artery embolization. She made a full recovery with satisfactory outcome. On subsequent follow up, there was no recurrence of symptoms and she is doing well socially and academically. The aim of this case report is to show feasibility and safety of embolization as a less-invasive management option for adult pulmonary sequestration complicated with hemoptysis and LRTIs and emphasize the importance of such minimally invasive technique to enhance the quality of life in such patients.

  15. Non-invasive assessment of pulmonary blood supply after staged repair of pulmonary atresia.

    OpenAIRE

    Del Torso, S.; Kelly, M J; Kalff, V; Stellin, G; Mee, R B; Venables, A W

    1985-01-01

    Radionuclide studies were performed to determine pulmonary blood flow in six children who had undergone surgery for pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary arteries with or without major aortopulmonary collateral arteries. Lung blood flow was assessed from both particle perfusion lung scans and the pulmonary and systemic phase of a radionuclide dynamic flow study. Five patients had perfusion defects identified on the particle perfusion lung scan. In three of th...

  16. {sup 99m}Tc-apcitide scintigraphy in patients with clinically suspected deep venous thrombosis and pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Dunzinger, Andreas; Piswanger-Soelkner, Jutta-Claudia; Lipp, Rainer W. [Medical University of Graz, Division of Nuclear Medicine, Department of Internal Medicine, Graz (Austria); Hafner, Franz; Brodmann, Marianne [Medical University of Graz, Divison of Angiology, Department of Internal Medicine, Graz (Austria); Schaffler, Gottfried [Medical University of Graz, Department of Radiology, Graz (Austria)

    2008-11-15

    Detection of acute deep venous thrombosis (DVT) in patients presenting with clinical symptoms suggesting DVT and pulmonary embolism (PE) with {sup 99m}Tc-apcitide, a synthetic polypeptide, binding to glycoprotein IIb/IIIa receptors expressed on activated platelets is the objective of the study. Nineteen patients (11 males, eight females) received within 24h after admission to the hospital a mean of 841MBq (range 667 to 1,080) {sup 99m}Tc-apcitide i.v. followed by planar recordings 10, 60, and 120min after injection. Images were compared to the results of compression ultrasonography and/or phlebography. Patients with clinically suspected PE underwent spiral computed tomography or lung perfusion scans. {sup 99m}Tc-apcitide scintigraphy showed acute clot formation in 14 out of 16 patients where the other imaging modalities suggested DVT. Positive scintigraphic results were seen up to 17days after the onset of clinical symptoms. In three out of three patients without any proof of DVT, {sup 99m}Tc-apcitide scintigraphy was truly negative. Glycoprotein receptor imaging showed only one segmental PE in six patients with imaging-proven subsegmental (N = 3) or segmental PE (N = 3). {sup 99m}Tc-apcitide scintigraphy may be an easy and promising tool for the detection of acute clot formation in patients with DVT up to 17days after the onset of clinical symptoms with a sensitivity of 87% and a specificity of 100%. However, it failed to demonstrate PE in 83% of examined patients with proven PE. (orig.)

  17. A patient who experienced thyroid storm complicated by rhabdomyolysis, deep vein thrombosis, and a silent pulmonary embolism: a case report

    Science.gov (United States)

    2013-01-01

    Background Thyroid storm is a serious condition of thyrotoxicosis. Hyperthyroidism often presents with thrombotic events, especially at cerebral sites; however, the possible association between a lower extremity deep vein thrombosis (LEDVT) and thyroid storm has not been previously reported. We encountered a patient who developed thyroid storm, associated with rhabdomyolysis, followed by LEDVT and a small silent pulmonary embolism (PE). The case is discussed with references to the pertinent literature. Case presentation A 50-year-old woman with no past medical history was referred to our hospital because of severe diarrhea, muscle weakness in her lower limbs (manual muscle testing: MMT 3), and disturbances of consciousness. She was diagnosed as having Graves’ disease based on the presence of struma, exophthalmos, and hyperthyroidism with TSH receptor antibody positivity; we further determined that the patient was experiencing thyroid storm based on the results of the Burch-Wartofsky scoring system and a Japanese diagnostic criteria. Treatment with steroids, iodine potassium, methimazole, and propranolol was initiated. Severe watery diarrhea continued, and the laboratory data revealed hypokalemia (2.0 meq/L). On day 14, a blood analysis showed a sudden elevation in her creatinine kinase (CK) level, leading to a diagnosis of rhabdomyolysis. Thereafter, the muscle weakness in her lower limbs advanced to a degree of MMT 1. Seven days after the diagnosis of rhabdomyolysis, pitting edema began to appear in bilateral lower extremities. Contrast-enhanced CT scans revealed a LEDVT involving the left common iliac vein, bilateral femoral veins, and left popliteal vein. Furthermore, a small PE was identified. Hyperthyroidism often presents with thrombotic events, especially at cerebral sites, but few reports of PE or LEDVT have been made. Conclusion This case suggests that the occurrence of thyroid storm may be associated with a risk of LEDVT and/or PE. We suggest that DVT

  18. Coagulopathy in patients with acute pulmonary embolism: a pilot study of whole blood coagulation and markers of endothelial damage.

    Science.gov (United States)

    Lehnert, Per; Johansson, Pär I; Ostrowski, Sisse R; Møller, Christian H; Bang, Lia E; Olsen, Peter Skov; Carlsen, Jørn

    2017-02-01

    Whole blood coagulation and markers of endothelial damage were studied in patients with acute pulmonary embolism (PE), and evaluated in relation to PE severity. Twenty-five patients were enrolled prospectively each having viscoelastical analysis of whole blood done using thrombelastography (TEG) and Multiplate aggregometry. Fourteen of these patients were investigated for endothelial damage by ELISA measurements of Syndecan-1 (endothelial glycocalyx degradation), soluble endothelial Selectin (endothelial cell activation), soluble Thrombomodulin (endothelial cell injury) and Histone Complexed DNA fragments (endothelial cytotoxic histones). The mean values of TEG and Multiplate parameters were all within the reference levels, but a significant difference between patients with high and intermediate risk PE was observed for Ly30 (lytic activity) 1.5% [0-10] vs. 0.2% [0-2.2] p = .04, and ADP (platelet reactivity) 92 U [20-145] vs. 59 U [20-111] p = .03. A similar difference was indicated for functional fibrinogen 21 mm [17-29] vs. 18 mm [3-23] p = .05. Analysis of endothelial markers identified a significant difference in circulating levels between high and intermediate risk PE patients for Syndecan-1 118.6 ng/mL [76-133] vs. 36.3 ng/mL [11.8-102.9] p = .008. In conclusion, patients with acute PE had normal whole blood coagulation, but high risk PE patients had signs of increased activity of the haemostatic system and significantly increased level of endothelial glycocalyx degradation.

  19. Values of the Wells and Revised Geneva Scores Combined with D-dimer in Diagnosing Elderly Pulmonary Embolism Patients

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    Dan-Jie Guo

    2015-01-01

    Full Text Available Background: Pulmonary embolism (PE can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients. Methods: Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or <65 years old. The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated. Results: Ninety-six cases (28.6% were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3% were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P < 0.05 in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612-0.746 and 0.655 (95% CI: 0.584-0.722, respectively (P = 0.389. The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively. Conclusions: The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.

  20. Values of the Wells and Revised Geneva Scores Combined with D-dimer in Diagnosing Elderly Pulmonary Embolism Patients

    Institute of Scientific and Technical Information of China (English)

    Dan-Jie Guo; Can Zhao; Ya-Dan Zou; Xu-Hang Huang; Jing-Min Hu; Lin Guo

    2015-01-01

    Background:Pulmonary embolism (PE) can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken.We aimed to compare the clinical diagnostic values of the Wells score,the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients.Methods:Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (_>65 or <65 years old).The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE,and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard;overall accuracy was evaluated by the area under the curve (AUC) of receiver operator characteristic curve;the negative predictive values of D-dimer,the Wells score combined with D-dimer,and the revised Geneva score combined with D-dimer were calculated.Results:Ninety-six cases (28.6%) were definitely diagnosed as PE among 336 cases,among them 56 cases (58.3%) were >65 years old.The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%,respectively (P < 0.05) in the elderly patients;the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]:0.612-0.746) and 0.655 (95% CI:0.584-0.722),respectively (P =0.389).The negative predictive values of D-dimer,the Wells score combined with D-dimer,and the revised Geneva score combined with D-dimer were 93.7%,100%,and 100% in the elderly,respectively.Conclusions:The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE.The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.

  1. Software-based hybrid perfusion SPECT/CT provides diagnostic accuracy when other pulmonary embolism imaging is indeterminate

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, Nishant; Xie, Karen; Mar, Winnie; Anderson, Thomas M.; Carney, Benjamin; Mehta, Nikhil; Machado, Roberto; Blend, Michael J.; Lu, Yang [University of Illinois Hospital and Health Sciences System, Chicago (Korea, Republic of)

    2015-12-15

    To investigate the diagnostic performance of perfusion single-photon emission computed tomography/computed tomography (Q-SPECT/CT) in patients suspected to have pulmonary embolism (PE) but with indeterminate computed tomographic pulmonary angiography (CTPA) or planar ventilation/perfusion (V/Q) scans. This retrospective study included two groups of patients. Group I consisted of 49 patients with nondiagnostic CTPA. These 49 patients underwent subsequent V/Q scans. Further Q-SPECTs were obtained in patients with indeterminate planar images and fused with existing CTPA. Group II consisted of 182 non-CTPA patients with indeterminate V/Q scans. These 182 patients underwent further Q-SPECT and separate noncontrast low-dose CT chest. Fusion Q-SPECT/CT scans were obtained through FDA-approved software and interpreted according to published criteria as positive, negative, or indeterminate for PE. Upon retrospective analyses, the final diagnosis was made using composite reference standards including all available clinical and imaging information for at least 6-month follow-up. In group I patients, 1 was positive, 24 were negative, and another 24 (49 %, 24/49) were indeterminate. In the subsequent 24 Q-SPECT/CTPAs, 4 were positive, 19 were negative, and 1 was indeterminate (4.2 %, 1/24). In group II patients, 9 (4.9 %, 9/182) were indeterminate, 33 were positive, and 140 were negative. The combined nondiagnostic rate for Q-SPECT/CT was only 4.9 % (10/206). There was six false-negative and one false-positive Q-SPECT/CT examinations. The sensitivity, specificity, and positive and negative predictive value of Q-SPECT/CT were 85.7 % (36/42), 99.4 % (153/154), 97.3 % (36/37) and 96.2 % (153/159), respectively. Q-SPECT/CT improves the diagnostic rate with promising accuracy in diagnosing PE that yields a satisfactory clinical verdict, especially when the CTPA and planar V/Q scan are indeterminate.

  2. EVALUATION OF PULMONARY HYPERTENSION AND STRATIFICATION OF RISK BY FIRST-PASS RADIONUCLIDE PULMONARY PERFUSION IMAGING IN PATIENTS WITH PULMONARY HYPERTENSION OF ACUTE PULMONARY EMBOLISM%应用首次通过法肺灌注显像对急性肺栓塞合并肺动脉高压的评价

    Institute of Scientific and Technical Information of China (English)

    王静; 李国华; 王雪梅

    2014-01-01

    Objective:The purpose of this study was to evaluate pulmonary hypertension( PH) and stratification of risk by first-pass radionuclide pulmonary perfusion imaging( FPPPI) in patients with PH of acute pulmonary embolism( APE) . Methods:twenty healthy volunteers(12 males,8 females,average age of 48. 47±13. 47)Twenty patients(11 males,9 females,average age of 49. 95±16. 13,accumulated from 2007-10~2009-02 ) with acute pulmonary embolism were included in our study. FPPPI were performed in all Subjects. Calculated by FPPPI lung equilibration time( LET) . Results:LET by FPPPI in healthy volunteers and APE patients were 12. 18±3. 28 sec and 32. 90±14. 29 sec,respectively. It is the significance between healthy volunteers and APE patients ( P<0 . 01 ) . Conclusion:FPPPI was a reliable,convenient andnon-invasivemethod in evaluating pulmonary hypertension in acute pulmonary embolism.%目的:应用首次通过法肺灌注显像( First-pass radionuclide pulmonary perfusion imaging,FPPPI)对急性肺栓塞( Acute pulmonary embolism APE)合并肺动脉高压( Pulmonary hypertension,PH)的评价。方法:20例健康自愿者,男12例,女8例,平均年龄为48.47依13.47岁(21~71岁),20例(2007-10~2009-02)临床诊断为急性肺栓塞病人,男11例,9例,平均年龄为49.95依16.13岁(23~82岁),所有受试者均行FPPPI检查,按FPPPI计算肺平衡时间(Lung equilibrium time LET)。结果:FPPPI法测定的肺平衡时间(LET),正常组LET 12.18依3.28 sec, APE组LET 32.90依14.29 sec 两组进行t检验,t=6.32,P<0.01,有统计学差别。结论:FPPPI是评价急性肺栓塞合并肺动脉高压的可靠、简便、无创性的方法。

  3. Suspected pulmonary embolism and deep venous thrombosis: A comprehensive MDCT diagnosis in the acute clinical setting

    Energy Technology Data Exchange (ETDEWEB)

    Salvolini, Luca [Radiology Department, ' Umberto I' Hospital - Ospedali Riuniti - ' Politecnica delle Marche' University, Via Conca, 60020 Ancona (Italy)], E-mail: lucasalvolini@alice.it; Scaglione, Mariano [Emergency and Trauma CT Section, Department of Radiology, Cardarelli Hospital, Via G. Merliani 31, 80127 Naples (Italy); Giuseppetti, Gian Marco; Giovagnoni, Andrea [Radiology Department, ' Umberto I' Hospital - Ospedali Riuniti - ' Politecnica delle Marche' University, Via Conca, 60020 Ancona (Italy)

    2008-03-15

    Both pulmonary arterial and peripheral venous sides of venous thromboembolism (VTE) can now be efficiently and safely investigated by multi-detector CT (MDCT) at the same time by a combined CT angiography/CT venography protocol. In the emergency setting, the use of such a single test for patients suspected of suffering from VTE on a clinical grounds may considerably shorten and simplify diagnostic algorithms. The selection of patients to be submitted to MDCT must follow well-established clinical prediction rules in order to avoid generalized referral to CT on a generic clinical suspicion basis and excessive population exposure to increased ionizing radiation dose, especially in young patients. Clinical and anatomical wide-panoramic capabilities of MDCT allow identification of underlying disease that may explain patients' symptoms in a large number of cases in which VTE is not manifest. The analysis of MDCT additional findings on cardiopulmonary status and total thrombus burden can lead to better prognostic stratification of patients and influence therapeutic options. Some controversial points such as optimal examination parameters, clinical significance of subsegmentary emboli, CT pitfalls and/or possible falsely positive diagnoses, and outcome of untreated patients in which VTE has been excluded by MDCT without additional testing, must of course be taken into careful consideration before the definite role of comprehensive MDCT VTE 'one-stop-shop' diagnosis in everyday clinical practice can be ascertained.

  4. Is the lung scan alive and well? Facts and controversies in defining the role of lung scintigraphy for the diagnosis of pulmonary embolism in the era of MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Reid, John H. [Borders General Hospital, Department of Radiology, Melrose, Scotland (United Kingdom); Coche, Emmanuel E. [Cliniques Universitaires St-Luc, Department of Medical Imaging, Brussels (Belgium); Inoue, Tomio [Yokohama City University Hospital, Department of Radiology, Yokohama (Japan); Kim, Edmund E. [MD Anderson Cancer Center, Nuclear Medicine Service, Houston, TX (United States); Dondi, Maurizio; Watanabe, Naoyuki [International Atomic Energy Agency, Vienna (Austria); Mariani, Giuliano [University of Pisa Medical School, Regional Centre of Nuclear Medicine, Pisa (Italy)

    2009-03-15

    The last decade has seen a changing pattern of utilization of multidetector CT (MDCT) versus lung perfusion scintigraphy in the investigation of pulmonary venous thromboembolism (VTE). In response to this the International Atomic Energy Agency (IAEA) determined that the subject required an overview. The IAEA has invited a group of five specialists in the relevant fields to review the current status and optimum role of scintigraphy, to explore some of the facts and controversies surrounding the use of both modalities and to make recommendations about the continued role of nuclear medicine for the investigation of pulmonary embolism. This paper identifies the relative merits of each technique, highlights benefits, focuses on complementary roles and seeks a nonadversarial symbiosis. The consultants reached a consensus that the continued use of scintigraphy for diagnosis of thromboembolic disease is recommended, particularly in scenarios where scintigraphy confers specific benefits and is complementary to MDCT. (orig.)

  5. Pulmonary embolism. A case report Trombo embolismo pulmonar. Presentación de un caso

    Directory of Open Access Journals (Sweden)

    Indira Martínez Chavarría

    2010-12-01

    Full Text Available The case of a male, white skin, 38 years old patient who came to the emergency department because of a severe respiratory distress is reported. The left patella fracture history was collected and an immobilization cast was implemented. The posterior to anterior chest X-ray showed opacities in the form of a veil at the base of the left hemithorax as well as increased cardiothoracic rates. A lung computed tomography angiography scan was performed using a SIEMENS SESATION 64 multislice computed tomography scanner. The study was rebuilt using volume rendering technique and 3D applications with virtual angioscopy. Thrombus occlusion was evident at the trunk of the left pulmonary artery and its branches. The patient was admitted for anticoagulation treatment. Patients with patellar fracture as a trigger for this serious condition involving life-risk had not been treated in this hospital, that is why it was decided to publish this case, as well as for the implementation of such an innovative, useful and quick diagnosis aided by multislice computed tomography angiography.Se presenta el caso de un paciente del sexo masculino, de color de piel blanca, de 38 años de edad que acudió al Servicio de Urgencias por padecer de dificultad respiratoria. Se recogió el antecedente de fractura a nivel de rótula izquierda e inmovilización con yeso. El rayos X del tórax en posición postero anterior mostró opacidades en forma de velo en la base del hemitórax izquierdo e índice cardiotorácico aumentado. Se realizó angiotomagrafía pulmonar en tomógrafo multicorte SIEMENS SESATION 64. Se reconstruyó el estudio con las aplicaciones VRT y 3D con angioscopia virtual. Se evidenció oclusión por trombo a nivel del tronco de la arteria pulmonar izquierda y sus ramas. Se ingresó para tratamiento de anticoagulación. Por no haber sido observado en este medio, en pacientes con fractura de rótula como factor desencadenante de esta afección grave que puede

  6. CT diagnosis of dual source for pulmonary embolism%肺动脉栓塞的炫速双源CT诊断

    Institute of Scientific and Technical Information of China (English)

    邢漠

    2015-01-01

    Objective: To investigae and analyze the CT diagnostic performance of dual source for pulmonary embolism.Methods: he records of 35 cases with pulmonary embolism from August 2012 to April 2015 were retrospectively analyzed by prior implementation of Hyun-speed dual-source CT scan followed by the elbow injection omnipaque or ultravist,the implementation of the second scan was delayed by 30 s.Finally,the results of diagnosis were observed and analyzed.Results: Hyun-speed dual-source CT scan examination diagnosed: 18 patients with markings sparse,16 patients of pulmonary infarction form,5 patients with pulmonary hypertension,11 patients with pleural effusion and 6 patients with pleural thickening.After enhanced scan,the majority of patients with arterial filling defect tiny face.Conclusion: Hyun-speed dual-source CT scanning for diagnosis of pulmonary embolism has advantage of being fast with good image clarity providing timely scan with safety and clear scannings.It can depict variety of small lesions.%目的:探讨分析肺动脉栓塞的炫速双源CT诊断效果.方法:采取回顾性分析法,抽取2012年8月—2015年4月经临床确诊的35例肺动脉栓塞患者,事先实施炫速双源CT平扫,而后经肘注射欧乃派克或者优维显,延迟30 s后实施第2次扫描,观察分析检查诊断结果.结果:经炫速双源CT平扫检查,有18例患者肺纹理稀疏,16例患者肺梗死灶形成,5例患者肺动脉高压,11例患者胸腔积液,6例患者胸膜肥厚.经增强扫描检查后,大部分患者充盈缺损与动脉面细小.结论:采用炫速双源CT扫描诊断肺动脉栓塞,速度快且图像清晰,可及时扫描并观察各种小病灶,安全有效.

  7. 急性肺栓塞患者的临床观察与护理策略%Clinical Observation and Nursing Strategy of Impatient with Acute Pulmonary Embolism

    Institute of Scientific and Technical Information of China (English)

    陈润芝; 姚艳敏; 宋巧凤; 周文华

    2013-01-01

    Unexplained shortness of breath or difficulty breathing is the first symptom in clinical. Conclusion: ①Thrombophlebitis is the most common dangerous factor; ②Males are more vulnerable than females. With the increasing of age , the incidence of pulmonary embolism increased as well; ③The shortness of breath or the dyspnea with unknown origin is the most common initial symptom. Care strategy: Through a variety of risk factors for pulmonary embolism, early symptoms , signs and correct assessment , then put forward the overall care and discharge instructions, it played a positive role in the diagnosis and treatment, also include prevent complications of patients with pulmonary embolism.

  8. Venous velocity of the right femoral vein decreases in the right lateral decubitus position compared to the supine position: a cause of postoperative pulmonary embolism?

    Directory of Open Access Journals (Sweden)

    Sato,Shizou

    2007-04-01

    Full Text Available The right lateral decubitus position is a risk factor for postoperative pulmonary embolism. We examined postural changes of femoral vein velocity in order to elucidate the mechanism. Thirty patients scheduled for general thoracic surgery were enrolled in this study. The common femoral veins on both sides were examined by color-duplex ultrasound for venous caliber and velocity when the patients were in the right lateral, left lateral, and supine positions. The maximum diameters of the right femoral vein in the right lateral decubitus position and the left femoral vein in the left decubitus position were significantly larger than those in the other positions. The venous velocity of the right femoral vein in the right lateral decubitus position was significantly smaller than that in the supine position, while the velocity of the left femoral vein in the left lateral decubitus position was not significantly decreased. We speculate that the decreased venous velocity of the right femoral vein in the right lateral decubitus position could result in a deep venous thromboembolism in the right leg, making this position a possible risk factor for postoperative pulmonary embolism.

  9. Retrievable Guenther Tulip Vena Cava Filter in the prevention of pulmonary embolism in patients with acute deep venous thrombosis in perinatal period

    Energy Technology Data Exchange (ETDEWEB)

    Koecher, Martin [Department of Radiology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic)], E-mail: martin.kocher@seznam.cz; Krcova, Vera [Department of Hematooncology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic); Cerna, Marie [Department of Radiology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic); Prochazka, Martin [Department of Obstetrics and Gynaecology, University Hospital, I.P. Pavlova 6, 775 20 Olomouc (Czech Republic)

    2009-04-15

    Objectives: To evaluate the feasibility and efficacy of the retrievable Guenther Tulip Vena Cava Filter in the prevention of pulmonary embolism in patients with acute deep vein thrombosis in the perinatal period and to discuss the technical demands associated with the filter's implantation and retrieval. Methods: Between 1996 until 2007, eight women (mean age 27.4 years, range 20-42 years) with acute deep iliofemoral venous thrombosis in the perinatal period of pregnancy and increased risk of pulmonary embolism during delivery were indicated for retrievable Guenther Tulip Vena Cava Filter implantation. All filters were inserted and removed under local anesthesia from the jugular approach. Results: The Guenther Tulip Vena Cava Filter was implanted suprarenally in all patients on the day of caesarean delivery. In follow-up cavograms performed just before planned filter removal, no embolus was seen in the filter in any patient. In all patients the filter was retrieved without complications on the 12th day after implantation. Conclusions: Retrievable Guenther Tulip Vena Cava Filters can be inserted and removed in patients during the perinatal period without major complications.

  10. 肺通气灌注扫描在孕妇肺栓塞诊断中的研究进展%Research advance of lung ventilation perfusion scanning for diagnosis of pulmonary embolism in pregnant women

    Institute of Scientific and Technical Information of China (English)

    张泽明; 刘丽君; 杨泽西

    2014-01-01

    Pulmonary embolism is the primary cause of maternal death in western countries.If the pulmonary embolism of the pregnant women can not get timely diagnosis and treatment,the life safety of the pregnant women and fetus will be seriously threatened.At present,the lung ventilation perfusion scanning examination is recognized as the most sensitive and noninvasive diagnosis method of pulmonary embolism in the world.But this check is partially limited,considering the influence on the pregnant women and fetus.This article reviews the application progress of lung ventilation perfusion scanning in the pregnant women with pulmonary embolism.%在西方国家,肺栓塞是孕产妇死亡的首要原因,如肺栓塞的孕妇得不到及时的诊断和治疗,将严重威胁孕妇及胎儿的生命安全.肺通气灌注扫描显像检查是目前国际上公认的诊断肺栓塞的最敏感而无创的检查方法,但考虑到对孕妇及胎儿的影响,此检查受到了一定的限制.本文就肺通气灌注扫描显像检查在孕妇可疑肺栓塞中的应用进展作一综述.

  11. The Application of Dual source CT and Dual Energy Imaging to the Diagnosis of Pulmonary Embolism%双源CT双能量成像在肺动脉栓塞诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    彭可雨; 阮兵; 梁汉欢; 张洪; 梁艳

    2016-01-01

    Objective To study the value of dual energy pulmonary angiography (DECTPA) with dual-source CT (DSCT) in pulmonary embolism (PE).Methods Collected the clinical data of 26 patients suspected of PE in our hospital underwent DECTPA with DSCT. Assessed the value of dual energy pulmonary angiography (DECTPA) with dual-source CT (DSCT) in pulmonary embolism (PE).Results The 96.30%, 90.57% agreement between DEPI and CTPA were showed in the levels of lung and partial lung respectively. Complete filling defects of segmental and subsegmental pulmonary arteries mostly showed correspon dence perfusion defects in the CT perfusion map. However, when there were partial filling defects, most of them were partial perfusion defects. A few of them were normal in the CT perfusion map. With CTPA as a reference standard,in the level of lung, the results show that compared with DEPI, the sensitivity was 96.30% (52/54), specificity of 100% (76/76).Conclusion There was moderate agreement between the judgement of CTPA and DEPI. The perfusion defects in the DEPI related to the degree and location of the filling defects in the CTP A. The combination of CTPA and DEPI will offer more information for diagnosis of the pulmonary embolism. It is worth promotion in the clinical.%目的:探讨双源CT双能量成像在肺动脉栓塞诊断中的应用价值。方法收集在我院使用双源CT双能量肺动脉成像检查的26例临床资料进行分析,探讨双源CT双能量肺动脉成像(DEPI)在肺动脉栓塞中的应用价值。结果在肺叶基础上,DEPI与CTPA检出血管栓塞的符合率为96.30%;在肺段的基础上,DEPI与CTPA检出血管栓塞的符合率为90.57%。当段、亚段肺动脉栓塞充盈缺损完全时,DEPI表现为肺段或亚段分布灌注缺损,当部分充盈缺损时,DEPI以灌注降低为主,少数表现为无灌注缺损;利用DEPI诊断PE的敏感性96.30%(52/54),特异性100%。结论 DEPI表现与CTPA肺动脉栓塞程度、部位有

  12. 2型糖尿病合并肺栓塞12例尸检分析%Analysis of 12 case autopsy of type 2 diabetes mellitus with pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    张伟; 王丁一; 崔娣; 刘东戈

    2015-01-01

    Objective To analyze the correlation between type 2 diabetes mellitus and pulmonary embolism. Method Retrospective analysis of clinical and pathological characteristics of type 2 diabetes mellitus with pulmonary embol-ism in autopsy samples. Result There are 12 cases of type 2 diabetes mellitus in 56 cases of pulmonary embolism. 6 cases of them are located at pulmonary artery, 1 of the 6 extensively involves in pulmonary artery and small and medium arteries of lung, and the rest are located at small and medium arteries of lung. Thrombosis in other sites can be found in 7 cases of them. Conclusion Diabetes mellitus may be an important risk factor of pulmonary embolism. The thrombosis are mainly located in small and medium arteries of lung in cases of type 2 diabetes mellitus with pul-monary embolism, and most of the cases contain thrombosis in other sites, which suggests that embolism in type 2 diabetes mellitus may be originated from in situ thrombosis of small and medium arteries of lung.%目的分析2型糖尿病并发肺栓塞的相关因素。方法回顾分析尸检病例中2型糖尿病合并肺栓塞的病例的临床及病理资料。结果56例尸检肺栓塞病例中有12例为2型糖尿病合并肺栓塞,占21.4%。其中6例肺栓塞部位位于肺动脉主干,1例广泛累及主干及中小动脉,6例位于中小动脉。其中有7例找到其他部位的血栓形成。结论糖尿病可能是肺栓塞的重要危险因素。合并糖尿病的肺栓塞患者其栓塞部位多见于肺中小血管,多数能找到其他深在部位的血栓形成,提示糖尿病患者伴发肺栓塞可能源于肺中小动脉的原位血栓形成。

  13. 定量测定血浆D-二聚体在肺栓塞诊断中的意义%The Clinical Significance of Plasma D-dimmer Detection in the Diagnosis of Pulmonary Embolism via VIDAS system

    Institute of Scientific and Technical Information of China (English)

    陈晓燕

    2011-01-01

    Objective To investigate the clinical value of plasma D-dimmer in patients with acute pulmonary embolism. Methods We used VIDAS automatic immunoassay system to detect the level of D-dimmer in patients with pulmonary embolism, meanwhile others who were not diagnosed with pulmonary embolism used as control. Results D-dimmer in patients with pulmonary embolism is higher than that in control cases( P <0. 01). Conclusion The VIDAS automatic immunoassay system of D-dimmer detection method could be used as an index in initial diagnosis of pulmonary embolism. It could be apply widespread in emergency treatment because of its sensitive,fast and cheap.%目的 探讨快速检测血浆D-二聚体在急性肺栓塞诊断中的临床价值.方法 使用VIDAS全自动免疫分析系统检测D-二聚体在急性PE患者和对照组(非PE患者)的血浆D-二聚体水平.结果 急性PE组患者血浆D-二聚体高于对照组(P<001)有统计学意义.结论 VIDAS全自动免疫分析系统D-二聚体测定法可作为PE的敏感、快速、廉价的初步筛选指标,值得在急诊临床中推广应用.

  14. Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge

    Directory of Open Access Journals (Sweden)

    Gyanendra Kumar Acharya

    2015-01-01

    Full Text Available Thrombus-in-transit is not uncommon in pulmonary embolism but Right Heart Transvalvular Embolus (RHTVE complicating this is rare. A 54-year-old obese male with recent hospitalization presented with severe dyspnea and collapse. Initial investigations revealed elevated d-dimer and troponin. CTA showed saddle pulmonary embolus and bedside echocardiogram revealed right ventricular (RV pressure overload and dilatation (RV > 41 mm, McConnell’s sign, and mobile echodensity attached to tricuspid valve. Patient was immediately resuscitated and promptly transferred for surgical embolectomy under cardiopulmonary bypass. A long segment of embolus traversing through the tricuspid valve and extensive bilateral pulmonary artery embolus were removed. IVC filter was placed for a persistent right lower extremity DVT. Hypercoagulable work-up was negative. Patient continued to do well after discharge on Coumadin. Open embolectomy offers great promises where there is no consensus in optimal management approach in such patients. Bedside echocardiogram is vital in risk stratification and deciding choice of advanced PE treatment.

  15. Embolia pulmonar na sala de cirurgia: relato de caso Embolia pulmonar en sala operatoria: relato de caso Pulmonary embolism in the operating room: case report

    Directory of Open Access Journals (Sweden)

    Karina Bernardi Pimenta

    2002-04-01

    elevado índice de sospecha no es suficiente para firmar el diagnóstico pues la embolia pulmonar es una enfermedad silenciosa y la rutina de investigación no posee elevada sensibilidad. La profilaxis precoz y adecuada es la mejor estrategia.BACKGROUND AND OBJECTIVES: Pulmonary embolism is a common postoperative complication. This report aimed at presenting a case of pulmonary embolism in the operating room and at calling the attention to the importance of venous thrombosis prophylaxis in surgical patients. CASE REPORT: The authors describe a case of a male patient, 55 years of age and 83 kg submitted to radical prostatectomy for prostate cancer. At the end of the surgery and already extubated, patient presented hemodynamic instability and a decrease in SpO2 to 80%. Patient was re-intubated and sent to the ICU. CT images suggested pulmonary embolism. Patient died in the 5th postoperative day. CONCLUSIONS: A high suspicion rate is not enough to establish a diagnosis because pulmonary embolism is a silent disease and its investigation routine is not highly sensitive. Early prophylaxis is the best strategy.

  16. Primary Nephrotic Syndrome in Adults as a Risk Factor for Pulmonary Embolism: An Up-to-Date Review of the Literature

    Directory of Open Access Journals (Sweden)

    Aibek E. Mirrakhimov

    2014-01-01

    Full Text Available Patients with nephrotic syndrome are at an increased risk for thrombotic events; deep venous thrombosis, renal vein thrombosis, and pulmonary embolism are quite common in patients with nephrotic syndrome. It is important to note that nephrotic syndrome secondary to membranous nephropathy may impose a greater thrombotic risk for unclear reasons. Increased platelet activation, enhanced red blood cell aggregation, and an imbalance between procoagulant and anticoagulant factors are thought to underlie the excessive thrombotic risk in patients with nephrotic syndrome. The current scientific literature suggests that patients with low serum albumin levels and membranous nephropathy may benefit from primary prophylactic anticoagulation. A thorough approach which includes accounting for all additional thrombotic risk factors is, therefore, essential. Patient counseling regarding the pros and cons of anticoagulation is of paramount importance. Future prospective randomized studies should address the question regarding the utility of primary thromboprophylaxis in patients with nephrotic syndrome.

  17. Home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban. Rationale and design of the HoT-PE Trial.

    Science.gov (United States)

    Barco, Stefano; Lankeit, Mareike; Binder, Harald; Schellong, Sebastian; Christ, Michael; Beyer-Westendorf, Jan; Duerschmied, Daniel; Bauersachs, Rupert; Empen, Klaus; Held, Matthias; Schwaiblmair, Martin; Fonseca, Cândida; Jiménez, David; Becattini, Cecilia; Quitzau, Kurt; Konstantinides, Stavros

    2016-07-01

    Pulmonary embolism (PE) is a potentially life-threatening acute cardiovascular syndrome. However, more than 95 % of patients are haemodynamically stable at presentation, and among them are patients at truly low risk who may qualify for immediate or early discharge. The Home Treatment of Pulmonary Embolism (HoT-PE) study is a prospective international multicentre single-arm phase 4 management (cohort) trial aiming to determine whether home treatment of acute low-risk PE with the oral factor Xa inhibitor rivaroxaban is feasible, effective, and safe. Patients with confirmed PE, who have no right ventricular dysfunction or free floating thrombi in the right atrium or ventricle, are eligible if they meet none of the exclusion criteria indicating haemodynamic instability, serious comorbidity or any condition mandating hospitalisation, or a familial/social environment unable to support home treatment. The first dose of rivaroxaban is given in hospital, and patients are discharged within 48 hours of presentation. Rivaroxaban is taken for at least three months. The primary outcome is symptomatic recurrent venous thromboembolism or PE-related death within three months of enrolment. Secondary outcomes include quality of life and patient satisfaction, and health care resource utilisation compared to existing data on standard-duration hospital treatment. HoT-PE is planned to analyse 1,050 enrolled patients, providing 80 % power to reject the null hypothesis that the recurrence rate of venous thromboembolism is >3 % with α≤0.05. If the hypothesis of HoT-PE is confirmed, early discharge and out-of-hospital treatment may become an attractive, potentially cost-saving option for a significant proportion of patients with acute PE.

  18. Identification of a novel SERPINA-1 mutation causing alpha-1 antitrypsin deficiency in a patient with severe bronchiectasis and pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Milger K

    2015-05-01

    Full Text Available Katrin Milger,1 Lesca Miriam Holdt,2 Daniel Teupser,2 Rudolf Maria Huber,1 Jürgen Behr,1 Nikolaus Kneidinger1 1Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, 2Institute of Laboratory Medicine, University of Munich, Munich, Germany Abstract: Deficiency in the serine protease inhibitor, alpha-1 antitrypsin (AAT, is known to cause emphysema and liver disease. Other manifestations, including airway disease or skin disorders, have also been described. A 44-year-old woman presented to our emergency department with dyspnea and respiratory insufficiency. She had never smoked, and had been diagnosed with COPD 9 years earlier. Three months previously, she had suffered a pulmonary embolism. Chest computed tomography scan revealed severe cystic bronchiectasis with destruction of the lung parenchyma. The sweat test was normal and there was no evidence of the cystic fibrosis transmembrane conductance regulator (CFTR mutation. Capillary zone electrophoresis showed a decrease of alpha-1 globin band and AAT levels were below the quantification limit (<25 mg/dL. No S or Z mutation was identified, but sequencing analysis found a homozygous cytosine and adenine (CA insertion in exon 2 of the SERPINA-1 gene, probably leading to a dysfunctional protein (PI Null/Null. This mutation has not been previously identified. The atypical presentation of the patient, with severe cystic bronchiectasis, highlights AAT deficiency as a differential diagnosis in bronchiectasis. Further, awareness should be raised regarding a possible increased risk of thromboembolism associated with AAT deficiency. Keywords: alpha-1 antitrypsin deficiency, bronchiectasis, SERPINA-1 mutation, pulmonary embolism

  19. 肺栓塞呼吸内科临床治疗方案探究%Clinical Treatment Plan of Pulmonary Embolism in Respiratory Department of Internal Medicine

    Institute of Scientific and Technical Information of China (English)

    于新淼

    2015-01-01

    目的:对肺栓塞呼吸内科疾病的临床治疗方案进行探究。方法全部患者予以心电图检查,并结合溶栓治疗和抗凝治疗,监测患者的二氧化碳分压及氧分压,比较治疗前后的疗效情况。结果治疗前后相比,二者的差异具有统计学意义(P<0.05);其中治疗后患者的心电图检查结果显示有所改善,经溶栓与抗凝治疗后,总有效率为91.1%。结论加强对肺栓塞患者的心电图检查,采取抗凝与溶栓相结合的治疗方案对患者的病情进行治疗,疗效安全可靠。%ObjectiveTo study the clinical treatment plan of pulmonary embolism respiratory department of internal medicine disease.MethodsAl patients were given ECG,combined with thrombolytic therapy and anticoagulant therapy,the carbon dioxide partial pressure and oxygen partial pressure of the patients were monitored,and the effect of the treatment was compared.Results Compared before and after treatment,their differences had statistical significance(P< 0.05),the after treatment patients ECG examination results showed improved,after thrombolytic and anticoagulant therapy. The total effective rate was 91.1%.Conclusion Strengthening the ECG examination of patients with pulmonary embolism,were treated by combination of anticoagulant and thrombolytic therapy on the patient's condition,safe and reliable curative effect.

  20. Coronary Artery Calcification Is Often Unreported in CT Pulmonary Angiograms in Patients With Suspected Pulmonary Embolism: An Opportunity to Improve Diagnosis of Acute Coronary Syndrome

    OpenAIRE

    Johnson, Patrick Connor

    2015-01-01

    Objective: In patients with suspected pulmonary thromboembolism (PTE), coronary artery calcification (CAC) can be an incidental finding in CT pulmonary angiograms. We evaluated the frequency of unreported CAC and its association with diagnosis of acute coronary syndrome (ACS). Methods: The data of 469 consecutive patients who were referred to the emergency radiology department for CT pulmonary angiography because of suspicion for PTE were reviewed. Radiology reports were rechecked, and pos...

  1. An interesting septic embolism

    Directory of Open Access Journals (Sweden)

    Funda Uluorman

    2014-01-01

    Full Text Available Septic pulmonary embolism is a rare disease but mortality and morbidity of it is high. Septic pulmonary emboli comes from infected heart valves, thrombophlebitis, and pulmonary artery catheter or infected pacemaker wires as many sources [1,2]. In recent years, pacemaker is a common treatment of the bradiarrhythmia that is persisted in the etiology of septic embolism, its applications has started to pick up [3]. There is the growing number of patients with pacemaker, according to this the frequency of pacemaker lead infection and the number of patients at risk for right-sided endocarditis increase [4]. The patients don't have specific clinical and radiological features because of this it is very difficult to define, so the diagnosis is often delayed [5]. A detailed medical history, a detailed physical examination in diagnosis and evaluation of good additional imaging methods is very important. Early diagnosis and proper treatment, the implementation of the management, can provide good results.

  2. An interesting septic embolism.

    Science.gov (United States)

    Uluorman, Funda; Tanrıverdi, Zülkif; Sevinç, Can; Badak, Özer; Çatalyürek, Hüdai

    2014-01-01

    Septic pulmonary embolism is a rare disease but mortality and morbidity of it is high. Septic pulmonary emboli comes from infected heart valves, thrombophlebitis, and pulmonary artery catheter or infected pacemaker wires as many sources [1,2]. In recent years, pacemaker is a common treatment of the bradiarrhythmia that is persisted in the etiology of septic embolism, its applications has started to pick up [3]. There is the growing number of patients with pacemaker, according to this the frequency of pacemaker lead infection and the number of patients at risk for right-sided endocarditis increase [4]. The patients don't have specific clinical and radiological features because of this it is very difficult to define, so the diagnosis is often delayed [5]. A detailed medical history, a detailed physical examination in diagnosis and evaluation of good additional imaging methods is very important. Early diagnosis and proper treatment, the implementation of the management, can provide good results.

  3. Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Hoey, Edward T.D.; Gopalan, Deepa; Agrawal, S.K.B. [Papworth Hospital, Cambridge (United Kingdom); Screaton, Nicholas J. [Papworth Hospital, Cambridge (United Kingdom); Papworth Hospital NHS Trust, Diagnostic Centre, Department of Radiology, Papworth Everard, Cambridgeshire (United Kingdom)

    2009-11-15

    The causes of pulmonary arterial hypertension (PAH) are diverse and include multiple congenital and acquired cardiac diseases as well as diseases primarily affecting the pulmonary vasculature, lung, pleura and chest wall. The traditional role of CT in evaluating PAH includes assessment of pulmonary vasculature and lung parenchyma with limited assessment of the heart. Advances in multidetector CT technology with improved spatial and temporal resolution now permit accurate delineation of cardiac morphology. CT pulmonary angiography (CTPA) is widely utilised in the workup of patients with suspected pulmonary vascular disease and can identify both pulmonary and cardiac causes. As the initial presentation for CTPA is often precipitated by nonspecific, unexplained symptoms and therefore undertaken by a general radiologist, it is important that a systematic approach to the interpretation of these studies, including cardiac evaluation, is routinely adopted. This paper reviews the CT evaluation in pulmonary hypertension with a particular focus on the cardiac causes, their subclassification into congenital systemic to pulmonary shunts and secondary to left heart disease, and their imaging features. It emphasises the use of a systematic approach to interpretation of CTPA examinations both in patients with known PAH and those with previously unsuspected disease. (orig.)

  4. The diagnosis and treatment of paradoxical embolism: a systematic review

    Directory of Open Access Journals (Sweden)

    Atooshe Rohani

    2016-11-01

    Full Text Available One in five adults has patent foramen ovale (PFO, which is typically without symptoms. Because of the low pressure in both atria and the anatomical position of the septum secundum, there is no left-to-right shunting and little right-to-left shunting in the general condition; however, when the right atrial pressure increases, this slit-like flap separates and allows right-to-left shunting. According to the Johnson criteria, simultaneous occurrences of arterial emboli, such as those caused by cerebrovascular accident or pulmonary embolism, demonstrate the presence of paradoxical embolism through a PFO. When a patient presents with multivascular arterial embolism, the clinician should perform a contrast transthoracic echo, a transesophageal (TEE, a real-time three-dimensional TEE, and even an intracardiac echocardiography (ICE in order to differentiate between PFO, flat atrial septal defect (ASD and hybrid defects. The randomized trials that have assessed therapeutic interventions for paradoxical embolism have not produced any clear guidelines as to how best to treat this condition. The classic treatment is surgical embolectomy with exploration of the right chambers and the pulmonary arteries under full cardiopulmonary bypass. Patients with a history of ≥1 paradoxical embolism may be indicated for device PFO closure.

  5. Pulmonary hypertension

    Science.gov (United States)

    ... that damage the lungs, such as scleroderma and rheumatoid arthritis Birth defects of the heart Blood clots in the lung ( pulmonary embolism ) Heart failure Heart valve disease HIV infection Low oxygen levels in the blood ...

  6. The present condition and prospects of the research into pulmonary embolism -deep venous thrombosis%肺栓塞-深静脉血栓形成的研究现状与展望

    Institute of Scientific and Technical Information of China (English)

    翟振国; 王辰

    2006-01-01

    @@ 肺栓塞(pulmonary embolism,PE)是肺循环领域中一个非常重要的医学课题.肺血栓栓塞症(pulmonary thromboembolism,PTE)为PE的最常见类型,占PE中的绝大多数(约90%以上),通常所称PE即指PTE.近年来,以PTE和深静脉血栓形成(deep venous thrombosis,DVT)为主要临床类型的静脉血栓栓塞性疾病(venous thromboembolism,VTE)的防治研究已有迅猛的发展.

  7. Clinical features of Behcet's disease complicated with pulmonary embolism and retrospective analysis%白塞病并发肺栓塞的临床特点

    Institute of Scientific and Technical Information of China (English)

    王新霞; 刘双; 杨京华; 朱光发

    2012-01-01

    Objective To observe the recognition of Behcet disease(BD) complicated with pulmonary embolism(PE),and to explore the diagnosis and treatment.Methods Based on the clinical data of 3 cases of BD complicated with PE at Beijing Anzhen Hospital from 2005 to 2011,and 13 cases of BD complicated with PE reported in domestic papers from 1996 to 2011,the clinical characteristics of BD complicated with PE were analyzed and summarized retrospectively.Results BD complicated with PE were more common in young people(8/9) and in male(8/9).There were 8 cases of oral ulcers,5 cases of genital ulcers and 4 cases of skin lesions(1 case of pseudo folliculitis,3 cases of erythema nodosum).There were 1 case of positive prick test,2 cases of the eye lesions,5 cases of fever,8 cases of hemoptysis,4 cases of cough,3 cases of breathing difficulties and 5 cases of deep vein thrombosis.Erythrocyte sedimentation rate in 4 cases increased among 6 cases who had erythrocyte sedimentation rate records.The level of C-reactive protein in 7 cases increased among 8 cases who had C-reactive protein records.Pulmonary artery pressure in 2 cases increased among 4 cases who had pulmonary artery pressure records.7 cases were diagnosed of PE by CT or MRI of pulmonary angiography,2 cases were diagnosed of radionuclide lung ventilation/perfusion.Conclusion Pulmonary embolism is involved in the Behcet's disease;the treatment of the patients includes prevention of the recurrence of thrombosis.%目的 提高对白塞病并发肺栓塞的认识,探讨其诊断与治疗.方法 收集我院3例白塞病并发肺栓塞患者,和国内1996-2011年文献检索刘的6例白塞病并发肺栓塞患者的临床资料,对白塞病并发肺栓塞的临床特点进行回顾性分析总结.结果 总结9例病例后发现白塞病并发肺栓塞病例多见于青年人(8/9),其中男性多见(8/9).9例患者临床表现的特点:口腔溃疡者8例,生殖器溃疡者5例,皮肤病变者4例(假性毛囊炎1

  8. Dextran Microsphere Hepatic Artery Embolization for Hepatoma: Pathological Assessment of Its Efficacy in Resected Cases

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To evaluate the therapeutic effect and the mechanism of dextran microsphere hepatic artery embolization for hepatoma. Methods Partial hepatectomy was performed in 11 patients with hepatoma pretreated with dextran microsphere hepatic artery embolization. All specimens were for histopathologic studies in order to observe the destiny of dextran microspheres and necrotic degree of the tumor. Results complete necrosis of the tumor was found in seven cases and incomplete necrosis of the tumor in the rest 4. Tumors in the later were near to areas rich in arterial collateral anastomoses. The extent of tumor necrosis was unrelated to the presence and thickness of tumor capsule and capsular invasions. Dextran microspheres could cause permanent embolization of distal arterioles. The microspheres were very biocompatible and cause little foreign body reaction. No inflammatory changes were seen both inside and outside of the embolized artery 191 days after embolization. Dextran microspheres were not absorbed and the vessel recanalization was also not seen. Dextran microsphere was not found in portal veins. Conclusion Some hepatomas distant from the collateral circulation of arteries could be cured with dextran microsphere hepatic artery embolization alone.

  9. Planar and SPECT ventilation/perfusion imaging and computed tomography for the diagnosis of pulmonary embolism: A systematic review and meta-analysis of the literature, and cost and dose comparison

    Energy Technology Data Exchange (ETDEWEB)

    Phillips, J.J., E-mail: jimphillips@nhs.net [Nuclear Medicine, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Road, Aberdeen AB25 2ZN (United Kingdom); Straiton, J. [Radiology, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Road, Aberdeen AB25 2ZN (United Kingdom); Staff, R.T. [Nuclear Medicine, Aberdeen Royal Infirmary, NHS Grampian, Foresterhill Road, Aberdeen AB25 2ZN (United Kingdom)

    2015-07-15

    Diagnosing acute pulmonary embolism (PE) is an indication for scintillation V/Q imaging (planar and SPECT) and/or CTPA. This study reviews, compares and aggregates the published diagnostic performance of each modality and assesses the short-term consequences in terms of diagnostic outcomes, monetary cost, and radiation burden. We performed a formal literature review of available data and aggregated the finding using a summary receiver operating characteristic. A decision tree approach was used to estimate cost and dose per correct diagnosis. The review found 19 studies, which comprised 27 data sets (6393 examinations, from 5923 patients). The results showed that planar V/Q was significantly inferior to both V/Q SPECT and CTPA with no difference between the latter two. CTPA represents best value; £129 per correct diagnosis compared to £243 (SPECT) and £226 (planar). In terms of radiation burden V/Q SPECT was the most effective with a dose of 2.12 mSv per correct diagnosis compared with 3.46 mSv (planar) and 4.96 (CTPA) mSv. These findings show no performance difference between V/Q SPECT and CTPA; planar V/Q is inferior. CTPA is clearly the most cost effective technique. V/Q SPECT should be considered in situations where radiation dose is of concern or CTPA is inappropriate.

  10. Deep venous thrombosis with suspected pulmonary embolism: simultaneous evaluation using combined CT venography and pulmonary CT angiography; Trombose venosa profunda e suspeita de tromboembolismo pulmonar: avaliacao simultanea por meio de angiotomografia pulmonar e venotomografia combinadas

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, Laura de Moraes [Universidade Federal, Rio de Janeiro (UFRJ), RJ (Brazil)]. E-mail: lauramgomes@terra.com.br; Marchiori, Edson [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil); Rodrigues, Rosana Souza [Hospital Copa D' Or, Rio de Janeiro, RJ (Brazil)

    2006-01-15

    Objective: To evaluate the occurrence and the correlation between pulmonary embolism (PE) and deep venous thrombosis (DVT) using a single CT angiography protocol. Materials and methods: This was a prospective study performed at Hospital Copa D'Or, Rio de Janeiro, Brazil from July 2003 to June 2004. We analyzed 116 CT angiography examinations of patients with clinical suspicion of PE. After an interval of approximately three minutes, venous phase images from the diaphragm to the knees were acquired without additional contrast injection in order to determine the presence of DVT. Results: From the 116 patients studied, 23 (19.8%) had PE, 24 (20.7%) had DVT, 15 (12.9%) had both PE and DVT and 9 (7.8%) had DVT alone. Among the 23 cases of PE, 15 (65.2%) had concomitant DVT whereas 8 (34.8%) had only PE. Among the 24 cases of DVT, 15 (62.5%) had associated PE and 9 (37.5%) had DVT alone. Conclusion: The results showed a strong relationship between PE and DVT, as well as the importance of investigating DVT in cases with suspected PE and the benefits of performing indirect CT venography after pulmonary CT angiography as a single examination alternative method for simultaneous investigation of PE and DVT. (author)

  11. Amniotic fluid embolism

    Directory of Open Access Journals (Sweden)

    Kiranpreet Kaur

    2016-01-01

    Full Text Available Amniotic fluid embolism (AFE is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion. The pathophysiology of AFE is not completely understood. Possible historical cause is that any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation. The presenting signs and symptoms of AFE involve many organ systems. Clinical signs and symptoms are acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy etc. Besides basic investigations lung scan, serum tryptase levels, serum levels of C3 and C4 complements, zinc coproporphyrin, serum sialyl Tn etc are helpful in establishing the diagnosis. Treatment is mainly supportive, but exchange transfusion, extracorporeal membrane oxygenation, and uterine artery embolization have been tried from time to time. The maternal prognosis after amniotic fluid embolism is very poor though infant survival rate is around 70%.

  12. Prevalence of deep venous thrombosis in the lower limbs and the pelvis and pulmonary embolism in patients with positive antiphospholipid antibodies

    Energy Technology Data Exchange (ETDEWEB)

    Kinuya, Keiko; Kakuda, Kiyoshi; Matano, Sadaya; Sato, Shigehiko; Sugimoto, Tatsuho [Tonami General Hospital, Toyama (Japan); Asakura, Hidesaku; Kinuya, Seigo; Michigishi, Takatoshi; Tonami, Norihisa

    2001-12-01

    Antiphospholipid antibodies (AA) are immunoglobulins that cross-react with phospholipid on cell membrane, and are therefore associated with a hypercoagulable state manifested by arterial/venous thromboses. We aimed to determine the prevalence of deep venous thrombosis in the lower limbs and the pelvic region (DVT) and pulmonary embolism (PE) in patients with positive AA. Sixty-six patients (48 female, 18 male) with positive lupus anticoagulant (LA) and/or positive anticardiolipin antibody (aCL) underwent radionuclide (RN) venography with 370 MBq of {sup 99m}Tc-MAA. Pulmonary perfusion scintigraphy was performed in 58 patients. Fifteen patients had positive LA and positive aCL (LA+/aCL+), 33 patients had positive LA only (LA+/aCL-) and 18 patients had positive aCL only (LA-/aCL+). Forty-three patients were diagnosed with primary antiphospholipid syndrome (APS) and 19 were diagnosed with APS associated with SLE. DVT was detected in 21 of 66 patients (32%). Patients with LA+/aCL+ showed higher prevalence of DVT (53%) as compared to LA+/aCL- (27%) and LA-/aCL+ (22%). PE was found in 13 of 58 patients (22%). The prevalence of PE was higher in patients with positive aCL (33% in LA+/aCL+; 36% in LA-/aCL+) than in patients with negative aCL (10%). Because of the high prevalence of DVT and PE in patients with AA, RN scintigraphy must be recommended in screening for these clinical troubles. These results indicate that the prevalence of DVT and PE may vary in subgroups of AA. (author)

  13. Ultralow contrast medium doses at CT to diagnose pulmonary embolism in patients with moderate to severe renal impairment: a feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Kristiansson, Mattias; Nyman, Ulf [Lasarettet Trelleborg, University of Lund, Department of Diagnostic Radiology, Trelleborg (Sweden); Holmquist, Fredrik [Malmoe University Hospital, University of Lund, Department of Diagnostic Radiology, Malmoe (Sweden)

    2010-06-15

    To analyse 80-kVp 16-MDCT in patients with clinically suspected pulmonary embolism (PE) and diminished renal function after a reduction in dose of contrast medium (CM) from 200 to 150 mg I/kg. Fifty patients with suspected PE and glomerular filtration rate (GFR) less than 50 mL/min underwent 80-kVp 16-MDCT with 150 mg I/kg. Mean density/image noise (1 standard deviation) was measured in a region of interest in the left pulmonary artery (LPA) and a lower lobe segmental artery (LLSA), and the contrast-to-noise ratio (CNR) was calculated. The values of LPA and LLSA were averaged. Median values/2.5-97.5 percentiles were: age 84/67-96 years, weight 65/43-84 kg, GFR 36/21-45 mL/min, CM dose 9.6/6.4-12 g of iodine, PA density 353/164-495 HU and CNR 11/4.4-20. PE incidence was 16%, and 8% and 12% of the examinations were regarded suboptimal by observer 1 and 2, respectively. Density/CNR values were within ranges reported for common 120-kVp MDCT protocols. None of 32 patients with plasma-creatinine follow-up within 1 week experienced a rise of more than 44.2 {mu}mol/L and none of 50 patients had oliguria/anuria or dialysis. None of 40 patients with a negative CT/no anticoagulation had thromboembolism during follow-up. 80-kVp MDCT combined with individualised ultralow CM doses may provide satisfactory diagnostic quality, which should be to the benefit of patients at risk of contrast medium-induced nephropathy. (orig.)

  14. Admission rates for emergency department patients with venous thromboembolism and estimation of the proportion of low risk pulmonary embolism patients: a US perspective

    Science.gov (United States)

    Singer, Adam J.; Thode, Henry C.; Peacock, W. Frank

    2016-01-01

    Objective Introduction of target specific anticoagulants and recent guidelines encourage outpatient management of low risk patients with venous thromboembolism. We describe hospital admission rates over time for patients presenting to US emergency departments (EDs) with deep vein thrombosis (DVT) and pulmonary embolism (PE) and estimate the proportion of low-risk PE patients who could potentially be managed as outpatients. Methods We performed a structured analysis of the National Hospital Ambulatory Medical Care Survey (a nationally representative weighted sampling of US ED visits) database for the years 2006–2010 including all adult patients with a primary diagnosis of DVT or PE. Simplified pulmonary embolus scoring index (sPESI) scores were determined in patients with PE to identify low risk patients. Results There were an estimated 652,000 and 394,000 ED visits for DVT and PE over the 5-year period (0.17%). Mean (SE) age was 59 (1.3), 50% were female, and 40% were > 65 years. Admission rates for DVT and PE were 52% and 90% respectively with no significant changes over time. In patients with DVT, predictors for admission were age (odds ratio, 1.03 per year of age [95% confidence interval, 1.01 to 1.05]) and race (odds ratio, 4.1 [95% confidence interval, 0.9 to 19.8] for Hispanics and 2.9 [1.2 to 7.4] for Blacks). Of all ED patients with PE, 51% were low risk based on sPESI scores. Conclusion Admission rates for DVT and PE have remained high and unchanged, especially with PE, minorities, and in older patients. Based on sPESI scores, up to half of PE patients might be eligible for early discharge or outpatient therapy.

  15. The 2007 John Charnley Award. Factors leading to low prevalence of DVT and pulmonary embolism after THA: analysis of genetic and prothrombotic factors.

    Science.gov (United States)

    Kim, Young-Hoo; Kim, Jun-Shik

    2007-12-01

    We evaluated 136 hips (104 patients) to determine the prevalence of and contributing factors in deep vein thrombosis (DVT) and pulmonary embolism (PE) in those who were not given thromboprophylaxis when undergoing primary cementless total hip arthroplasty (THA). We performed coagulation assays, a full blood count, blood typing, and serum chemical profile tests for all patients on three separate occasions. Molecular genetic testing was performed preoperatively to detect the genetic traits involving DVT. DVT was diagnosed by roentgenographic venography, and PE was diagnosed by perfusion lung scanning. Our patients had a low prevalence of DVT and no patient had PE. Patients with bilateral THA had similar rates (p = 0.158; CI, -0.134-0.125) of venographic DVT as patients with unilateral THA (16 of 65 or 25% versus 12 of 72 or 17% respectively). We observed a relationship between DVT and factor V Leiden mutation, antithrombin-III level, and prothrombin promoter G20210A mutation. We saw no relationship between DVT and coagulation or thrombophilic data. We conclude combinations of absent thrombophilic polymorphisms with low clinical prothrombotic risk factors led to low prevalence of DVT and virtually absent PE after THA in the current series of patients, who had not received any form of prophylactic or therapeutic treatment for DVT.

  16. Diagnostic accuracy of unenhanced, contrast-enhanced perfusion and angiographic MRI sequences for pulmonary embolism diagnosis: results of independent sequence readings

    Energy Technology Data Exchange (ETDEWEB)

    Revel, Marie Pierre [Hopital Europeen Georges Pompidou, APHP, Departments of Radiology, Paris (France); Universite Paris Descartes Sorbonne Paris Cite, Paris (France); Hotel-Dieu, Service de Radiologie, Paris (France); Sanchez, Olivier; Meyer, Guy [Hopital Europeen Georges Pompidou, APHP, Respiratory and intensive care and, Paris (France); Universite Paris Descartes Sorbonne Paris Cite, Paris (France); INSERM Unite 765, Paris (France); Lefort, Catherine; Couchon, Sophie; Hernigou, Anne; Frija, Guy [Hopital Europeen Georges Pompidou, APHP, Departments of Radiology, Paris (France); Niarra, Ralph [Hopital Europeen Georges Pompidou, APHP, Clinical Epidemiology, Paris (France); Universite Paris Descartes Sorbonne Paris Cite, Paris (France); Chatellier, Gilles [Hopital Europeen Georges Pompidou, APHP, Clinical Epidemiology, Paris (France); Universite Paris Descartes Sorbonne Paris Cite, Paris (France); INSERM CIC-EC E4, Paris (France)

    2013-09-15

    To independently evaluate unenhanced, contrast-enhanced perfusion and angiographic MR sequences for pulmonary embolism (PE) diagnosis. Prospective investigation, including 274 patients who underwent perfusion, unenhanced 2D steady-state-free-precession (SSFP) and contrast-enhanced 3D angiographic MR sequences on a 1.5-T unit, in addition to CTA (CT angiography). Two independent readers evaluated each sequence independently in random order. Sensitivity, specificity, predictive values and inter-reader agreement were calculated for each sequence, excluding sequences judged inconclusive. Sensitivity was also calculated according to PE location. Contrast-enhanced angiographic sequences showed the highest sensitivity (82.9 and 89.7 %, reader 1 and reader 2, respectively), specificity (98.5 and 100 %) and agreement (kappa value 0.77). Unenhanced angiographic sequences, although less sensitive overall (68.7 and 76.4 %), were sensitive for the detection of proximal PE (92.7 and 100 %) and showed high specificity (96.1 and 99.1 %) and good agreement (kappa value 0.62). Perfusion sequences showed lower sensitivity (75.0 and 79.3 %), specificity (84.8 and 89.7 %) and agreement (kappa value 0.51), and a negative predictive value of 84.8 % at best. Compared with contrast-enhanced angiographic sequences, unenhanced sequences demonstrate lower sensitivity, except for proximal PE, but high specificity and agreement. The negative predictive value of perfusion sequences was insufficient to safely rule out PE. (orig.)

  17. An study on significance of clinical scales in diagnosis for pulmonary embolism%临床量表对肺栓塞诊断价值的研究

    Institute of Scientific and Technical Information of China (English)

    程克斌; 刘锦铭; 高蓓兰

    2010-01-01

    目的 评价和比较Wells量表与Geneva量表对肺栓塞的诊断价值.方法 回顾性分析1995年1月至2009年1月诊治的可疑肺栓塞958例患者的临床资料,分别以Wells量表和Geneva量表进行肺栓寨的可能性评估,并与最终影像学检查确诊的诊断结果进行分析比较.结果 以影像学检查结果为标准,共有347例患者确诊为肺栓塞.两个量表诊断肺栓塞的敏感度、特异度、阳性预测值和阴性预测值:Wells量表分别为82.4%、58.1%、52.8%和85.3%;Geneva量表分别为88.8%、55.3%、53.1%和89.7%.诊断肺栓塞的阳性似然比、阴性似然比、Youden指数和一致性系数:WeBs 量表为1.97、0.30、0.41和0.21;Geneva量表分别为1.99、0.20、0.44和0.25.Geneva量表的ROC曲线下面积为0.79,大于WeHs量表的0.73,两者差异有统计学意义(Z=2.25,P<0.05).Geneva量表与Wells量表诊断肺栓寨的敏感度和特异度比较差异有统计学意义(χ2值分别为7.12和6.84,均P<0.05).结论 虽然临床量表与影像学确诊检查方法的准确性尚有很大差距,但均可用于各级医院Geneva量表与Wells量表的筛查,具有一定的辅助诊断价值,有利于节省不必要的医疗开支;与WeHs量表相比,Geneva量表更加实用、准确,值得临床推广.%Objective To assess diagnostic value of Wells and Geneva seales in patients with suspected pulmonary embolism(PE).Methods Clinical data of 958 consecutive cases of suspected PE admitted to Shanghai Pulmonary Hospital form January 1,1995 to January 1,2009,were analyzed retrospectively,and all patients were assessed with Wells and Geneva scales,respectively for likelihood of PE,as compared to those diagnosed by lung imaging Results Three hundred and forty-seven patients with PE were diagnosed with lung imaging as gold standard,sensitivity,specificity,and positive and negative predictive values for Wells scale and Geneva scale in diagnosis for PE were 82.4%,58.1%,52.8%and 85.3%.and 88

  18. Predictive Value of Wells Score and Revised Geneva Score on Pulmonary Embolism%Wells 评分与修正的 Geneva 评分对肺栓塞的预测价值研究

    Institute of Scientific and Technical Information of China (English)

    赵玉珂; 冯广华

    2014-01-01

    Objective To evaluate the predictive value of Wells score and revised Geneva score on pulmonary embol-ism. Methods A total of 153 cases suspected as pulmonary embolism were collected in our hospital from December 2009 to De-cember 2012. They were evaluated by Wells score and revised Geneva score,and pulmonary arteriography(CTPA)results was served as golden standard for pulmonary embolism. Results By CTPA results,78 cases were diagnosed as pulmonary embol-ism. Coincidence rate of Wells score in predicting the low - possibility,middle - possibility and high - possibility of pulmonary embolism was 0,49. 5% ,82. 1% ,respectively;that of revised Geneva score was 33. 3% ,55. 3% ,90. 9% ,respective-ly. ROC curve showed that,AUC of Wells score in predicting pulmonary embolism was 0. 770〔95% CI(0. 696,0. 844)〕, that of revised Geneva score was 0. 733〔95% CI(0. 653,0. 813)〕,the difference was not significantly different(P > 0. 05). The best threshold of Wells score in predicting pulmonary embolism was 3. 5,and the sensitivity was 76. 9% ,the specificity was 66. 7% ;the best threshold of revised Geneva score in predicting pulmonary embolism was 5. 5,and the sensitivity was 60. 3% , the specificity was 82. 7% . Conclusion Both of Wells score and revised Geneva score have certain predictive value on pulmona-ry embolism,the choice to make is depending on patient's clinical situation,or joint them together.%目的:评价 Wells 评分与修正的 Geneva 评分对肺栓塞的预测价值。方法连续选择2009年12月-2012年12月在我院住院的疑诊肺栓塞患者153例,均进行 Wells 评分与修正的 Geneva 评分,以肺动脉造影(CTPA)检查结果作为诊断肺栓塞的“金标准”。结果经 CTPA 检查确诊肺栓塞78例,Wells 评分预测低度、中度、高度可能肺栓塞的符合率分别为0、49.5%、82.1%,修正的 Geneva 评分预测低度、中度、高度可能肺栓塞的符合率分别为33.3%、55.3%、90.9%。绘制 ROC

  19. Pulmonary Embolism and Subclavian Vein Thrombosis in a Patient with Parathyroid Carcinoma: Case Report and Review of Literature.

    Science.gov (United States)

    Manosroi, Worapaka; Wannasai, Komson; Phimphilai, Mattabhorn

    2015-09-01

    Parathyroid carcinoma is a rare etiology of primary hyperparathyroidism responsible for 0.4 to 5.2% of all primary hyperparathyroidism cases. The overt hyperparathyroid bone or renal disease with palpable neck mass, as well as severe hypercalcemia with extremely high parathyroid hormone, are clinical parameters raising the suspicionforparathyroid carcinoma. However a definite diagnosis can be confirmed only by examining the histopathology of the tumor. The curative treatment solely depends on an en bloc surgical approach. Therefore, preoperative clinical diagnosis of carcinoma is essentialfor optimal surgical planning. Thepresent study reported asymptomatic subclavian vein thrombosis andpulmonary embolism in parathyroid carcinoma, suggesting paraneoplastic syndrome of hypercoagulability in this cancer type. The presence of this paraneoplastic syndrome in a case of overt clinical hyperparathyroidism in addition to a palpable neck mass indicated the diagnosis of carcinoma preoperatively in the present patient, which led to an en bloc surgical plan. Since this paraneoplastic syndrome can be asymptomatic, the exploration ofthis syndrome by a commonly used imaging technique for parathyroid tumor localization, computerized tomography, would enable a preoperative diagnosis of cancer especially in an equivocal situation.

  20. Diagnostic Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension: A Clinical Practice Guideline

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    Sanjay Mehta

    2010-01-01

    Full Text Available BACKGROUND: Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembolic pulmonary hypertension (CTEPH. Many care gaps exist in the diagnosis and management of CTEPH patients including lack of awareness, incomplete diagnostic assessment, and inconsistent use of surgical and medical therapies.

  1. The clinical application of combined dualenergy CT pulmonary angiography and indirect venography

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    富青

    2013-01-01

    Objective To assess the usefulness of combined dual-energy CT pulmonary angiography (DE-CTPA) and indirect CT venography(CTV) in the diagnosis of venous thromboembolism(VTE). Methods Forty-nine patients with leg swelling suspected of pulmonary embolism(PE) underwent both DE-CTPA combined with CTV and lower

  2. Predication of Wells and revised Geneva score for pulmonary embolism%Wells 评分和改良 Geneva 评分对肺栓塞的诊断价值

    Institute of Scientific and Technical Information of China (English)

    马育霞; 刘毅; 王鹏升; 李英; 赵红英; 刘云峰; 李建英; 李楠

    2014-01-01

    Objective To reduce misdiagnosis and underdiagnosis rates of pulmonary embolism ,the prediction of the Wells score and revised Geneva score for pulmonary embolism were compared and analyzed by receiver operating characteristic curves .Meth-ods Six hundred and thirty-seven cases with suspected pulmonary embolism ( PE) were collected ,among whom 256 cases with PE were clinically confirmed .Before CTPA test or on condition that test results were unknown ,clinical scoring was assessed prospectively by the Wells score and the Revised Geneva score .ROC curves was used to evaluate the probability of PE predicted by the Wells and the re -vised Geneva scores.Results The prevalence of PE was 7.7% with a low clinical probability (Wells Score6 points).The confirmed PE was 12.1%with a low probability(Geneva score 0-3 points),46.6% in intermediate probability(4-10 points),60.0% in high probability(score≥11 points).The area under curve (AUC) of the ROC curve in the Wells and Geneva scores was 0.849(95%Cl:0.817-0.881) and 0.813(95%Cl:0.778-0.849).Optimal cut off value was 2.75 points in the Wells Score and 6.5 points in the Geneva score .The comparison of the area under curve between the Wells and the Geneva score had a statistically signifcant difference ( P <0.05).Conclusion The Wells score and the revised Geneva score are valuable in prediction of pulmonary embolism .The Wells score is generally superior to the revised Geneva score .%目的:为减少肺栓塞误诊漏诊,探讨并应用受试者工作特征曲线( receiver operator characteristic curve , ROC曲线),比较改良Geneva评分和Wells评分系统对肺栓塞的预测价值。方法选择临床疑似诊断为肺栓塞并接受经CT肺动脉造影( CTPA)检查的患者637例,确诊肺栓塞256例,临床医师用Wells评分和改良Geneva评分对患者进行临床评分,应用ROC曲线比较两种评分法对肺栓塞的预测价值。结果 Wells评分<2分肺栓塞可能性为7.7%,2

  3. Direct oral anticoagulants in the treatment of venous thromboembolism, with a focus on patients with pulmonary embolism: an evidence-based review

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    Gómez-Outes A

    2014-11-01

    Full Text Available Antonio Gómez-Outes,1 Mª Luisa Suárez-Gea,1 Ramón Lecumberri,2 Ana Isabel Terleira-Fernández,3,4 Emilio Vargas-Castrillón3,41Division of Pharmacology and Clinical Evaluation, Medicines for Human Use, Spanish Agency for Medicines and Medical Devices (AEMPS, Madrid, Spain; 2Department of Hematology, University Clinic of Navarra, Pamplona, Spain; 3Department of Clinical Pharmacology, Hospital Clínico, Madrid, Spain; 4Department of Pharmacology, Universidad Complutense, Madrid, SpainAbstract: Pulmonary embolism (PE is a relatively common cardiovascular emergency. PE and deep vein thrombosis (DVT are considered expressions of the same disease, termed as venous thromboembolism (VTE. In the present review, we describe and meta-analyze the efficacy and safety data available with the direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, apixaban, edoxaban in clinical trials testing these new compounds in the acute/long-term and extended therapy of VTE, providing subgroup analyses in patients with index PE. We analyzed ten studies in 35,019 randomized patients. A total of 14,364 patients (41% had index PE. In the acute/long-term treatment of VTE, the DOAC showed comparable efficacy in preventing recurrent VTE to standard treatment in patients with index PE (risk ratio [RR]: 0.88; 95% confidence interval [CI]: 0.70–1.11 and index DVT (RR: 0.93; 95% CI: 0.75–1.16 (P for subgroup differences =0.76. VTE recurrence depending on PE anatomical extension and presence/absence of right ventricular dysfunction was only reported in two trials, with results being consistent with those obtained in the overall study populations. In the single trial comparing extended therapy of VTE with DOAC versus warfarin, the point estimate for recurrent VTE tended to disfavor the DOAC in patients with index PE (RR: 2.05; 95% CI: 0.83–5.03 and in patients with index DVT (RR: 1.11; 95% CI: 0.49–2.50 (P for subgroup differences =0.32. In trials that compared DOAC

  4. An Independent Risk of Gout on the Development of Deep Vein Thrombosis and Pulmonary Embolism: A Nationwide, Population-Based Cohort Study.

    Science.gov (United States)

    Huang, Chien-Chung; Huang, Po-Hao; Chen, Jiunn-Horng; Lan, Joung-Liang; Tsay, Gregory J; Lin, Hsiao-Yi; Tseng, Chun-Hung; Lin, Cheng-Li; Hsu, Chung-Yi

    2015-12-01

    Previous studies indicated that gout is a risk factor of cardiovascular diseases. This study aimed to determine if patients with gout have an increased risk of deep vein thrombosis (DVT) or pulmonary embolism (PE).We used the Longitudinal Health Insurance Database, a subset of the national insurance claim dataset, which enrolled 1 million Taiwanese to identify 57,981 patients with gout and 115,961 reference subjects matched by sex, age, and entry date of diagnosis. The risk of DVT and PE was analyzed using the Cox proportional hazards model.In this Taiwanese dataset observed from 2000 to 2010, we found the incidence of DVT was 5.26 per 10 person-years in the gout cohort, which was twofold higher than the incidence of 2.63 per 10 person-years in the reference cohort. After adjusting for age, sex, and 9 comorbidities, the hazard ratio (HR) of developing DVT was 1.66 (95% confidence interval [CI] = 1.37-2.01). Among patients with gout, the youngest age group had the highest increase in the risk of developing DVT (HR [95% CI] = 2.04 [1.24-3.37] for ages 20 to 49 years, 1.80 [1.28-2.51] for ages 50 to 64 years, and 1.45 [1.11-1.91] for ages ≥65 years). The incidence of PE was about one-fifth that of DVT in gout patients, but the effect of gout on the risk was similar (HR [95% CI] = 1.53 [1.01-2.29]).Our analysis confirmed that gout increased the risk of DVT and PE. Further exploration is needed in the future.

  5. Differential haemostatic risk factors for pregnancy-related deep-vein thrombosis and pulmonary embolism: a population-based case-control study.

    Science.gov (United States)

    Bergrem, Astrid; Dahm, Anders E A; Jacobsen, Anne Flem; Sandvik, Leiv; Sandset, Per Morten

    2012-12-01

    Limited data exist on thrombophilia and the risk of venous thrombosis (VT) during pregnancy and postpartum. The objectives of the present study were to investigate the role of haemostatic risk factors for pregnancy-related VT and their phenotypic expression in deep-vein thrombosis (DVT) and pulmonary embolism (PE). Total 313 cases with objectively verified first time VT and 353 controls were selected from a source population of 377,155 women with 613,232 pregnancies. The adjusted odds ratio (aOR) for pregnancy-related VT was 1.7 (95% confidence interval [CI] 1.1-2.8) for women with factor VIII >90th percentile. The aOR for VT for endogenous thrombin potential and D-dimer values >90th percentiles were 1.8 (95% CI 1.1-3.0) and 2.1 (95% CI 1.3-3.3), respectively. Factor IX >90th percentile or free protein S ≤the 5th percentile increased the risk for PE, and the aORs were 2.4 (95% CI 1.1-5.0) and 3.1 (95% CI 1.3-7.2), respectively. Women carrying the factor V Leiden (F5 rs6025) polymorphism, or who had reduced sensitivity to activated protein C (aPC) in the absence of F5 rs6025, had increased risk for DVT, with unadjusted ORs 7.7 (95% CI 4.7-12.7) and 3.5 (95% CI 2.2-5.4), respectively. Women with a history of pregnancy-related VT showed activation of coagulation and had elevated factor VIII. Furthermore, high levels of factor IX and low levels of free protein S were associated with increased risk for PE, whereas aPC resistance and F5 rs6025 were risk factors for DVT and not PE.

  6. Homocysteine lowering by B vitamins and the secondary prevention of deep vein thrombosis and pulmonary embolism: A randomized, placebo-controlled, double-blind trial.

    Science.gov (United States)

    den Heijer, Martin; Willems, Huub P J; Blom, Henk J; Gerrits, Wim B J; Cattaneo, Marco; Eichinger, Sabine; Rosendaal, Frits R; Bos, Gerard M J

    2007-01-01

    The Vitamins and Thrombosis (VITRO) study investigated the effect of homocysteine lowering by daily supplementation of B vitamins on the risk reduction of deep vein thrombosis (DVT) and pulmonary embolism (PE). Patients between 20 to 80 years old with a first objectively confirmed proximal DVT or PE in the absence of major risk factors and a homocysteine concentration above the 75th percentile of a reference group were asked to participate (hyperhomocysteinemic group). A similar study was conducted in a random sample of patients with a homocysteine below the 75th percentile of the reference group (normohomocysteinemic group). After informed consent was obtained, patients were randomized to daily multivitamin supplementation (5 mg folic acid, 50 mg pyridoxine, and 0.4 mg cyanocobalamin) or placebo and were followed for 2.5 years. End points were objectively diagnosed recurrent DVT or PE. A total of 701 patients were enrolled (360 in the hyperhomocysteinemic and 341 in the normohomocysteinemic group). The number of recurrent events of venous thrombosis was 43 of 353 in the vitamin group (54/1000 py) and 50 of 348 in the placebo group (64/1000 py). The hazard ratio associated with vitamin treatment was 0.84 (95% CI, 0.56-1.26): 1.14 (95% CI, 0.65-1.98) in the hyperhomocysteinemic group and 0.58 (95% CI, 0.31-1.07) in the normohomocysteinemic group. The results of our study do not show that homocysteine lowering by B vitamin supplementation prevents recurrent venous thrombosis.

  7. Research on the application value of spiral CT multi period mixed injection tracking method in the diagnosis of pulmonary embolism%螺旋CT多期混合注射跟踪法在肺动脉栓塞诊断中的应用价值

    Institute of Scientific and Technical Information of China (English)

    李小明; 浦江; 董宏宇

    2016-01-01

    Objective:To investigate the 256 slice spiral CT pulmonary angiography (CTPA) application value by using multiple stage double mixed injection velocity tracking method in the diagnosis of pulmonary embolism.Methods: Fifty patients with pulmonary embolism from 2014 January to 2015 January were treated in our hospital patients as the research object. Using a random number table method, all patients were randomly divided into observation group and control group, 25 cases each group of patients, two groups of patients in our hospital by imaging with 256 slice spiral CT pulmonary artery (CTPA), the control group were treated by routine pre injection time density curve method, was used in the observation group than in mixed injection agent tracking method by two physicians, CT, using the "double-blind" assessment of two groups of patients with image quality and quantification of pulmonary artery trunk.Results: in the control group, 25 patients were satisfied with the time - density curve, the results of 5 conventional image quality scores showed no significant difference between the two imaging methods, was not statistically significant; two groups of patients with pulmonary artery trunk, branch clear imaging score and endovascular CT value had no significant difference(t=1.892,t=1.952,t=1.832;P>0.05), but the observation group patients with CTPA were examined by contrast agent dose was significantly lower than the control group, the patient''s heart rate, blood pressure was significantly lower than the control group(t=2.315,t=1.958,t=2.982;P0.05),但观察组患者CTPA检查应用对比剂剂量明显低于对照组,患者术中心率、血压变化率明显低于对照组,差异有统计学意义(t=2.315,t=1.958,t=2.982;P<0.05).结论:CTPA肺动脉成像中采用多期双流速混合注射跟踪法可在保证图像质量以及诊断价值的基础上,有效降低检查应用对比剂剂量以及对心功能的影响,且检查相对较为简单、安全,具有临床应用及推广价值.

  8. Variation of D-dimer values as assessment of pulmonary thromboembolism during adulticide treatment of heartworm disease in dogs.

    Science.gov (United States)

    Carretón, E; Morchón, R; González-Miguel, J; Simón, F; Juste, M C; Montoya-Alonso, J A

    2013-07-01

    Dirofilaria immitis adult worms lodged in the pulmonary arteries are the causative agent of heartworm disease, characterized by endarteritis and obstruction of the blood flow. Dying worms form embolic fragments which trigger thrombosis. Thus, pulmonary thromboembolism is an inevitable consequence of successful adulticide therapy. Clinical signs of pulmonary thromboembolisms are highly variable and non-specific, and its diagnosis is often difficult to obtain. The D-dimer assay is considered the marker of choice for dogs with a suspicion of pulmonary thromboembolism. The aim of the present study was to evaluate the variation of D-dimer and platelets in 15 heartworm-infected dogs during the adulticide treatment with ivermectin, doxycycline and melarsomine. Nine dogs were considered to have a low parasite burden and 6 had a high burden. Measurements were carried out on days 0, 60, and afterwards weekly on days 67, 75, 82, 91, 98, 106, 113, 120, and finally on day 271 after treatment. 40% of dogs showed pathological concentrations of D-dimer and 40% showed slight or mild thrombocytopenia on day 0. The levels of D-dimer decreased by day 60, probably due to the joint action of the ivermectin, doxycycline and exercise restriction. All dogs with high parasite burden showed elevated values of D-dimer on several occasions during the treatment, reaching the highest values the first and second week after the injections of melarsomine. Only 33.3% of the dogs with low parasite burden showed elevated D-dimer levels at some point during the treatment, and all of them showed undetectable levels from the third week after the first injection of melarsomine. On day 271, all dogs showed undetectable levels of D-dimer. There was no correlation between thrombocytopenia and levels of D-dimer during the treatment. The evaluation of serum D-dimer appears to be a supportive test in the assessment and monitoring of pulmonary thromboembolism in dogs with heartworm disease during the adulticide

  9. Transcatheter Arterial Embolization for Postpartum Hemorrhage with Disseminated Intravascular Coagulation: Outcome Assessment

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    An, Eun Jung; Kim, Young Hwan; Kwon, Bo Ra; Kim, See Hyung [Dept. of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2011-12-15

    We evaluated the efficacy and predictors of clinical outcome after transcatheter arterial embolization (TAE) for treatment of postpartum hemorrhage with disseminated intravascular coagulation (DIC). Of 127 patients who underwent TAE for postpartum hemorrhage, 46 progressed to DIC (group 1), 81 showed normal range hematological parameters (group 2). We retrospectively evaluated etiology, embolization methods and the efficacy of TAE for intergroup comparison Pearson Chi-Square test and logistic regression model. Overall TAE failed to control bleeding in 9 patients in spite of technical success. Lower bleeding control rate was found in group 2 (82.6%) relative to group 1 (98.8%, p = 0.001). And embolization methods were not statistically different between two groups no statistically significant predictors associated with failed hemostasis except the amount of transfusion in group 1. Although bleeding control rate is lower in postpartum hemorrhage with DIC than without DIC, we believe that TAE with correction of DIC is an effective method for postpartum hemorrhage with DIC.

  10. The usefulness of contrast during exercise echocardiography for the assessment of systolic pulmonary pressure

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    Cordeiro Ana

    2008-10-01

    Full Text Available Abstract Background The systolic pulmonary artery pressure (PAPs can be accurately estimated, non-invasively, using continuous-wave Doppler (CWD ultrasound measurement of the peak velocity of a tricuspid regurgitant (TR jet. However, it is often difficult to obtain adequate tricuspid regurgitation signals for measurement of PAPs, what could lead to its underestimation. Therefore, utilization of air-blood-saline contrast has been implemented for the improvement of Doppler signal in several clinical contexts. It is now recommended in the evaluation of patients with pulmonary hypertension. Physical activity is severely restricted in patients with PAH, being exertional dypnea the most typical symptom. Exercise stress echo-Doppler imaging allows assessment of the response to exercise. It is an excellent screening test for patients with suspected PAH. Our purpose was to evaluate the value and accuracy of agitated saline with blood contrast echocardiography, in the improvement of the Doppler signal, to quantify PAPs during treadmill exercise-echocardiography. Purpose To evaluate the value of contrast echocardiography, using agitated saline with blood, in the improvement of the Doppler signal used to quantify the pulmonary artery systolic pressure during exercise. Methods From a total of 41 patients (pts, we studied 38 pts (93%, 35 women, aged 54 ± 12 years-old. 27 with the diagnosis of systemic sclerosis, 10 with history of pulmonary embolism and one patient with a suspected idiopathic PAH, who were referred to the Unity of Heart Failure and Pulmonary Hypertension for screening of PAH. According to the Unity protocol, a transthoracic echocardiogram was made, in left decubitus (LD, with evaluation of right ventricle-right atria gradient (RV/RAg. A peripheral venous access was obtained, with a 3-way stopcock and the patients were placed in orthostatism (O, with a new evaluation of RV/RAg. Exercise echocardiography (EE was begun, with evaluation of RV

  11. Successful liver transplantation in a patient with splanchnic vein thrombosis and pulmonary embolism due to polycythemia vera with Jak2v617f mutation and heparin-induced thrombocytopenia.

    Science.gov (United States)

    Biagioni, Emanuela; Pedrazzi, Paola; Marietta, Marco; Di Benedetto, Fabrizio; Villa, Erica; Luppi, Mario; Girardis, Massimo

    2013-10-01

    Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin treatment resulting in a severe acquired thrombophilic condition with an associated mortality of about 10 %. We report the first case of successful urgent liver transplantation (LT) in a patient with end-stage liver disease due to a Budd-Chiari syndrome, portal vein thrombosis and pulmonary embolism due to acquired thrombophilia associated to polycythemia vera carrying JAK2V617F gene mutation and HIT in the acute phase. Lepirudin was used to provide anticoagulation in the LT perioperative period that was performed without haemorrhagic and thrombotic complications despite the donor received heparin during liver explantation.

  12. Acute myocardial infarction and pulmonary embolism in a young man with pernicious anemia-induced severe hyperhomocysteinemia

    Directory of Open Access Journals (Sweden)

    Hofmann Marion A

    2009-05-01

    Full Text Available Abstract A 27 year-old man who presented to the hospital with progressive lower extremity weakness, developed an acute ST elevation myocardial infarction on his second hospital day. Primary angioplasty to the left anterior descending coronary artery was performed. Due to persistent dyspnea, the patient underwent a diagnostic chest computed tomography which confirmed multiple small pulmonary emboli. Laboratory analysis revealed a megaloblastic anemia with a reduced vitamin B12 level and positive titers for antibodies against intrinsic factor, establishing a diagnosis of pernicious anemia. Screening for hypercoaguable markers documented an isolated severely elevated homocysteine levels (105 μmol/l. No other significant risk factors for coronary artery disease including a family history of premature atherosclerosis were identified. This case illustrates the importance of testing for hyperhomocysteinemia as part of a workup for atherothrombotic disease, especially in patients without other significant risk factors. The severity of hyperhomocysteinemia found in our patient is unusual for patients with vitamin B12 malabsorption and raises the question of whether the widely practiced folic acid fortification in the United States may mask or even worsen vitamin B12 deficiency over time, leading to more severe cases of vitamin B12 deficiency and hyperhomocysteinemia than seen in the past.

  13. Risk factors associated with the occurrence of silent pulmonary embolism in patients with deep venous thrombosis%下肢深静脉血栓发生无症状性肺栓塞的相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    林万里; 丁锐; 万圣云; 王成宏; 童钟

    2014-01-01

    Objective To investigate the prevalence of silent pulmonary embolism in patients with deep venous thrombosis in the lower limbs, and to evaluate the associated risk factors .Methods A total of 203 patients with acute deep venous thrombosis was retrieved as subjects .All patients completed computed tomography pulmonary arteriography and were assigned into silent PE group and non silent PE groups.The association between covariates and the prevalence of silent pulmonary embolism in patients with deep venous thrombosis in lower limbs were assessed using chi -square test and multivariable Logistic regression analysis .Results Of 203 patients with deep venous thrombosis in lower limbs 64 patients had silent pulmonary embolism (31.5%).Univariate analysis indicated that position of deep venous thrombosis , DVT limb, previous DVT history , coexisting heart diseases were significantly associated with silent pulmonary embolism(P<0.01).Multivariate Logistic regression analysis showed that the central type of deep venous thrombosis (OR=0.158;95%CI,0.063~0.393;P<0.01), the right leg(OR=3.632;95%CI,1.004~13.138;P=0.045), no previous history of deep ve-nous thrombosis(OR=0.179;95%CI,0.046~0.704;P=0.014), coexisting heart diseases(OR=4.063;95%CI,1.107~14.918;P=0.035)were risk factors for silent pulmonary embolism .Conclusions Silent pulmonary embolism occurs frequently in patients with acute deep venous thrombosis in lower limbs .And central type of deep venous thrombosis , the right leg , no previous history of deep ve-nous thrombosis and coexisting heart diseases increase the risk for the occurrence of silent pulmonary embolism .%目的:探讨下肢深静脉血栓( DVT)患者无症状性肺栓塞( PE)的发生率及相关危险因素。方法收集2009-2013年入住血管外科的急性下肢深静脉血栓患者共203例,所有患者均完成计算机断层扫描肺动脉造影( CTPA)。并根据结果分为发生无症状性PE组和未发生无症状性PE组,

  14. Progress on Nursing Care of Acute Pulmonary Embolism%急性肺栓塞的护理进展

    Institute of Scientific and Technical Information of China (English)

    谢京辰

    2014-01-01

    急性肺栓塞(PE)具有发病急、易漏诊误诊、病死率高、易猝死等特点。其发病与以下因素密切相关:下肢静脉血栓形成、下肢水肿、心力衰竭、活动少等;高龄;外科手术、创伤和骨折;血管内皮功能损伤(肺部感染、反复静脉穿刺及静脉输液、外科手术)。临床表现多样复杂,与发生速度、血管堵塞的数量和程度、心肺基础状态有关;护理除了基础护理外,应加强心理护理及溶栓及抗凝治疗的护理;对患者及其家属的健康教育也非常重要。%Acute PE has the features of acute onset,easy to missed diagnosis or misdiagnose,high mortality,easy to sudden death et al.Its incidence is closely related with deep venous thrombosis of lower extremity,lower extremity edema,heart failure,few activities,elderly;surgical operation,trauma and fracture;vascular endothelial function injury(pulmonary infection,repeated puncture and venous transfusion,surgical operation);its clinical manifestations is complex and varius,associated with speed,number and extent of blockage,heart and Lung foundation state;its nursing in addition to basic nursing,the psychological nursing and nursing of thrombolytic and anticoagulant therapy;health education to patients and their families is also very important.

  15. CT肺血管成像对急性大面积肺栓塞患者的动态分析价值%The dynamic study of the massive pulmonary embolism on CT pulmonary angiography

    Institute of Scientific and Technical Information of China (English)

    王建国; 郭佑民; 朱力; 王辰; 杨媛华; 郭晓娟; 刘敏; 马红霞; 郭玉林

    2008-01-01

    Objective To dynamically evaluate the pulmonary artery obstruction index and the right ventricular function of the massive pulmonary embolism on CT pulmonary angiography (CTPA). Methods Twenty-three cases of massive pulmonary embolism were analyzed retrospectively. The pulmonary artery obstruction index (PAOI) and the right ventricular function parameters were collected and analyzed on CTPA before thrombolytic therapy, 24 hours and 14 days after therapy respectively. Student's ANOVA and LSD test was used to analyze the change of PAOI and quantification parameters of right ventricular function parameters. The right ventricular quantification parameters were analyzed by Chi-square test. Pearson correlation analysis was used to study the correlation of PAOI and right ventricular function. Results The PAOI decreased gradually after thrombolytic therapy. There was significant difference in Qanadli and Mastora scores between before (Qanadli score 50. 0,Mastora score 46. 5) and 24 hours (42. 5/12. 1) after therapy(t =2. 830,6. 493 ,P , 26. 37 cm2) ofleft ventricle increased, the RVd/LVd (1.07) and RVs/LVs (0. 94) decreased apparently. The aboveparameters were significantly different (t = 2. 081-4. 959, P < 0. 05) compared with which before therapy (5.07 cm, 25.42 cm2, 3.57 cm, 20. 17 cm2, 1.59, 1.38 respectively). The pulmonary artery symbolicpressure decreased from 58. 61 mm Hg before therapy to 40. 92 mm Hg 24 hours after therapy significantly(t = 2. 824, P < 0. 01). There was correlation to different degree between the PAOI and the right ventricularfunction parameters before therapy and 24 hours after therapy(r = 0. 034-0. 598, P < 0. 01). ConclusionCTPA can evaluate the pulmonary artery obstruction degree and right ventricular function after pulmonaryembolism dynamically.%目的 探讨CT肺血管成像(CTPA)对大面积肺栓塞患者的动脉栓塞程度及右心功能的动态分析价值.方法 回顾性分析23例大面积肺栓塞患者的CTPA资

  16. 心脏型脂肪酸结合蛋白对急性肺栓塞早期预后评估的价值%Prognostic Value of Heart Type Fatty Acid Binding Protein in Acute Pulmonary Embolism

    Institute of Scientific and Technical Information of China (English)

    黄奕奕; 沈翔; 张淑云

    2015-01-01

    Objective To assess the value of heart type fat y acid binding protein (H-FABP)for prognosis of patients with acute pulmonary embolism(APE).Methods There were 51 patients with APE, divided into two groups:H-FABP≥10μg/l group (n=21)and H-FABP<10μg/l group (n=30),The relations between H-FABP and risk stratification and prognosis evaluating were evaluated in the two groups.Results In the positive group,there were 9 high-risk PE,10 middle-risk PE,2 low-risk PE,6 died within 1 months.In the negative group,there were 4 high-risk PE,14 middle-risk PE,12 low-risk PE,2 died within 1 months. There was statistical significance in the occur ence of hypotension,right heart dysfunction and myocardial damage between the two groups ( <0.05).Also there was statistical significance in the cases with high-risk,low-risk and death( <0.05).Conclusion H-FABP is a reliable predictor of short-term of patient with APE.%目的:探讨心脏型脂肪酸结合蛋白(heart type fat y acid binding protein,H-FABP)水平对急性肺栓塞(acute pulmonary embolism,APE)早期预后的评估价值。方法51例急性肺栓塞患者根据H-FABP测定值分为阳性组21例(H-FABP≥10μg/l)及阴性组30例(H-FABP<10μg/l),分析H-FABP升高对APE患者危险分层与临床预后的关系。结果阳性组中高危9例,中危10例,低危2例,死亡6例。阴性组中高危4例,中危14例,低危12例,死亡2例。两组比较低血压、右心室功能不全以及心肌损伤的发生率之间差异有统计学意义(<0.05);在高危、低危及1月内死亡人数方面相比差异亦具有统计学意义(<0.05)。结论 H-FABP对急性肺栓塞患者的早期预后判定有着很好的相关性。

  17. Avaliação da hipertrofia da camada média nos pacientes com embolia pulmonar: estudo anatomopatológico Medial hypertrophy in patients with pulmonary embolism: anatomopathological study

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    Renato Tambellini Arnoni

    2007-06-01

    Full Text Available OBJETIVO: Comparar a resposta arterial dos casos de embolia aguda e crônica, procurando associar o remodelamento isquêmico pulmonar à evolução para cronificação. MÉTODOS: Análise retrospectiva de 61 casos de necropsia de pacientes que evoluíram a óbito no Instituto do Coração (31 casos de embolia pulmonar e 30 casos de infarto agudo do miocárdio. Foram obtidas lâminas de tecido pulmonar de todos os casos e análise qualitativa e quantitativa (mensuração da espessura da camada média das artérias. RESULTADOS: A análise qualitativa permitiu diferenciar os casos de embolia do grupo controle, caracterizando os dois grupos e definindo a escolha adequada do grupo controle. Houve predomínio das alterações nos pacientes com embolia (edema e inflamação alveolar, infarto, vasoconstrição, proliferação intimal concêntrica, presença de trombo. A análise quantitativa demonstrou porcentagem de espessura da camada média mais elevados nos casos de embolia do que no grupo controle; dentre os casos de embolia não houve diferença nas artérias intra (agudo - 19,74 e crônico - 20,04 e pré-acinares (agudo - 18,85 e crônico - 18,68. CONCLUSÃO: A ausência de diferença entre os grupos com embolia e os valores mais elevados de porcentual de espessura nas artérias da periferia permite concluir que a resposta vascular é mais intensa e se inicia nessas artérias.OBJECTIVE: To compare the arterial response of cases of acute and chronic embolism, seeking to associate ischemic pulmonary remodeling with progression to chronicity. METHODS: Retrospective analysis of 61 necropsies of patients who died in the Instituto do Coração (31 cases of pulmonary embolism and 30 cases of acute myocardial infarction. Slides of pulmonary tissue were obtained from all cases and analyzed qualitative and quantitatively (medial thickness measurement. RESULTS: Qualitative analysis enabled the differentiation between cases of embolism and the control group

  18. 双源CT双能量肺动脉血管成像技术早期诊断肺动脉栓塞患者的实效性评价%The Effectiveness of Dual-source Dual-energy CT Pulmonary Angiography of the Early Diagnosis of Patients with Pulmonary Embolism

    Institute of Scientific and Technical Information of China (English)

    李卫星; 姚菁菁

    2015-01-01

    Objective To investigate the effectiveness of dual-source dual-energy CT pulmonary angiography of the early diagnosis of patients with pulmonary embolism. Methods 40 patients with suspicious pulmonary disease were chosen in our hospital to receive treatment. All patients are dual-source dual-energy CT scan lung machine, with dual-energy scan data evaluation software were analyzed and the lungs into upper, middle and lower, the energy imaging were analyzed. MPR, MIP, VR, CTVE technology to reconstruct the original data were used. Results In 40 patients, 18 patients were diagnosed with pulmonary embolism, pneumonia in 4 patients, 3 patients with lung cancer, 15 patients with normal. 18 cases of patients with pulmonary embolism, a total of 218 emboli, which of central emboli 90, eccentric 46, mural-type 42, type 40 totally were occluded. 15 normal patients, their lung tissue perfusion were analyzed, the upper lungs and lungs, middle and lower comparative analysis, the difference was not statistically significant (t= 1.149,1.021,1.027,1.135, P> 0.05). The normal lung tissue perfusion and pulmonary embolism were analyzed, the upper lungs and lungs, middle and lower comparative analysis, the difference was not statistically significant (t = 6.394,6.092,6.607,6.862, P <0.05). Conclusion Dual-source dual-energy CT pulmonary angiography for the diagnosis of pulmonary embolism in patients has a very important sense and the ability to detect the disease at an early stage of pulmonary embolism, so it is worthy of promotion.%目的:探讨双源CT双能量肺动脉血管成像技术早期诊断肺动脉栓塞患者的实效性评价,为临床提供参考。方法选择我院2013年1月至2014年3月收治的40例可疑肺栓塞疾病患者,所有患者均以双源CT机进行肺部双能量扫描,扫描数据以双能量的评估软件分析,肺部分成上、中、下,进行能量成像分析。采用MPR、MIP、VR、CTVE技术对原始数据进行重建。结果40

  19. Emergence of Panton-Valentine leukocidin-positive ST59 methicillin-susceptible Staphylococcus aureus with high cytolytic peptide expression in association with community-acquired pediatric osteomyelitis complicated by pulmonary embolism.

    Science.gov (United States)

    Sawanobori, Emi; Hung, Wei-Chun; Takano, Tomomi; Hachuda, Koji; Horiuchi, Tadahiro; Higuchi, Wataru; Hung, Wei-Wen; Iwao, Yasuhisa; Nishiyama, Akihito; Reva, Ivan; Reva, Galina; Teng, Lee-Jene; Yamamoto, Tatsuo

    2015-10-01

    A 15-year-old boy, who had had a furuncle on his femur, developed femoral pyomyositis and osteomyelitis complicated by septic pulmonary embolism. Panton-Valentine leukocidin-positive (PVL(+)) ST59 methicillin-susceptible Staphylococcus aureus (MSSA) was isolated from pus and blood. Chemotherapy was started with cefazolin, followed by combination therapy with meropenem/vancomycin with surgery. The MSSA (strain KS1) was positive for increased levels of cytolytic peptide (psmα and hld) and staphylococcal enterotoxin B (SEB), and manifested IS1216V-mediated multidrug resistance (to erythromycin, clindamycin, kanamycin, streptomycin, and chloramphenicol), similar to a genome-analyzed reference strain (PM1) of ST59/SCCmecV(5C2&5) community-associated methicillin-resistant S. aureus (Taiwan CA-MRSA), but unlike another reference strain (M013) of Taiwan CA-MRSA in terms of resistance. The data suggest that CA-MSSA KS1, characterized by PVL, increased levels of cytolytic peptide, SEB, and multidrug resistance, is a possible ancestral strain of Taiwan CA-MRSA and causes the unique association of osteomyelitis and septic pulmonary embolism, requiring complicated management.

  20. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery

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    Tabitha Schrufer-Poland

    2015-04-01

    Full Text Available Introduction - Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description - A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion - Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality.

  1. Rivaroxaban for the treatment of symptomatic deep-vein thrombosis and pulmonary embolism in Chinese patients: a subgroup analysis of the EINSTEIN DVT and PE studies

    Science.gov (United States)

    2013-01-01

    Background The worldwide EINSTEIN DVT and EINSTEIN PE studies randomized 8282 patients with acute symptomatic deep-vein thrombosis (DVT) and/or pulmonary embolism (PE) and, for the first time in trials in this setting, included patients in China. This analysis evaluates the results of these studies in this subgroup of patients. Methods A total of 439 Chinese patients who had acute symptomatic DVT (n=211), or PE with or without DVT (n=228), were randomized to receive rivaroxaban (15 mg twice daily for 21 days, followed by 20 mg once daily) or standard therapy of enoxaparin overlapping with and followed by an adjusted-dose vitamin K antagonist, for 3, 6, or 12 months. The primary efficacy outcome was symptomatic recurrent venous thromboembolism. The principal safety outcome was major or non-major clinically relevant bleeding. Results The primary efficacy outcome occurred in seven (3.2%) of the 220 patients in the rivaroxaban group and in seven (3.2%) of the 219 patients in the standard-therapy group (hazard ratio, 1.04; 95% confidence interval 0.36–3.0; p=0.94). The principal safety outcome occurred in 13 (5.9%) patients in the rivaroxaban group and in 20 (9.2%) patients in the standard-therapy group (hazard ratio, 0.63; 95% confidence interval 0.31–1.26; p=0.19). Major bleeding was observed in no patients in the rivaroxaban group and in five (2.3%) patients in the standard-therapy group. In fragile patients (defined as age >75 years, creatinine clearance <50 mL/min, and/or body weight ≤50 kg), the principal safety outcome occurred in four (8.9%) of the 45 patients who received rivaroxaban compared with seven (15.2%) of the 46 patients who received standard therapy. Conclusions In Chinese patients with acute symptomatic DVT and/or PE, rivaroxaban was as efficacious as enoxaparin followed by vitamin K antagonist therapy, with a similar safety profile. The relative efficacy and safety of rivaroxaban compared with enoxaparin/vitamin K antagonist were

  2. Direct oral anticoagulants in the treatment of venous thromboembolism, with a focus on patients with pulmonary embolism: an evidence-based review.

    Science.gov (United States)

    Gómez-Outes, Antonio; Suárez-Gea, M Luisa; Lecumberri, Ramón; Terleira-Fernández, Ana Isabel; Vargas-Castrillón, Emilio

    2014-01-01

    Pulmonary embolism (PE) is a relatively common cardiovascular emergency. PE and deep vein thrombosis (DVT) are considered expressions of the same disease, termed as venous thromboembolism (VTE). In the present review, we describe and meta-analyze the efficacy and safety data available with the direct oral anticoagulants (DOAC; dabigatran, rivaroxaban, apixaban, edoxaban) in clinical trials testing these new compounds in the acute/long-term and extended therapy of VTE, providing subgroup analyses in patients with index PE. We analyzed ten studies in 35,019 randomized patients. A total of 14,364 patients (41%) had index PE. In the acute/long-term treatment of VTE, the DOAC showed comparable efficacy in preventing recurrent VTE to standard treatment in patients with index PE (risk ratio [RR]: 0.88; 95% confidence interval [CI]: 0.70-1.11) and index DVT (RR: 0.93; 95% CI: 0.75-1.16) (P for subgroup differences =0.76). VTE recurrence depending on PE anatomical extension and presence/absence of right ventricular dysfunction was only reported in two trials, with results being consistent with those obtained in the overall study populations. In the single trial comparing extended therapy of VTE with DOAC versus warfarin, the point estimate for recurrent VTE tended to disfavor the DOAC in patients with index PE (RR: 2.05; 95% CI: 0.83-5.03) and in patients with index DVT (RR: 1.11; 95% CI: 0.49-2.50) (P for subgroup differences =0.32). In trials that compared DOAC versus placebo for extended therapy, the reduction in recurrent VTE was consistent in patients with PE (RR: 0.15; 95% CI: 0.01-1.82) and in patients with DVT (RR: 0.25; 95% CI: 0.10-0.61) (P for subgroup differences =0.71). The DOAC were associated with a consistently lower risk of clinically relevant bleeding (CRB) than standard treatment of acute VTE and higher risk of CRB than placebo for extended therapy of VTE regardless of index event. In summary, the DOAC were as effective as, and safer than, standard

  3. 急性肺栓塞患者决定就医延迟的原因分析%Factors leading to delay in decision to seek treatment in patients with acute pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    赵月霞

    2014-01-01

    目的:调查济宁地区急性肺栓塞患者决定就医延迟程度及影响因素。方法:入选2012年11月至2013年10月底就诊于济宁地区12家医院并与发病后24h内到院的169例急性肺栓塞患者。通过与患者进行结构式访谈及查阅病历,收集资料。以决定就医延迟30min为切点,分为早决定组及晚决定组,对比分析两组资料。结果:中位决定就医延迟为60min。多因素回归分析显示:肺栓塞病史、胸痛不明显、症状不典型、症状能够耐受、对该病的认识不够重视及未将症状归于急性肺栓塞是决定就医延迟>30m i n的独立预测因素。早决定组患者具有更高的早期再灌注治疗率及更短的发病至再灌注治疗延迟。结论:济宁地区急性肺栓塞患者决定就医时间明显延迟,患者耐受情况、症状特点及认知因素影响决定就医延迟程度。%Objective To investigate the factors associated with delay in decision to seek treatment in patients with acute pulmonary embolism(PE) in Shandong. Methods This prospective, cross-sectional,multicenter survey was conducted from November 1,2008 and December 31,2009. The participants consisted of 699 patients with acute pulmonary embolism within 24 h of symptom onset to 30 hospitals in Shandong. Data were col ected by semi-structured interviews and medical records review. The patients were categorized into an early decision group and the a late decision group based on the 30 min cut-off . Results The median(25%,75%) decision delay in PE patients was 60(20,180) min Factors associated with late decision in an univariate analysis were age≥65 years, retirement or unemployment , history of pulmonary embolism,symptom onset at home and intermittent symptoms, whereas presence of bystanders such as friends, coworkers or even strangers,unbearable symptoms, dyspnea,sweating, syncope and attribution of symptoms to cardiac origin were related to early decision

  4. Apixaban for the prophylaxis and treatment of deep vein thrombosis and pulmonary embolism: an evidence-based review

    Directory of Open Access Journals (Sweden)

    Mandernach MW

    2015-08-01

    Full Text Available Molly W Mandernach,1 Rebecca J Beyth,1,2 Anita Rajasekhar11Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA; 2North Florida/South Georgia Veterans Health System (NF/SGVHS, Geriatric Research, Education and Clinical Center (GRECC, Gainesville, Florida Abstract: Venous thromboembolism (VTE results in significant morbidity and mortality. The prevention and treatment of VTE is managed with anticoagulant therapy, historically parenteral anticoagulants such as unfractionated heparin, low molecular weight heparin, and fondaparinux, and oral vitamin K antagonists such as warfarin. In the last few years, several target-specific oral anticoagulants have been developed, including the direct thrombin inhibitor dabigatran and anti-Xa inhibitors rivaroxaban, apixaban, and edoxaban. The target-specific oral anticoagulants have proven to be noninferior to vitamin K antagonists and heparins in the prevention and treatment of VTE. This review will focus on the pharmacology, clinical trial data, and laboratory assessment of apixaban. Moreover, perioperative management, use in special populations, and management of bleeding complications in patients taking apixaban for the prevention and treatment of VTE will also be discussed. Keywords: venous thromboembolism, apixaban, new oral anticoagulant, target-specific oral anticoagulant, thromboprophylaxis

  5. Endovascular Thrombin Injection for a Pulmonary Artery Pseudoaneurysm: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Jin Ho; Shin, Ji Hoon; Yoon, Hyun Ki [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    Massive hemoptysis caused by pulmonary artery pseudoaneurysms is uncommon, and endovascular treatment such as coil embolization is the first choice for treating pulmonary artery pseudoaneurysms. Various embolic agents could be used according to the angiographic findings, yet embolization with thrombin injection is very rare. Herein, we describe a case of a pulmonary artery pseudoaneurysm that was successfully treated by endovascular thrombin injection using a microcatheter because of the difficulty in performing a coil embolization due to a short feeding artery.

  6. Use of radioisotope techniques for the evaluation of patients with pulmonary disease

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, H.N. Jr.

    1976-02-01

    Although it is true that pulmonary perfusion scanning is generally accepted primarily in the differential diagnosis of pulmonary embolism, the introduction of regional ventilation studies with radioactive /sup 133/Xe, the use of the computer to provide quantitative data, and the advances being made in cardiovascular nuclear medicine indicate that nuclear medicine procedures will be used more and more in the evaluation of patients with a variety of lung and heart diseases. They have already proved of value in the following circumstances: differential diagnosis of pulmonary embolism; assessment of regional involvement in pulmonary parenchymal disease, including degenerative, neoplastic, and infectious diseases; detection of bullous disease and the determination of the possible effectiveness of surgery; assessment of the response to radiation therapy in patients with carcinoma of the lung; detection of pulmonary venous hypertension in patients with mitral valve or left ventricular disease; detection of cor pulmonale; and differential diagnosis of cyanosis in newborn infants.

  7. Clinical Analysis of Cancer Patients Complicated by Pulmonary Embolism to Start with Syncope%以晕厥等为首发症状的癌症并发肺栓塞临床分析

    Institute of Scientific and Technical Information of China (English)

    王吉云

    2011-01-01

    目的 分析癌症并发肺栓塞的临床特点,指导临床早期发现肺栓塞,早期治疗.方法 2006年3月至2011年1月间,连续纳入年龄在31~85岁,在我院心脏中心病房及门诊就诊,并确诊的癌症并发肺栓塞的患者11例.分析引发肺栓塞的癌症病因构成及相关的临床表现.结果 患者平均年龄65±17岁.男8例(81.8%),女3例(27.5%).11例患者中胃癌5例(27.5%),前列腺癌2例(18.2%),肺癌2例(18.2%),卵巢癌2例(18.2%),乳腺癌1例(9.1%),及结肠癌1例(9.1%).11例患者并发肺栓塞的临床表现有晕厥5例(27.5%)、直立位低血压5例(27.5%)、窭性心动过达2例(18.2%)、胸闷气短7例(65.6%)、胸痛4例(56.4%)、下肢水肿1例(9.1%),紧张焦虑情绪1例(9.1%).所有患者均经积极的低分子抗凝治疗及随后的华法林口服治疗症状消失.本观察中无因肺栓塞死亡的病例.结论 癌症是肺栓塞发生的高危人群,尤其是本研究中观察纠的上述癌症类型可能更容易合并肺栓塞.这些患者出现晕厥等本研究观察到的上述症状时更应警惕肺栓塞的筛查.%To analyse the clinical charateristics of cancers complicated by pulmonary embolism inorder to detect pulmonary embolism early and start therapy early.Methods We enrolled 11 inpatient and outpatient department patients aged 31-85years old continuously from March, 2006 to January, 2011. All patients are diagnosed with cancers. All cancers are confirmed by pathological examination, lab tests, physical checkup and clinical presentations. Eight cases are diagnosed with pulmonary embolism by pulmonary ventilation/perfusion imaging, 3 cases are diagnosed by spiral computed tomographic pulmonary angiography.We analysed the contributed cancer etiology and their related clinical presentation.Results Mean age is 63±17 years old Eight cases are male(81.8%), three cases are female(27.3%).Gastric cancer(27.3%), prostate cancer(18.2%), breast cancer(9.1%), ovarian cancer(18.2

  8. Postpartum Acute Pulmonary Oedema with Sub clinical Rheumatic Heart Disease

    OpenAIRE

    2015-01-01

    Acute dyspnea with pulmonary oedema in postpartum is uncommon but life-threatening event. Contributing factors for pulmonary oedema include, administration of tocolytics, underlying cardiac disease, iatrogenic fluid overload and preeclampsia acounting 0.08% of pregnancies. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration and pulmonary oedema are some of the potentially devastating conditions that should be considered by the attending physician.

  9. Embolia pulmonar decorrente de coriocarcinoma metastático com apresentação atípica Pulmonary embolism resulting from metastatic choriocarcinoma with atypical presentation: report of a case

    Directory of Open Access Journals (Sweden)

    Teresa de Jesus Jhayya

    1999-12-01

    Full Text Available É apresentado o caso de uma paciente de 36 anos, com coriocarcinoma metastático pulmonar com apresentação clínica e radiológica atípica. O achado de hipertensão pulmonar indicou a possibilidade de tromboembolia pulmonar; todavia, o diagnóstico definitivo e causa da embolia pulmonar foram dados na autópsia. Discutem-se as formas de apresentação das metástases do coriocarcinoma, sua repercussão e o período de latência que pode existir até evidenciar a neoplasia.A case is presented of a 36 year-old woman, with metastatic lung choriocarcinoma with atypical clinical and radiological presentation. The finding of pulmonary hypertension indicated the possibility of pulmonary thromboembolism, still, the definitive diagnosis and cause of pulmonary embolism were done in the autopsy. The authors discuss the manners of choriocarcinoma metastasis presentation, its repercussions and the latent period which may exist until it presents evidence of neoplasm.

  10. Comparison and combination of a hemodynamics/biomarkers-based model with simplified PESI score for prognostic stratification of acute pulmonary embolism: findings from a real world study

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    Luca Masotti

    2015-11-01

    Full Text Available Background: Prognostic stratification is of utmost importance for management of acute Pulmonary Embolism (PE in clinical practice. Many prognostic models have been proposed, but which is the best prognosticator in real life remains unclear. The aim of our study was to compare and combine the predictive values of the hemodynamics/biomarkers based prognostic model proposed by European Society of Cardiology (ESC in 2008 and simplified PESI score (sPESI. Methods: Data records of 452 patients discharged for acute PE from Internal Medicine wards of Tuscany (Italy were analysed. The ESC model and sPESI were retrospectively calculated and compared by using Areas under Receiver Operating Characteristics (ROC Curves (AUCs and finally the combination of the two models was tested in hemodinamically stable patients. All cause and PE-related in-hospital mortality and fatal or major bleedings were the analyzed endpoints Results: All cause in-hospital mortality was 25% (16.6% PE related in high risk, 8.7% (4.7% in intermediate risk and 3.8% (1.2% in low risk patients according to ESC model. All cause in-hospital mortality was 10.95% (5.75% PE related in patients with sPESI score and #8805;1 and 0% (0% in sPESI score 0. Predictive performance of sPESI was not significantly different compared with 2008 ESC model both for all cause (AUC sPESI 0.711, 95% CI: 0.661-0.758 versus ESC 0.619, 95% CI: 0.567-0.670, difference between AUCs 0.0916, p=0.084 and for PE-related mortality (AUC sPESI 0.764, 95% CI: 0.717-0.808 versus ESC 0.650, 95% CI: 0.598-0.700, difference between AUCs 0.114, p=0.11. Fatal or major bleedings occurred in 4.30% of high risk, 1.60% of intermediate risk and 2.50% of low risk patients according to 2008 ESC model, whereas these occurred in 1.80% of high risk and 1.45% of low risk patients according to sPESI, respectively. Predictive performance for fatal or major bleeding between two models was not significantly different (AUC sPESI 0.658, 95% CI

  11. Uterine Fibroid Embolization (UFE)

    Science.gov (United States)

    ... embolization. This occurs when fibroids located inside the uterine cavity detach after embolization. Women with this problem may require a procedure called D & C (dilatation and curettage) to ... who undergo uterine fibroid embolization, normal menstrual cycles resume after the ...

  12. Prevalência e preditores de embolia pulmonar em pacientes com insuficiência cardíaca agudamente descompensada Prevalence and predictors of pulmonary embolism in patients with acutely decompensated heart failure

    Directory of Open Access Journals (Sweden)

    Luís C. L. Correia

    2012-02-01

    Full Text Available FUNDAMENTO: Não existe descrição da prevalência de Embolia Pulmonar (EP em pacientes internados por quadro clássico de Insuficiência Cardíaca descompensada (IC. OBJETIVO: Em pacientes internados por IC, (1 descrever a prevalência de EP, e (2 avaliar a acurácia diagnóstica dos Escores de Wells e de Genebra. MÉTODOS: Pacientes internados primariamente por IC realizaram sistematicamente cintilografia pulmonar de ventilação/perfusão, sendo EP definida por laudo de alta probabilidade. Para fins de interpretação, definimos baixa probabilidade clínica de EP como prevalência BACKGROUND: The prevalence of pulmonary embolism (PE has not been reported in patients hospitalized due to classical findings of decompensated heart failure (HF. OBJECTIVE: To describe the prevalence of PE and to assess the diagnostic accuracy of the Wells and Geneva scores in patients hospitalized due to HF. METHODS: Patients hospitalized primarily due to HF underwent systematic ventilation-perfusion lung scan, and PE was defined by a result of high probability. Aiming at interpreting, low clinical probability of PE was defined as prevalence < 5%, according to the literature. When calculating the sample size, 49 patients were required to provide a 95% confidence interval with ±10% accuracy, estimating an a priori prevalence of 15%. RESULTS: Of 51 patients studied, six had a high probability of PE on lung scan, resulting in 12% prevalence (95% CI = 5% - 23%. The Wells and Geneva scores had an area under the ROC curve of 0.53 (95% CI = 0.27 - 0.80; p = 0.80 and 0.43 (95% CI = 0.13 - 0.73; p = 0.56, respectively, indicating lack of accuracy for the diagnosis of PE. Alternatively, variables related to HF showed a tendency towards association with PE, and an exploratory model formed by that type of variable showed diagnostic accuracy for PE (ROC = 0.81; 95% CI = 0.66 - 0.96; p = 0.01. CONCLUSION: (1 Despite the lack of primary suspicion, patients admitted with HF have

  13. Cerebral Fat Embolism: A diagnostic challenge

    Science.gov (United States)

    Gupta, Babita; Kaur, Manpreet; D’souza, Nita; Dey, Chandan Kumar; Shende, Seema; Kumar, Atin; Gamangatti, Shivanand

    2011-01-01

    Fat embolism syndrome (FES) is a rare but a serious clinical catastrophe occurring after traumatic injury to long bones. Cerebral involvement in the absence of pulmonary or dermatological manifestation on initial presentation may delay the diagnosis of cerebral fat embolism (CFE). We discuss a case series of CFE which posed a challenge in diagnosis. The clinical presentations of these patients did not satisfy the commonly used clinical criteria for aiding the diagnosis of FES. Early MRI brain (DWI and T2 weighted sequences) in patients with neurological symptoms after trauma even in the absence of pulmonary and dermatological findings should be the goal. PMID:21957425

  14. Cerebral fat embolism: A diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Babita Gupta

    2011-01-01

    Full Text Available Fat embolism syndrome (FES is a rare but a serious clinical catastrophe occurring after traumatic injury to long bones. Cerebral involvement in the absence of pulmonary or dermatological manifestation on initial presentation may delay the diagnosis of cerebral fat embolism (CFE. We discuss a case series of CFE which posed a challenge in diagnosis. The clinical presentations of these patients did not satisfy the commonly used clinical criteria for aiding the diagnosis of FES. Early MRI brain (DWI and T2 weighted sequences in patients with neurological symptoms after trauma even in the absence of pulmonary and dermatological findings should be the goal.

  15. Partial Splenic Artery Embolization

    Directory of Open Access Journals (Sweden)

    Gh. Shadmani

    2010-05-01

    Full Text Available Background/Objective: Hypersplenism often accompanies chronic liver disease and splenomegaly is one of the four cardinal signs of hypersplenism, the other three being cytopenia, normal or hyperplastic bone marrow and response splenectomy. Surgical splenectomy is the traditional treatment."nIn the recent years, partial splenic embolization has been widely used in patients with hypersplenism and cirrhosis.This study was conducted to assess the safety and efficacy of partial splenic embolization using PVA (poly vinyl alcohol and steel coil in the management of hypersplenism."nPatients and Methods: Between Aban 1387 and Aban 1388, ten patients with hypersplenism related hematologic abnormalities (leukopenia, thrombocytopenia, variceal hemorrhage or other sequels underwent partial splenic embolization with PVA and coil. A comparison between pre-procedure and post-procedure lab data, endoscopy and splenic volumetery was done."nResults: All patients showed dramatic improvement in platelet and leukocyte counts. Platelet and leukocyte counts remained at an appropriate level during the follow up period. In one patient after one year progressive decline in the platelet count was noted, however the values remained significantly higher than before PSE (70000 vs 15000."nAlmost all patients had problems related to post embolization syndrome. In one patient severe pain was noted that lasted nearly ten days, in the other patients, pain was less severe. No significant complication (splenic abscess, pancreatitis, portal vein thrombosis developed in this study."nConclusion: The efficacy of PSE observed in our study confirms the results of previous studies in pa-tients with hypersplenism. This safe, fast method can be used bridging therapy for cirrhotic patients waiting for liver transplantation. Hematological response is related to the extension of embolization.

  16. Risk factors and clinical analysis of thirty four patients with acute pulmonary embolism%急性肺栓塞34例危险因素及临床分析

    Institute of Scientific and Technical Information of China (English)

    陈洪喜; 余国忠; 吕庆连

    2013-01-01

    Objective To investigate the relationship between the risk factors and onset of acute pulmonary embolism and to develop a proper diagnostic strategy and clinical management for patients with acute pulmonary embolism. Methods Predisposing factors,clinical manifestation, treatment and outcomes of 34 consecutive patients with established acute pulmonary embolism were analyzed retrospectively.The patients were definitely diagnosed in our hospital from 2005 to 2013. Results The patients with APE often had one or more risk factors. Indications of 34 cases with thrombolysis 9 cases, including 2 cases during cardiopulmonary resuscitation (CPR) thrombolysis, died, 1 case died of upper gastrointestinal bleeding after thrombolysis; Simple lines of anticoagulant treatment of 21 cases , 4 cases died;Anticoagulation+inferior vena cava filter placement in 1 case;Because of anticoagulation, thrombolysis, taboo in 3, only symptomatic support, dealing with death. 10 cases, death rate of 29.41%. 24 patients survived (6 cases of thrombolysis, 17 cases of pure anticoagulation, 1 case of anticoagulant treatment+inferior vena cava filter placement. Conclusion The incidence of acute pulmonary embolism is closely related to the associated factors. CTPA has confirmed as the preferred method of inspection.%目的探讨急性肺栓塞(APE)危险因素与发病的关系,提高APE诊治水平。方法对34例确诊为APE患者的易患因素、临床表现、辅助检查、治疗方法进行回顾性分析。结果患者常有多种危险因子,34例患者中有溶栓适应证9例,其中有2例在心肺复苏时溶栓,均死亡,1例死于溶栓后上消化道大出血;单纯行抗凝治疗21例,死亡4例;抗凝+下腔静脉滤器置入1例;因有抗凝、溶栓禁忌3例,仅对症、支持处理均死亡。共死亡10例,病死率为29.41%。24例存活(6例溶栓,17例单纯抗凝,1例抗凝+下腔静脉滤器置入治疗)。结论APE的发病与易患因素

  17. ANCA在系统性红斑狼疮肺栓塞中的诊断价值%Diagnostic value of antineutrophil cytoplasmic antibodies in patients with systemic lupus erythematosus merge pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    杨栋; 宫怡; 杨吉娟

    2009-01-01

    目的 观察抗中性粒细胞胞浆抗体(Anti-neutrophil cytopasmic antibodies,ANCA)在系统性红斑狼疮(Systematic lupus erythematosus,SLE)合并肺栓塞(Pulmonary Embolism,PE)诊断中的价值.方法 比较36例系统性红斑狼疮肺栓塞患者与50例无肺栓塞的系统性红斑狼疮患者的临床表现及ANCA阳性率.结果 系统性红斑狼疮肺栓塞患者组ANCA阳性率明显高于无肺栓塞的系统性红斑狼疮患者组.结论 血清ANCA抗体有助于系统性红斑狼疮肺栓塞的诊断.

  18. Role of curcurmin in acute lung injury by acute pulmonary embolism and expression of CFTR%姜黄素对急性肺动脉栓塞大鼠肺损伤及CFTR表达的影响

    Institute of Scientific and Technical Information of China (English)

    王征; 玉寒冰; 罗全

    2014-01-01

    目的:观察姜黄素对急性肺栓塞大鼠肺损伤的保护作用及对CFTR表达的影响。方法:大鼠分为假手术组,模型组,姜黄素(150mg/kg)﹢APE组。制备左肺动脉结扎模拟急性肺动脉栓塞模型。进行血气分析,检测AFC及肺湿干比,real-time PCR方法检测肺组织的CFTR的表达。结果:与模型组比较,姜黄素升高PaO2水平,减轻AFC下降趋势,及减少肺湿干比的增加。姜黄素能提高肺组织的CFTR的表达。结论:姜黄素对急性肺动脉栓塞大鼠的急性肺损伤有保护作用,并上调CFTR的表达。%Objective:To observe whether the curcumin could protect the acute lung injury by acute lung embolism and affect the expression of CFTR. Methods:SPF rats were divided into 3 groups:sham group,acute pulmonary em-bolism(APE)group and curcumin group(150mg/kg). The model of acute pulmonary embolism was ligatured the left artery. Blood gas analysis,AFC and wet-to-dry ratio and CFTR mRNA expression were observed. Results:Curcu-min could increase artery O2 pressure,decrease the AFC downward and wet-to-dry ratio. Curcumin could increase the expression of CFTR mRNA. Conculsion:Curcumin could protect the acute lung injury by APE and associated with upward of CFTR mRNA.

  19. A comparative study of contrast-enhanced and unenhanced MR pulmonary angiography in the diagnosis of pulmonary embolism%增强与非增强MR肺动脉血管成像诊断肺栓塞准确性的对比研究

    Institute of Scientific and Technical Information of China (English)

    袁思殊; 王梓; 夏黎明

    2015-01-01

    目的:比较对比增强MR血管成像(contrast-enhanced MR pulmonary angiography,CE-MRA)与非增强空间标记多反转脉冲序列(applying spatial labeling with multiple inversion pulses sequence,SLEEK) MR血管成像诊断肺栓塞(pulmonary embolism,PE)的准确性。材料与方法26例CT肺动脉血管成像诊断肺栓塞的患者(男15例,女11例)于多排螺旋CT肺动脉造影(CT pulmonary angiography,CTPA)检查48 h内行CE-MRA以及非增强SLEEK MR检查。CTPA作为参考标准,计算并比较每种MR技术诊断肺栓塞的敏感性、特异性、阳性预测值以及阴性预测值。结果 CE-MRA诊断肺栓塞的敏感性为78.8%,特异性97.7%。非增强SLEEK MRI诊断肺栓塞的敏感性83.8%,特异性100%。两阅片者间存在高度一致性(k=0.87)。结论 CE-MRA和SLEEK MRI诊断肺栓塞的准确性无统计学差异,但非增强SLEEK MRI血管成像无需使用对比剂,有希望成为肺栓塞诊断策略中的一部分。%Objective: To evaluate relative detection accuracy of pulmonary embolism (PE) with contrast-enhanced MR angiography (CE-MRA) and unenhanced MR angiography by applying spatial labeling with multiple inversion pulses sequence (SLEEK) imaging.Materials and Methods: Twenty-six patients (15 males and 11 females) with computed tomographic pulmonary angiography (CTPA) diagnosed pulmonary embolism (PE) underwent contrast-enhanced MR pulmonary angiography and SLEEK MR angiography within 48 hours after CTPA. Referring to CTPA, sensitivity, specificity, and positive and negative predictive values for PE detection were calculated and compared for each MR method.Results:Sensitivities for PE detection were 78.8% for contrast-enhanced MR pulmonary angiography and 83.8%for SLEEK MR angiography respectively. Speciifcities for PE detection were 97.7% for contrast-enhanced MR Pulmonary angiography and 100% for SLEEK MR angiography respectively. Agreement between readers was relatively high (k=0

  20. Assessment of pulmonary function using pixel indexes of multiple-slice spiral CT low-dose two-phase scanning in chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    张利华

    2012-01-01

    Objective To explore the values of pixel indexes (PI) with multiple-slice spiral CT low-dose two-phase scanning for assessing the pulmonary function in chronic obstructive pulmonary disease(COPD) . Methods Thirty-six patients with COPD (COPD group) and 30 healthy people(control group) underwent pulmonary

  1. Tratamento cirúrgico da embolia pulmonar crônica: análise da experiência inicial Surgical treatmentent of chronic pulmonary embolism: analisys of initial experience

    Directory of Open Access Journals (Sweden)

    Fábio B Jatene

    1995-06-01

    Full Text Available Após a tromboembolia pulmonar aguda, na maioria dos casos, ocorre lise com recanalização dos ramos pulmonares. Entretanto, em pequeno, mas indeterminado número de pacientes (pts com embolia pulmonar (EP crônica, a incompleta resolução do material embólico pode resultar em grave hipertensão pulmonar. A tromboendarterectomia pulmonar (TP é uma opção, especialmente quando a obstrução é proximal e os pts apresentam falência ao tratamento clínico. Dentre as técnicas cirúrgicas já empregadas, a que utiliza, atualmente, a esternotomia com circulação extracorpórea (CEC e parada circulatória total (PCT é a que tem apresentado melhores resultados. Até janeiro/95 foram operados 15 pts portadores de EP recurrente. A arteriografia pulmonar mostrou comprometimento bilateral em 66,7% dos casos. Esternotomia foi realizada em 73,3% dos pts. Nestes pts, a técnica utilizada foi a TP por tração retrógrada dos trombos. Circulação extracorpórea foi utilizada em todos os pts, com tempo médio de 124,8 min, sendo em 66,7% dos casos realizada PCT, com tempo médio de 34,2 min. Os valores pressóricos médios na artéria pulmonar eram 91/32/55 mmHg no pré e apresentaram queda para 52/15/27 mmHg no pós-operatório.Houve 1 (6,7% óbito hospitalar por coagulopatia e 1 tardio devido a problemas não relacionados à operação. Dos 13 pts vivos, 1 (7,7% apresentou reobstrução e 12 (92,3% encontram-se assintomáticos sob anticoagulação oral, tendo retornado às atividades habituais, em um período de seguimento de até 165 meses (média 47m. Em conclusão, a TP realizada por esternotomia e, quando necessário, com auxílio de PCT é procedimento viável e seguro para resolução de EP crônica, levando à remissão da sintomatologia destes pts e à manutenção do resultado a longo prazo.After the acute pulmonary embolism, in the majority of the cases lysis occurs with recanalization of the pulmonary branches. However, in a small but

  2. Pulmonary arterial wall distensibility assessed by intravascular ultrasound in children with congenital heart disease : an indicator for pulmonary vascular disease?

    NARCIS (Netherlands)

    Berger, Rolf M F; Cromme-Dijkhuis, Adri H; Hop, Wim C J; Kruit, Marco N; Hess, John; Berger, Rudolphus

    2002-01-01

    BACKGROUND: Both pulmonary hypertension and pulmonary overflow are associated with functional and structural changes of the pulmonary arterial wall. Current techniques to evaluate the pulmonary vasculature neglect the pulsatile nature of pulmonary flow. STUDY OBJECTIVES: To determine whether the dyn

  3. [Nursing assessment and management of patients with cardiogenic pulmonary edema].

    Science.gov (United States)

    Wang, Yu-Jyuan; Liao, Chieh-Yin; Kao, Chi-Wen

    2012-02-01

    Cardiogenic pulmonary edema (CPE) is a clinical health problem that induces impaired gas exchange, dyspnea and hypoxia. This serious condition results in acute respiratory failure and high mortality rate. This article suggests an effective approach to CPE patient clinical symptom assessment and management. In accordance with evidence-based methods, we searched Cochrane, CINAHL and ScienceDirect and identified four Oxford Ia or Ib reports that employed a randomized controlled trial, systematic review and meta-analysis. Results suggest that prompt application of a non-invasive positive ventilator, especially continuous positive or bi-level positive airway pressure, can help patients reduce intubation risks, ICU stay days, and mortality rates. The authors hope to see more clinical trials on this topic to support evidence-based clinical nursing care.

  4. 增强核磁共振肺灌注扫描技术与增强核磁共振肺动脉造影术对肺动脉栓塞的诊断价值对比分析%Analysis of Enhanced Magnetic Resonance Perfusion Lung Scanning Technology with Enhanced Magnetic Resonance Pulmonary Angiography in Pulmonary Embolism Diagnosis Value of Contrast

    Institute of Scientific and Technical Information of China (English)

    张超

    2015-01-01

    目的:探讨增强核磁共振灌注扫描技术(MRPP)与增强核磁共振肺动脉造影术(MRPA)对于肺动脉栓塞患者诊断的敏感度与特异度差异,比较两者诊断的临床价值。方法对我院自2010年12月至2013年6月期间收治的32例确诊肺动脉栓塞患者的临床资料进行分析。均对其行增强核磁共振灌注扫描术与增强核磁共振肺动脉造影术,其中10例患者同时行核素肺灌注扫描,另有7例患者在经过溶栓治疗以后,对其进行MRPP以及MRPA的复查。检查时在患者的异常区域以及上部、中部以及下部肺动脉病变区域设置感兴趣区(ROI),对信号-时间曲线、信号强度(SI)进行测量,从而获得血流灌注高峰时段信号强度的变化率(TROS)。结果对上述32例肺动脉栓塞患者行MRPA,发现共有137条肺动脉出现闭塞,行MRPP后发现共有125个肺部血流灌注异常区域和MRPA结果吻合,吻合率为91.24%。32例肺动脉栓塞患者在MRPP检查中发现有57个肺动脉段合并段以远及段的动脉栓塞。10例同时行核素肺灌注扫描患者结果表明,共有81个肺动脉段灌注缺损,而此时MRPA检查结果显示77个肺段受到累及,敏感度为95.06%,MRPP检查结果显示73个肺段受累,敏感度为90.12%。结论 MRPP对于肺动脉诊断的敏感度显著低于MRPA,MRPP以及MRPA都有可以有效观察区别肺动脉栓塞的低灌注区和灌注缺损区。%Objective To investigate the enhancement scanning technique of nuclear magnetic resonance perfusion (MRPP) with enhanced magnetic resonance pulmonary angiography (MRPA) for the diagnosis of pulmonary embolism in patients with sensitivity and specificity differences, compare the clinical value of diagnosis.Methods to analyse the clinical data in our hospital from 2010 December to 2013 June period of 32 patients with pulmonary embolism patients. On the enhanced magnetic resonance perfusion scanning and enhanced

  5. Pulmonary Edema Assessed by Ultrasound: Impact in Cardiology and Intensive Care Practice.

    Science.gov (United States)

    Blanco, Pablo A; Cianciulli, Tomás F

    2016-05-01

    Pulmonary edema is a frequent condition found in adult patients hospitalized in cardiology wards and intensive care units. Ultrasonography is a diagnostic modality with a high sensitivity for the detection of extravascular lung water, visualized as B lines, and usually caused by cardiogenic or noncardiogenic pulmonary edema. This paper highlights a simple method for the assessment of patients with pulmonary edema, which allows for a differential diagnosis of its possible mechanism and contributes to therapeutic intervention guiding and monitoring.

  6. Age-dependent D-dimer cut-off to avoid unnecessary CT-exams for ruling-out pulmonary embolism; Altersangepasste Anhebung des D-Dimer-Grenzwertes zur Vermeidung unnoetiger CT-Untersuchungen bei Verdacht auf Lungenarterienembolie

    Energy Technology Data Exchange (ETDEWEB)

    Altmann, M.M.; Hoehne, M.; Herold, T. [HELIOS Klinikum Berlin-Buch (Germany). Radiology; Wrede, C.E. [HELIOS Klinikum Berlin-Buch (Germany). Emergency Department; Peetz, D. [HELIOS Klinikum Berlin-Buch (Germany). Laboratory Medicine; Stroszczynski, C. [University Medical Center, Radiology, Regensburg (Germany)

    2015-09-15

    To evaluate the effect of an age-dependent D-Dimer cut-off in patients who underwent a computed tomography pulmonary angiogram (CTPA) for suspected pulmonary embolism (PE). Retrospective application of an age-dependent D-dimer cut-off (age/100 in patients aged over 50) in 530 consecutive patients, both in- and outpatients, aged over 18, who underwent CTPA for suspected PE according to the guidelines. The application of an age-dependent D-dimer cut-off showed a now negative test-result in 17 of 530 patients (3.2 %). The proportion was 4.1 % (17 of 418) in patients aged over 50. None of these 17 cases was diagnosed with PE in CTPA, the false-negative rate was 0 %. The effect could be seen in outpatients (14 of 377 [3.7 %]) as well as in inpatients(3 of 153 [2.0 %]) with no statistically significant difference (p > 0.05). The application of an age-dependent D-dimer cut-off as part of the guideline-based algorithm for suspected PE reduced the number of necessary CTPA in outpatients as well as in inpatients.

  7. Enoxaparin for the prevention of post-surgical pulmonary embolism%低分子肝素预防外科术后患者的肺栓塞

    Institute of Scientific and Technical Information of China (English)

    夏锡仪; 金雷; 谭玉林; 孙亚伟; 严国度; 戎亚雄; 任全海; 刘建跃; 徐学忠; 单国平

    2011-01-01

    safety of the administration of enoxaparin,a low molecular weight heparin (LMWH),in the prevention of post surgical deep vein thrombosis (DVT) and pulmonary embolism (PE).Methods 1 928 patients hospitalized for general surgery were randomly divided into:(① test group (n=960) to receive enoxaparin (40 mg,s.c.,12 hours before and after surgery,then once daily for 7 consecutive days); ② control group (n=968) without intervention.The incidence of DVT,PE and bleeding were recorded for statistical analysis during hospitalization and a 2 months follow-up after discharge.Results ① No significant difference was found between the two groups in age,sex,average body mass index,type of surgery,and DVT/PE risk factors (obesity,varicose veins,and history of:venous thrombosis,chronic obstructive pulmonary disease,chronic heart failure,and hormone therapy).The percentage of non-malignant/malignant tumor surgery were 36.5%/63.5% (average operation time 2.3 hours) in control group and 35.6%/64.4% (2.2 hours) in test group (both P>0.05).② During the hospitalization period,59 eases (incidence =6.1 %) of DVT and 14 cases (incidence =1.4 % ) of PE (among them 6 were fetal,42.8% of all PE cases) were found in the control group,while 28 cases of DVT (2.9%) and 3 cases (0.3%) of PE (1 fetal,33.3% of all PE cases) were found in test group.The incidence of DVT,PE (total),and PE (fetal) were significant lower in test group (P< 0.05 or P< 0.01).During the follow-up,14 more cases of DVT (1.4%) and 1 more case (0.1% ) of PE (a fetal) were found in the control group,and 2 more DVT cases (0.2%) in test group,with the DVT incidence in test group significantly lower (P<0.01).(③ During the enoxaparin administration,30 cases (3.1 %) minor bleeding and 8 cases (0.8%) major bleeding were found in the control group,while 33 cases (3.4%) minor bleeding events and 9 cases (0.9%) major bleeding events were found in the test group.The results in the two groups

  8. Pseudo planar images obtained from pulmonary SPECT: Agreement of reading and comparison to planar images; Images pseudoplanaires issues des tomographies pulmonaires: etude de la reproductibilite de lecture et comparaison aux images planaires

    Energy Technology Data Exchange (ETDEWEB)

    Ciappuccini, R.; Boichot, C.; Cochet, A.; Touzery, C.; Dygai-Cochet, I.; Berriolo-Riedinger, A.; Toubeau, M.; Brunotte, F. [Centre Georges-Francois-Leclerc, Service de Medecine Nucleaire, 21 - Dijon (France)

    2009-02-15

    Purpose Due to a long time of acquisition, performing during the same examination planar and pulmonary tomography is time expensive. Then, pseudo planar images have been advocated to be used instead of planar images in the diagnosis of pulmonary embolism. We aim to compare both kinds of images in terms of probability and to assess intra- and inter-observer agreement. Materials and methods Thirty-four patients referred to our unit to diagnose or rule out pulmonary embolism, underwent a planar ventilation/perfusion (V/Q) lung scan and a V/Q lung SPECT. Using the SPECT projections, eight pseudo planar images were created for each examination. Two experienced physicians read twice both sets of anonymous planar and pseudo planar images. They checked the probability of pulmonary embolism using the modified PIOPED criteria but without the chest X-ray. Results For both readers, intra-observer agreement for pseudo planar images is good (kw = 0.69 and 0.78), and similar to the planar images agreement. Interobserver agreement (kw = 0.63) is also good. Both modalities show a good agreement in terms of probability of pulmonary embolism. Conclusions We showed that pseudo planar pulmonary images have a good intra- and interobserver agreement. Furthermore, in our population, these images lead to the same results in terms of probability of pulmonary embolism as those obtained using the standard planar technique. (authors)

  9. Assessment of pulmonary dynamics in normal newborns: a pneumotachographic method.

    Science.gov (United States)

    Estol, P; Píriz, H; Pintos, L; Nieto, F; Simini, F

    1988-01-01

    A pneumotachographic method for assessment of pulmonary dynamics in critically ill newborns in an intensive care setting was developed in our laboratory. Before the results obtained with this method could be applied, the normal range of values were determined in 48 normal term and preterm newborns. Their body weight ranged between 1200 and 4100 g, and postnatal ages between 24 hours and 21 days. In three infants, two determinations were performed after an interval of 7 days. The studies were performed with a pneumotachograph applied to the upper airway by means of an inflatable face mask or latex nasal prongs. The air flow signal was electronically integrated to time to produce a volume signal. Airway pressure was determined proximal to the pneumotachograph. Esophageal pressure was determined with a water filled catheter placed in the lower third of the esophague. Tidal volume (VT), minute ventilation (V), Dynamic compliance (Cdyn), total pulmonary resistance (R), total pulmonary work (Wt), Elastic work (We), and flow resistive work (Wv), were determined. A significant linear correlation was found between Cdyn and body weight (r = 0.50, p less than 0.01) whereas no significative correlation was found between body weight and VT, V or R. Values for VT, V and Cdyn were corrected for body weight and means (X), standard deviation (SD) so as 10th and 90th percentiles are shown in table III. X, SD and percentiles for R were shown in table III. Wt, We and Wv were corrected for V, and X, SD and percentiles shown in table III. Values of VT/Kg, Cdyn/Kg and R are similar to those found by other authors with pneumotachography and plethysmography. The V/Kg values obtained by us were higher than those reported by other authors, which together with the lack of correlation of VT and V with body weight, question the reliability of V values in our study. This could be explained by: 1) excessive increase in dead space in cases in which a face mask was used; 2) nocioceptive stimulus

  10. Cerebral Air Embolism from Angioinvasive Cavitary Aspergillosis

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    Chen Lin

    2014-01-01

    Full Text Available Background. Nontraumatic cerebral air embolism cases are rare. We report a case of an air embolism resulting in cerebral infarction related to angioinvasive cavitary aspergillosis. To our knowledge, there have been no previous reports associating these two conditions together. Case Presentation. A 32-year-old female was admitted for treatment of acute lymphoblastic leukemia (ALL. Her hospital course was complicated by pulmonary aspergillosis. On hospital day 55, she acutely developed severe global aphasia with right hemiplegia. A CT and CT-angiogram of her head and neck were obtained demonstrating intravascular air emboli within the left middle cerebral artery (MCA branches. She was emergently taken for hyperbaric oxygen therapy (HBOT. Evaluation for origin of the air embolus revealed an air focus along the left lower pulmonary vein. Over the course of 48 hours, her symptoms significantly improved. Conclusion. This unique case details an immunocompromised patient with pulmonary aspergillosis cavitary lesions that invaded into a pulmonary vein and caused a cerebral air embolism. With cerebral air embolisms, the acute treatment option differs from the typical ischemic stroke pathway and the provider should consider emergent HBOT. This case highlights the importance of considering atypical causes of acute ischemic stroke.

  11. Forecast value of combination of troponin Ⅰ and pulmonary embolism severity index for severity in patients with pulmonary embolism%肺栓塞严重程度指数联合肌钙蛋白Ⅰ对肺栓塞病情严重程度的预测价值

    Institute of Scientific and Technical Information of China (English)

    段炜; 李嘉; 胡晓芸

    2012-01-01

    Objective To study the forecast value of combination of troponin Ⅰ and pulmonary embolism severity index for severity in patients with pulmonary embolism (PE).Methods The data of 245 patients with PE confirmed in the First Hospital of Shanxi Medical University.According to PESI,level of troponin Ⅰ and combination of troponin Ⅰ and PESI,the patients were divided into different groups.The incidence rates of non-massive,massive and sub-massive PE patients were compared.The forecast value of the PESI score,the level of troponin Ⅰ and combination of troponin Ⅰ and PESI for the severity in PE patients were evaluated.Results In the PESI classification,both class Ⅰ and class Ⅱ ( low-risk group) were non-massive PE.In the class Ⅲ (intermediate-risk group),the non-massive PE accounted for 42.5% the massive and sub-massive PE accounted for 57.5%.The massive and sub-massive PE in the class Ⅳ and class Ⅴ (high-risk group) respectively accounted for 92.5% and 100.0%.The positive predictive value (PPV) and specificity were respectively 96.9 %,95.2% in the high-risk group,while both the negative predictive value (NPV) and sensitivity were 100.0% in the low-risk group.The incidence rate of massive and sub-massive PE,PPV and specificity were respectively 98.2%,98.2% and 36.5% in the group of negative troponin Ⅰ,but incidence rate of non-massive PE,NPV and sensitivity were respectively 94.1%,94.1% and 48.0%.The incidence rate of massive and sub-massive PE,PPV and specificity were respectively 94.1%,94.1% and 94.3% in the combination of positive troponin Ⅰ and intermediate-risk group.Conclusions The high-risk group has a higher predictive value for severity of massive and sub-massive PE.It has less predictive value for the severity of PE to use the level of troponin Ⅰ than the combination of troponin Ⅰ and PESI.%目的 探讨肺栓塞严重程度指数(PESI)联合肌钙蛋白Ⅰ(cTnI)对肺栓塞(PE)病情严

  12. Comparison of efficacy and safety of treatment for low pulmonary embolism severity index outpatient versus inpatient with acute pulmonary embolism%低肺栓塞严重程度指数急性肺栓塞患者住院及非住院治疗的疗效及安全性比较

    Institute of Scientific and Technical Information of China (English)

    陈中华; 余定红; 刘满生

    2013-01-01

    目的 评估对低肺栓塞严重程度指数(PESI)急性肺栓塞(APE)患者进行院外自我抗凝管理的疗效及安全性.方法 将PESI分级Ⅰ~Ⅱ级的68例APE患者按随机数字表法分为院外治疗组和住院治疗组,每组34例.所有患者均给予低分子量肝素联合口服抗凝药物治疗,院外治疗组进行自我抗凝管理.观察两组患者治疗后2周及3个月时的疗效,包括静脉血栓栓塞(VTE)的复发情况、国际标准化比值(INR)达标时间、VTE相关的急救次数、出血事件的发生及总体病死率.结果 治疗期间住院治疗组2例(5.9%,2/34)VTE复发,院外治疗组仅1例(2.9%,1/34) VTE复发,差异无统计学意义(P>0.05).住院治疗组INR达标时间(8.5±2.9)d,明显短于院外治疗组的(16.1±4.4)d,差异有统计学意义(P<0.01).两组患者VTE相关的急救次数比较差异无统计学意义(P>0.05).68例患者中仅院外治疗组发生1例严重出血、1例死亡.结论 对于PESI分级Ⅰ~Ⅱ级的APE患者早期进行院外自我抗凝管理,安全有效,可大大缩短住院时间,减轻患者的物质及精神负担.%Objective To evaluate the efficacy and safety of self-management anticoagulation treatment for low pulmonary embolism severity index (PESI) outpatient with acute pulmonary embolism (APE).Methods Sixty-eight patients with APE of PESI grade Ⅰ-Ⅱ were divide into inpatient group and outpatient group with 34 cases each by random digits table.All the patients were treated with low molecular heparin followed by oral anticoagulation,and self-management was used in outpatient group.The efficacy was observed within 14 days and 3 months.The efficacy outcome included recurrent venous thromboembolism (VTE),standardization time of international normalized ratio (INR),VTE-related emergency department visit times,bleeding events and total mortality.Results There were 2 cases(5.9%,2/34) in inpatient group and 1 case (2.9%,1/34) in outpatient group with

  13. Hemoptysis and hemoperitoneum due to metastatic gestational choriocarcinma: bronchial artery embolization and superselective splenic artery embolization: a case report

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    Shin, Tae Beom; Park, Byung Ho; Yoon, Seong Kuk; Kim, Chan Sung; Lee, Jin Hwa; Oh, Jong Young [Donga University School of Medicine, Pusan (Korea, Republic of); Seong, Chang Kyu; Kim, Yong Joo; Kim, Young Hwan [Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2003-01-01

    Gestational choriocarcinoma is easily disseminated hematogenously and its hypervascular nature places the patient at risk of significant hemorrhage both at the sites of metastatic lesion and in the uterus. In addition, its tends to give rise to pseudoaneurysm formation. Treatment of the condition by percutaneous embolization has been reported in several published articles, and hemoperitoneum secondary to rupture of splenic metastasis of gestational choriocarcinoma has also been reported, as has angiographic embolization. Hemoptysis resulting from pulmonary metastasis and treatment by means of embolization of the bronchial artery have not been reported, however. In this article, we describe a case of hemoptysis and hemoperitoneum due to pulmonary and splenic metastasis of gestational choriocarcinoma. Treatment of the condition involved embolization of the bronchial artery and superselective embolization of the splenic artery.

  14. CT pulmonary angiography of adult pulmonary vascular diseases: Technical considerations and interpretive pitfalls.

    Science.gov (United States)

    Taslakian, Bedros; Latson, Larry A; Truong, Mylene T; Aaltonen, Eric; Shiau, Maria C; Girvin, Francis; Alpert, Jeffrey B; Wickstrom, Maj; Ko, Jane P

    2016-11-01

    Computed tomography pulmonary angiography (CTPA) has become the primary imaging modality for evaluating the pulmonary arteries. Although pulmonary embolism is the primary indication for CTPA, various pulmonary vascular abnormalities can be detected in adults. Knowledge of these disease entities and understanding technical pitfalls that can occur when performing CTPA are essential to enable accurate diagnosis and allow timely management. This review will cover a spectrum of acquired abnormalities including pulmonary embolism due to thrombus and foreign bodies, primary and metastatic tumor involving the pulmonary arteries, pulmonary hypertension, as well as pulmonary artery aneurysms and stenoses. Additionally, methods to overcome technical pitfalls and interventional treatment options will be addressed.

  15. Application and its clinical significance of 16 row spiral CT enhanced scanning in the diagnosis of pulmonary embolism%16排螺旋CT增强扫描在肺动脉栓塞诊断中的应用及其临床意义

    Institute of Scientific and Technical Information of China (English)

    杨震杰

    2015-01-01

    Objective:To explore the application and its clinical significance of 16 row spiral CT enhanced scanning in the diagnosis of pulmonary embolism.Methods:28 patients with pulmonary embolism were selected from May 2011 to April 2014.They were diagnosed using 16 slice spiral CT enhanced scan.We evaluated the clinical application.Results:By 16 slice spiral CT scan, we could find out the exact location and morphology of pulmonary embolism.Conclusion:The 16 row spiral CT scan can clearly diagnose pulmonary embolism,and timely provide the advantageous basis for treatment,and it has important clinical significance.%目的:探讨16排螺旋CT增强扫描在肺动脉栓塞诊断中的应用及其临床意义.方法:2011年5月-2014年4月收治肺动脉栓塞患者28例,采用16排螺旋CT增强扫描后进行肺动脉栓塞的诊断,并对其在临床上的应用进行评价.结果:经过16排螺旋CT扫描能准确找出肺动脉栓塞发生的部位和形态.结论:采用16排螺旋CT增强扫描能明确诊断肺动脉栓塞的情况,并为治疗提供及时有利的依据,具有重要的临床意义.

  16. The value of tools to assess pulmonary arterial hypertension

    Directory of Open Access Journals (Sweden)

    H. Gupta

    2011-12-01

    Full Text Available Pulmonary hypertension is a common but complex clinical problem. When suspected in an appropriate clinical setting or detected incidetally, an array of investigative tools are employed with an intent to confirm the diagnosis, define aetiology, evaluate the functional and haemodynamic impairment, define treatment options, monitor the therapy, and establish long-term prognosis. However, no single tool provides comprehensive information that encompasses the aforementioned aims. Therefore, judicious use of these tools is of paramount importance, in order to maximise outcome and cost-effectiveness, while minimising risks and redundancies. Furthermore, a number of promising tools and techniques are emerging rapidly in the arena of pulmonary hypertension. These tools augment our understanding of pathophysiology and natural history of pulmonary hypertension. There is, therefore, increasing need for validating these emerging paradigms in multicentre trials. In this review, we focus on the tools commonly used to evaluate pulmonary arterial hyertension and also define some of the new approaches to pulmonary arterial hypertension.

  17. CT Assessment of Subtypes of Pulmonary Emphysema in Females

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    Togami,Taro

    2011-02-01

    Full Text Available We performed a retrospective study examining the prevalence and subtypes of pulmonary emphysema (PE identified by computed tomography (CT in females. We reviewed the records of 1,687 female subjects who had undergone CT. They were divided into the following 2 age groups:group A (<50 years and group B (>_50 years. PE was diagnosed by the presence of low-attenuation areas using visual assessment (grades 0-3 on CT images. Two subtypes of PE were observed:centrilobular emphysema (CLE and paraseptal emphysema (PSE. PE was divided into the following 3 categories:I (CLE or CLE-predominant;II (CLE and PSE of equal extent;and III (PSE or PSE-predominant. PE was found in 64 of 274 smokers (23.3% and 54 of 1,413 non-smokers (3.8%. In smoking subjects, when grades 1 and 2 were grouped together as mild PE, the mean age for CT grade 3 (severe PE was significantly higher than that for mild PE. In group A, category III predominated, whereas category I was more prevalent in group B, in both smoking and non-smoking subjects. A high incidence of PE was found in smoking subjects as compared with non-smoking subjects. PSE predominated in younger subjects, whereas CLE predominated in older subjects.

  18. MRI assessment of bronchial compression in absent pulmonary valve syndrome and review of the syndrome