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Sample records for assessing pulmonary embolisms

  1. Pulmonary embolism

    International Nuclear Information System (INIS)

    Pulmonary embolism is a common medical problem whose incidence is likely to increase in our aging population. Although it is life-threatening, effective therapy exists. The treatment is not, however, without significant complications. Thus, accurate diagnosis is important. Unfortunately, the clinical manifestations of pulmonary embolism are nonspecific. Furthermore, in many patients the symptoms of an acute embolism are superimposed on underlying chronic heart or lung disease. Thus, a high index of suspicion is needed to identify pulmonary emboli. Laboratory parameters, including arterial oxygen tensions and electrocardiography, are as nonspecific as the clinical signs. They may be more useful in excluding another process than in diagnosing pulmonary embolism. The first radiologic examination is the chest radiograph, but the clinical symptoms are frequently out of proportion to the findings on the chest films. Classic manifestations of pulmonary embolism on the chest radiograph include a wedge-shaped peripheral opacity and a segmental or lobar diminution in vascularity with prominent central arteries. However, these findings are not commonly seen and, even when present, are not specific. Even less specific findings include cardiomegaly, pulmonary infiltrate, elevation of a hemidiaphragm, and pleural effusion. Many patients with pulmonary embolism may have a normal chest radiograph. The chest radiograph is essential, however, for two purposes. First, it may identify another cause of the patient's symptoms, such as a rib fracture, dissecting aortic aneurysm, or pneumothorax. Second, a chest radiograph is essential to interpretation of the radionuclide V/Q scan. The perfusion scan accurately reflects the perfusion of the lung. However, a perfusion defect may result from a variety of etiologies. Any process such as vascular stenosis or compression by tumor may restrict blood flow. 84 references

  2. [Pulmonary embolism].

    Science.gov (United States)

    Söffker, Gerold; Kluge, Stefan

    2015-01-01

    Acute pulmonary embolism is an important differential diagnosis of acute chest pain. The clinical signs are often non-specific. However, diagnosis and therapy must be done quickly in order to reduce morbidity and mortality. The new (2014) European guidelines for acute pulmonary embolism (PE) focus on risk-adapted diagnostic algorithms and prognosis adapted therapy concepts. According to the hemodynamic presentation the division in a high-risk group (unstable patient with persistent hypotension or shock) or in non-high-risk groups (hemodynamically stable) was proposed. In the high-risk group the immediate diagnosis is usually done by multidetector spiral computed tomography (MDCT) and primarily the medical therapy of right ventricular dysfunction and thrombolysis is recommended.In the non-high-risk group, this is subdivided into an intermediate-risk group and low-risk group, the diagnosis algorithm based on the PE-pretest probability--determined by validated scores. Moreover, the diagnosis is usually secured by MDCT--the new gold standard in the PE-diagnosis, scores, or it can be primarily ruled out due to the high negative predictive value of D-dimer determination. To improve the prognostic risk stratification in non-high-risk group patients the additional detection of right ventricular dysfunction (MDCT, echocardiography), cardiac biomarkers (troponin, NT proBNP) and validated scores (e.g. Pulmonary Embolism Severity Index) is recommended. Therefore, the intermediate-risk group can be further subdivided. For treatment of non-high-risk group patients, the initial anticoagulation (except those with severe renal insufficiency) using low molecular weight heparin/fondaparinux and conversion to vitamin-K antagonists or alternatively with direct oral anticoagulants (DOAK) is recommended. Hemodynamically stable patients with right ventricular dysfunction and myocardial ischemia (Intermediate-high-risk group patients) but with clinically progressive hemodynamic

  3. Competitive assessments of pulmonary embolism: Noninvasiveness versus the golden standard.

    Science.gov (United States)

    Ma, Yuxia; Yan, Shi; Zhou, Lin; Yuan, Dong-Tang

    2016-04-01

    Diagnosis of suspected pulmonary embolism (PE) is crucial as undiagnosed and over-diagnosis can both lead to serious consequences. Contemporary diagnostic approach of PE is a sequential combination assessment beginning with clinical assessment, validated with D-dimer measurement and confirmed with pulmonary angiography or imaging. Since the invasive pulmonary angiography is risky and costly, imaging is a warranted tool in the diagnosis procedure. CT pulmonary angiography is a less-invasive method with general availability, studies provide favorable evidences for CT pulmonary angiography as a stand-alone test for excluding PE, and it has become the first choice of tests in emergency department for suspected PE in most centers. Ventilation/perfusion single-photon emission CT signifies a new era in nuclear medicine. It has excellent sensitivity and specificity, fast procedure, low radiation exposure, few complications and contradictions. Besides, MR angiography is another possible and promising approach for diagnosis of suspected PE with much safer contrast agents than CT and no ionizing radiation. With wide availability and less invasive effects, imaging becomes a firsthand tool to obtain optimal accuracy in the diagnosis work up in clinic nowadays. This review summarizes the current methods in diagnosing PE and the update of imaging assessments of the disease. PMID:26038123

  4. Assessment of pulmonary ventilation scans using Xenon-127 in the diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    Pulmonary ventilation scans using 127Xe were compared with scans using 133Xe in the diagonsis of pulmonary embolism. A perfusion scan using sup(99m)Tc-microspheres and ventilation scans with each of the xenon isotopes were performed on 44 patients referred for lung scanning to confirm or exclude a suspected clinical diagnosis of pulmonary embolism. No significant difference was found in the frequency of diagnosis of pulmonary embolism when comparing each of the ventilation scans with the corresponding perfusion scan. For reasons discussed, 127Xe may be more useful than 133Xe for pulmonary ventilation scanning. (orig.)

  5. Knowledge of the D-dimer test result influences clinical probability assessment of pulmonary embolism

    NARCIS (Netherlands)

    R.A. Douma; J.B.F. Kessels; H.R. Büller; V.E.A. Gerdes

    2010-01-01

    Background: In patients with suspected pulmonary embolism (PE), an unlikely or non-high probability assessment combined with a normal D-dimer test can safely exclude the diagnosis. We studied the influence of early D-dimer knowledge on clinical probability assessment. Methods: A questionnaire was se

  6. Diagnosing pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Khosla Rahul

    2006-01-01

    Full Text Available Pulmonary embolism (PE is a common, treatable, highly lethal emergency, which despite advances in diagnostic testing, remains an under diagnosed killer. The mortality rate of diagnosed and treated pulmonary embolism ranges from 3-8%, but increases to about 30% in untreated pulmonary embolism. PE is a part of the spectrum of venousthromboembolic disease and most pulmonary emboli have their origin from clots in the iliac, deep femoral, or popliteal veins. Nonspecific clinical signs and symptoms with low sensitivity and specificity of routine tests such as arterial blood gas, chest roentgenogram and electrocardiogram make the diagnosis of PE very challenging for the clinician. Pulmonary angiography is the gold standard diagnostic test, but this technique is invasive, expensive, not readily available and labor intensive. Diagnostic strategies have revolved around establishing clinical probabilities based on predictive models, then ruling in or ruling out the diagnosis of PE with various tests. The aim of this article was to review the literature and present an evidence- based medicine approach to diagnosis of pulmonary embolism.

  7. 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.

  8. METABOLIC DISORDERS AND PULMONARY EMBOLISM

    Directory of Open Access Journals (Sweden)

    O. Ya. Vasiltseva

    2015-12-01

    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

  9. Computed tomography densitometry of the lung: a method to assess perfusion defects in acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Groell, Reinhard E-mail: reinhard.groell@kfunigraz.ac.at; Peichel, Karl H.; Uggowitzer, Martin M.; Schmid, Ferdinand; Hartwagner, Karin

    1999-12-01

    Objective: To evaluate the potential of spiral computed tomography (CT) densitometry of the lung to assess segmental perfusion defects in patients with acute pulmonary embolism. Materials and Methods: Ten patients with known segmental or lobar perfusion defects on ventilation/perfusion scintigraphy and with normal findings in the contralateral lung segment underwent spiral CT of the thorax before and after the administration of contrast material. Regions of interest were defined in 14 segments with normal perfusion and in 14 segments with reduced perfusion. Three consecutive densitometry measurements were performed in each segment. Results: Those segments with reduced perfusion showed a significantly lower mean CT value on the enhanced scans (-813.4{+-}57.1 Hounsfield units (HU) vs -794.0{+-}44.8 HU, P=0.01) and a significantly decreased contrast enhancement (12.3{+-}18.2 HU vs 29.8{+-}16.6 HU, P<0.01) when compared to segments with normal perfusion. Measurements from the unenhanced CT scans were not statistically different between segments with reduced and normal perfusion. Conclusions: Spiral CT densitometry allows the assessment of at least segmental perfusion defects in patients with acute pulmonary embolism.

  10. PULMONARY EMBOLISM: DIAGNOSIS BY FOUNDATIONS

    OpenAIRE

    Грабовський, Ю. В.

    2015-01-01

    Pulmonary embolism (PE) – this obstruction pulmonary arterial clot (embolus or) formed in the venous system, the right atrium and right ventricle of the heart, or other material that ended up in the pulmonary circulation (droplets of fat, bone marrow, tumor cells, air, parasites, fragments of catheters etc.), resulting in lung parenchyma preryvayetsya circulation. This leads to the development of hypertension, pulmonary circulation and compensated or decompensated pulmonary heart. This is one...

  11. Pulmonary embolism in adolescents

    Institute of Scientific and Technical Information of China (English)

    MA Qing-bian; YAO Wan-zhen; CHEN Jian-ming; GE Hong-xia; LI Shu; ZHENG Ya-an

    2012-01-01

    Background Pulmonary embolism (PE) is rare and seldom considered in adolescent patients; however it occurs with a greater frequency than is generally recognized,and it is a potentially fatal condition.The aim of the current study was to understand its epidemiology,clinical features and the cause of delay of its diagnosis in adolescents.Methods A retrospective analysis of nine adolescents with acute PE admitted to the Peking University Third Hospital over the past 16-year period was performed.The epidemiology,clinical features and risk factors of the adolescents were described and compared with those of adults and elderly patients.The time to diagnosis and misdiagnosed diseases were analyzed.Pretest probability of PE was assessed retrospectively by the Wells score and revised Geneva score.Results The incidence of PE was 43.6 per 100 000 hospitalized adolescents in our hospital.The incidence of PE in adolescents was much lower than that in adults and PE is diagnosed in about 1/50 of elderly people.The clinical features in adolescents were similar to those in adults.But fever and chest pain were more common in adolescents (P<0.05).The major risk factors included surgery,systemic lupus erythematosus (SLE),thrombocytopenia,long-term oral glucocorticoids and trauma.The mean diagnostic time was (7.8±8.4) days.Six cases had a delayed diagnosis.The mean delay time from symptom onset to diagnosis was (11.0±8.8) days.The time of presentation to diagnosis in patients initially admitted to the emergency department was less than one day,and was much shorter than the time in outpatients,(9.4±7.5) days.Most of the patients were initially misdiagnosed with a respiratory tract infection.Most patients' values of Wells score or revised Geneva score were in the moderate or high clinical probability categories; 88% by Well score vs.100% by revised Geneva score.Conclusions PE was seldom considered in the adolescent patients by physicians,especially outpatient physicians,so the

  12. [Pulmonary circulation in embolic pulmonary edema].

    Science.gov (United States)

    Sanotskaia, N V; Polikarpov, V V; Matsievskiĭ, D D

    1989-02-01

    The ultrasonic method was used in acute experiments on cats with open chest under artificial lung ventilation to obtain blood flow in low-lobar pulmonary artery and vein, the blood pressure in pulmonary artery, as well as the left atrial pressure in fat (olive oil) and mechanical (Lycopodium spores) pulmonary embolism. It is shown that pulmonary embolism produces the decrease in the blood flow in pulmonary artery and vein, the increase of the pressure in pulmonary artery and left atria, the increase of lung vessels resistance. The decrease is observed of systemic arterial pressure, bradycardia, and extrasystole. After 5-10 min the restoration of arterial pressure and heart rhythm occur and partial restoration of blood flow in pulmonary artery and vein. In many experiments the blood flow in vein outdoes that in the artery--it allows to suppose the increase of the blood flow in bronchial artery. After 60-90 min there occur sudden decrease of systemic arterial pressure, the decrease of the blood flow in pulmonary artery and vein. The pressure in pulmonary artery and resistance of pulmonary vessels remain high. Pulmonary edema developed in all animals. The death occurs in 60-100 min after the beginning of embolism. PMID:2923969

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  14. Out of hospital treatment of pulmonary embolism: guidance through risk assessment

    NARCIS (Netherlands)

    Agterof, M.J.

    2011-01-01

    The implementation of low-molecular-weight-heparine (LMWH) bridging therapy in the standard treatment of patients with nonmassive pulmonary embolism (PE), has led to high interests in the treatment of patients with PE on an outpatient basis. To enable outpatient treatment of these patients, it is of

  15. Acute pulmonary embolism following air travel

    OpenAIRE

    Ledermann, J. A.; Keshavarzian, Ali

    1983-01-01

    Three cases of pulmonary embolism following long air flight are described. There was no previous history of venous disease. The symptoms were transient in one and severe in two. The occurrence of pulmonary embolism immediately after air travel is emphasized.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Institute of Scientific and Technical Information of China (English)

    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.

  18. An unusual case of pulmonary embolism.

    Science.gov (United States)

    Khakural, Prabhat; Shrestha, Kajan R; Sapkota, Ranjan; Shrestha, Uttam K

    2015-01-01

    Pulmonary embolism carries a significant morbidity and mortality. Metastatic choriocarcinoma presenting as pulmonary embolism is a rare event. Here, we report a case of a 25-year-lady with a history of worsening shortness of breath for 4 months who was treated as a case of pneumonia and tuberculosis. Owing to the worsening condition, she had a contrast enhanced computed tomography (CECT) chest done and was diagnosed to have pulmonary embolism. She underwent pulmonary embolectomy. The histopathological examination of the embolus revealed it to be metastatic choriocarcinoma. She showed a good response to chemotherapy. Metastatic choriocarcinoma should be considered as a differential diagnosis in females presenting with pulmonary embolism. PMID:25687445

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

    Science.gov (United States)

    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.

  20. Use of /sup 81m/Kr for diagnosis of pulmonary embolism and for assessment of cerebral perfusion

    International Nuclear Information System (INIS)

    Continuous inhalation of krypton-81m provides functional images of pulmonary ventilation in multiple views. These can be obtained without cooperation on the part of the patient and in the same session on a technetium-99m perfusion scan. Multiple view ventilation-perfusion study is routinely used for the differential diagnosis of acute pulmonary disorders. In pulmonary embolism, multiple segmental defects on the perfusion scan are associated with a normal ventilation. Parenchymal lung disease and bronchitis share matching defects of both perfusion and ventilation. Continuous carotid infusion of /sup 81m/Kr affords an assessment of cerebral perfusion. The association of carotid infusion of /sup 81m/Kr in single-photon emission computerized tomography provides a tridimensional assessment of brain blood flow, which can be displayed in horizontal, sagittal, or frontal sections

  1. Acute pulmonary embolism: the clinical conundrum

    Institute of Scientific and Technical Information of China (English)

    WANG Zeng-li

    2012-01-01

    Despite important advances in the diagnosis and treatment of acute pulmonary embolism (APE),assessment of risk and appropriate management of patients remains a difficult task in clinical practice.In addition to hemodynamic instability and critically clinical condition,acute right ventricular dysfunction (RVD) is a major determinant of in-hospital outcomes.The purpose of this review is to discuss the results of these recent developments.Some outcome evaluation,clinical assessment,and therapeutic implications are also included.

  2. Patient management of pulmonary embolism

    International Nuclear Information System (INIS)

    This is the first article in a four-part continuing education series addressing patient care and the clinical management of disease. This series is not directed at nuclear medicine procedures themselves, but focuses on topics related to patients referred for nuclear medicine studies. After reading this article, the reader should be able to: 1) discuss the diagnosis of pulmonary embolism; and 2) discuss conventional versus thrombolytic approaches to therapy

  3. Clinical update on pulmonary embolism

    OpenAIRE

    Duru, Serap; Keleşoğlu, Arif; Ardıç, Sadık

    2013-01-01

    Pulmonary embolism (PE) is a major cause of cardiovascular mortality and financial burden that affects the community. The diagnosis of PE can be difficult because of the nonspecific symptoms, which include cough, dyspnea, hemoptysis and pleuritic chest pain. Hereditary and acquired risk factors are associated with PE. Incidence of PE is increasing, associated with the development in the diagnostic methods. Evidence-based algorithms can help clinicians diagnose PE. Serum D-dimer level, compute...

  4. Pulmonary embolism, part II: Management

    OpenAIRE

    Bĕlohlávek, Jan; Dytrych, Vladimír; Linhart, Aleš

    2013-01-01

    Acute pulmonary embolism (PE) bears a significant burden on health and survival. Rapid and accurate risk stratification and management are of paramount importance to ensure the highest quality of care. This present article summarizes currently available and emerging management strategies for the disease. The authors not only review current evidence regarding early therapy of acute PE, including supportive care, anticoagulation, thrombolysis, surgical and catheter-based treatment, but also the...

  5. Fat embolism syndrome and pulmonary microvascular cytology.

    Science.gov (United States)

    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.

  6. The diagnostic management of suspected pulmonary embolism

    OpenAIRE

    Nijkeuter, Mathilde

    2007-01-01

    Pulmonary embolism is a potentially fatal disease in which early recognition and institution of anticoagulant treatment can prevent mortality. The diagnostic tools available to establish whether a patient has a pulmonary embolism were limited to pulmonary angiography and ventilation-perfusion scintigraphy. Both tests have considerable limitations. Helical CT evolved as a new technique in diagnosing PE and gained widespread interest but has been implemented rapidly, without appropriate assessm...

  7. Diagnostic value of gas exchange tests in patients with clinical suspicion of pulmonary embolism

    OpenAIRE

    Prediletto, Renato; Miniati, Massimo; Tonelli, Lucia; Formichi, Bruno; Di Ricco, Giorgio; Marini, Carlo; Bauleo, Carolina; Allescia, Germana; Cocci, Franca; Monti, Simonetta; Pistolesi, Massimo; Giuntini, Carlo

    1999-01-01

    Objective: To assess the value of parameters derived from arterial blood gas tests in the diagnosis of pulmonary embolism. Method: We measured alveolar-arterial partial pressure of oxygen [P(A–a)O2] gradient, PaO2 and arterial partial pressure of carbon diaxide (PaCO2) in 773 consecutive patients with suspected pulmonary embolism who were enrolled in the Prospective Investigative Study of Acute Pulmonary Embolism. Diagnosis: The study design required pulmonary angiography in all patients with...

  8. Pulmonary Artery Cement Embolism after a Vertebroplasty

    Directory of Open Access Journals (Sweden)

    Anas Nooh

    2015-01-01

    Full Text Available Background Context. Vertebroplasty is a minimally invasive procedure most commonly used for the treatment of vertebral compression fractures. Although it is relatively safe, complications have been reported over time. Among those complications, massive cement pulmonary embolism is considered a rare complication. Here we report a case of massive diffuse cement pulmonary embolism following percutaneous vertebroplasty for a vertebral compression fracture. Study Design. Case report. Methods. This is a 70-year-old female who underwent vertebroplasty for T11 and T12 vertebral compression fracture. Results. CT-scan revealed an incidental finding of cement embolism in the pulmonary trunk and both pulmonary arteries. Since the patient was asymptomatic, she was monitored closely and she did not need any intervention. Conclusion. Vertebroplasty is a minimally invasive procedure used for treatment of vertebral compression fracture. Despite the low rate of complications, a pulmonary cement embolism can occur. The consequences of cement embolism range widely from being asymptomatic to embolism that can cause paralysis, radiculopathy, or a fatal pulmonary embolism.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  10. Recent advances of ventilation-perfusion scintigraphy in clinical diagnosis and interventional treatment of pulmonary embolism

    International Nuclear Information System (INIS)

    Ventilation-perfusion scintigraphy can reflect the pulmonary function of ventilation and perfusion, then, indirectly assess the distribution of embolism. This technique is especially valuable in evaluating hemodynamic stability in patients with suspected pulmonary embolism. Ventilation-perfusion scintigraphy is superior to other imaging means in clinical practice as it is non-invasive and carries high specificity in detecting sub-segmental embolism. Furthermore, the advantages of interventional therapy are of significant clinical value in treating pulmonary embolism. This paper aims to make a comprehensive review for the ventilation-perfusion scintigraphy diagnosis, as well as the interventional treatment, of pulmonary embolism. (authors)

  11. Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)

    International Nuclear Information System (INIS)

    To determine the sensitivities and specificities of ventilation/perfusion lung scans for acute pulmonary embolism, a random sample of 933 of 1,493 patients was studied prospectively. Nine hundred thirty-one underwent scintigraphy and 755 underwent pulmonary angiography; 251 (33%) of 755 demonstrated pulmonary embolism. Almost all patients with pulmonary embolism had abnormal scans of high, intermediate, or low probability, but so did most without pulmonary embolism. Of 116 patients with high-probability scans and definitive angiograms, 102 (88%) had pulmonary embolism, but only a minority with pulmonary embolism had high-probability scans. Of 322 with intermediate-probability scans and definitive angiograms, 105 (33%) had pulmonary embolism. Follow-up and angiography together suggest pulmonary embolism occurred among 12% of patients with low-probability scans. Clinical assessment combined with the ventilation/perfusion scan established the diagnosis or exclusion of pulmonary embolism only for a minority of patients--those with clear and concordant clinical and ventilation/perfusion scan findings

  12. CT for Assessment of Thrombosis and Pulmonary Embolism in Multiple Stages of Single-Ventricle Palliation: Challenges and Suggested Protocols.

    Science.gov (United States)

    Ghadimi Mahani, Maryam; Agarwal, Prachi P; Rigsby, Cynthia K; Lu, Jimmy C; Fazeli Dehkordy, Soudabeh; Wright, Robyn A; Dorfman, Adam L; Krishnamurthy, Rajesh

    2016-01-01

    The total cavopulmonary connection (TCPC), or Fontan procedure, diverts systemic venous blood directly into the pulmonary arteries and is the palliative surgery of choice for patients with a wide variety of congenital heart diseases with single-ventricle physiologic characteristics. Pulmonary embolism and thrombosis are known complications and are among the major causes of morbidity and mortality in patients after TCPC. Magnetic resonance (MR) imaging is usually performed for postoperative evaluation of patients after single-ventricle repair; however, screening for thrombosis or embolism with MR imaging is not always feasible because of the emergent nature of the clinical presentation or because of artifacts from metallic devices or coils. Computed tomographic (CT) angiography is an effective method for diagnosing pulmonary embolism in children. However, because of altered hemodynamics after single-ventricle palliation, there are unique challenges in achieving optimal opacification of the pulmonary arteries and Fontan circuit that can result in nondiagnostic CT angiographic studies or erroneous image interpretation. Radiologists should be familiar with the multiple stages of single-ventricle palliation, understand the technique for performing pulmonary CT angiography at each stage, and recognize common pitfalls in obtaining and interpreting pulmonary CT angiographic images in patients who have undergone single-ventricle repair. Online supplemental material is available for this article. (©)RSNA, 2016. PMID:27618316

  13. Acute pulmonary embolism in helical computed tomography

    International Nuclear Information System (INIS)

    Pulmonary embolism is a common condition in which diagnostic and therapeutic delays contribute to substantial morbidity and mortality. Clinical diagnosis is difficult because the signs and symptoms re unspecific, and a differential diagnosis is extensive, including pneumonia or bronchitis, asthma, myocardial infraction, pulmonary edema, anxiety, dissection of the aorta, pericardial tamponade, lung cancer, primary pulmonary hypertension, rib fracture, and pneumothorax. The purpose of the study was to present the use of CT in diagnosing acute pulmonary embolism. A group of 23 patients with clinically suspected pulmonary embolism underwent CT examination with a helical CT scanner (Somatom Emotion, Siemens) before and after administration of 150 ml of Ultravist. Pulmonary embolism was found in the CT examinations of 13 patients. In two of these it was a central filling defect. Amputation of the artery was found in one. Parietal filling defect in three patients formed an acute angle with the vessel walls. Saddle emboli appearing as filling defects in the contrast column that hung over vessel bifurcations was found in two patients. In five patients,emboli were found in small segmental arteries. CT provides information not only on the pulmonary arteries, but also on the lung parenchyma, hila, mediastinum, and the heart. Alternative findings may be identified by CT chest examination, stablishing alternative diagnoses, including pulmonary disorders (such as pneumonia or fibrosis), pleural abnormalities, and cardiovascular disease (such as aortic dissection or pericardial tamponade). Another advantage of the CT is its widespread availability.(author)

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

    Science.gov (United States)

    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.

  15. Pulmonary Embolism with Vertebral Augmentation Procedures

    Directory of Open Access Journals (Sweden)

    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.

  16. Dermatomyositis masquerading as pulmonary embolism

    Directory of Open Access Journals (Sweden)

    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.

  17. Neural Hypernetwork Approach for Pulmonary Embolism diagnosis

    CERN Document Server

    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...

  18. Screening for pulmonary embolism with a D-dimer assay: do we still need to assess clinical probability as well?

    OpenAIRE

    Hammond, Christopher J; Hassan, Tajek B.

    2005-01-01

    Clinical risk stratification and D-dimer assay can be of use in excluding pulmonary embolism in patients presenting to emergency departments but many D-dimer assays exist and their accuracy varies. We used clinical risk stratification combined with a quantitative latex-agglutination D-dimer assay to screen patients before arranging further imaging if required. Retrospective analysis of a sequential series of 376 patients revealed that no patient with a D-dimer of

  19. 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

  20. Perfusion visualization and analysis for pulmonary embolism

    Science.gov (United States)

    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.

  1. When a pulmonary embolism is not a pulmonary embolism: a rare case of primary pulmonary leiomyosarcoma

    Directory of Open Access Journals (Sweden)

    Nargiz Muganlinskaya

    2015-12-01

    Full Text Available Arterial leiomyosarcomas account for up to 21% of vascular leiomyosarcomas, with 56% of arterial leiomyosarcomas occurring in the pulmonary artery. While isolated cases of primary pulmonary artery leiomyosarcoma document survival up to 36 months after treatment, these uncommon, aggressive tumors are highly lethal, with 1-year survival estimated at 20% from the onset of symptoms. We discuss a rare case of a pulmonary artery leiomyosarcoma that was originally diagnosed as a pulmonary embolism (PE. A 72-year-old Caucasian female was initially diagnosed with ‘saddle pulmonary embolism’ based on computerized tomographic angiography of the chest 2 months prior to admission and placed on anticoagulation. Dyspnea escalated, and serial computed tomography scans showed cardiomegaly with pulmonary emboli involving the right and left main pulmonary arteries with extension into the right and left upper and lower lobe branches. An echocardiogram on admission showed severe pulmonary hypertension with a pulmonary artery pressure of 82.9 mm Hg, and a severely enlarged right ventricle. Respiratory distress and multiorgan failure developed and, unfortunately, the patient expired. Autopsy showed a lobulated, yellow mass throughout the main pulmonary arteries measuring 13 cm in diameter. The mass extended into the parenchyma of the right upper lobe. On microscopy, the mass was consistent with a high-grade primary pulmonary artery leiomyosarcoma. Median survival of patients with primary pulmonary artery leiomyosarcoma without surgery is one and a half months, and mortality is usually due to right-sided heart failure. Pulmonary artery leiomyosarcoma is a rare but highly lethal disease commonly mistaken for PE. Thus, we recommend clinicians to suspect this malignancy when anticoagulation fails to relieve initial symptoms. In conclusion, early detection and suspicion of pulmonary artery leiomyosarcoma should be considered in patients refractory to anticoagulation

  2. 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) The ...... and may be life-saving in patients with cardiac arrest suspected to be caused by pulmonary embolism.......) The importance of optimal anticoagulant treatment in the prevention of pulmonary embolism reoccurrence. (2) The benefit of immediate accessibility to echocardiography in the handling of haemodynamically unstable patients with an unknown underlying cause. (3) Thrombolytic treatment should always be considered...

  3. Endovascular embolization of pulmonary arteriovenous malformations

    Institute of Scientific and Technical Information of China (English)

    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

  4. Echocardiography and pulmonary embolism severity index have independent prognostic roles in pulmonary embolism.

    Science.gov (United States)

    Sanchez, Olivier; Trinquart, Ludovic; Planquette, Benjamin; Couturaud, Francis; Verschuren, Franck; Caille, Vincent; Meneveau, Nicolas; Pacouret, Gérard; Roy, Pierre-Marie; Righini, Marc; Perrier, Arnaud; Bertoletti, Laurent; Parent, Florence; Lorut, Christine; Meyer, Guy

    2013-09-01

    We analysed a cohort of patients with normotensive pulmonary embolism (PE) in order to assess whether combining echocardiography and biomarkers with the pulmonary embolism severity index (PESI) improves the risk stratification in comparison to the PESI alone. The PESI was calculated in normotensive patients with PE who also underwent echocardiography and assays of cardiac troponin I and brain natriuretic peptide. 30-day adverse outcome was defined as death, recurrent PE or shock. 529 patients were included, 25 (4.7%, 95% CI 3.2-6.9%) had at least one outcome event. The proportion of patients with adverse events increased from 2.1% in PESI class I-II to 8.4% in PESI class III-IV, and to 14.3% in PESI class V (p<0.001). In PESI class I-II, the rate of outcome events was significantly higher in patients with abnormal values of biomarkers or right ventricular dilatation. In multivariate analysis, the PESI (class III-IV versus I-II, OR 3.1, 95% CI 1.2-8.3; class V versus I-II, OR 5.5, 95% CI 1.5-25.5 and echocardiography (right ventricular/left ventricular ratio, OR (for an increase of 0.1) 1.3, 95% CI 1.1-1.5) were independent predictors of an adverse outcome. In patients with normotensive PE, biomarkers and echocardiography provided additional prognostic information to the PESI. PMID:23258789

  5. Ventilation-perfusion studies and the diagnosis of pulmonary embolism: concise communication

    International Nuclear Information System (INIS)

    Various diagnostic strategies for the assessment of pulmonary embolism were developed using the results of scintigraphic examinations in 169 patients who had both scintigraphic studies and pulmonary angiography. Likelihood ratios for several perfusion and ventilation-perfusion patterns were first obtained, and Bayes' Theorem was then applied using a range of prior probabilities for pulmonary embolism. Resulting posterior probabilities ranged from under 10% to over 90%. The former values held for patients with small perfusion defects and no ventilation study, regardless of their prior probabilities for pulmonary embolism. The latter values held for patients with average to high prior probabilities and ventilation-perfusion mismatches

  6. 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

  7. Lung cancer mimicking massive pulmonary embolism

    OpenAIRE

    Kaier, Thomas Edward; Madani, Yasser

    2012-01-01

    Pulmonary embolism (PE) is a common finding in patients with underlying malignancy and is the commonest cause of acute cor pulmonale. A 65-year-old woman with a background of non-small-cell lung cancer presented to the emergency department with nausea and vomiting after starting erlotinib; she was pyrexial and had raised C-reactive protein. Despite aggressive fluid resuscitation and antibiotics the patient remained tachycardic, hypotensive, profoundly hypoxic and had a persistent raised jugul...

  8. Neural Hypernetwork Approach for Pulmonary Embolism diagnosis

    OpenAIRE

    Rucco, Matteo; Sousa-Rodriges, David; Merelli, Emanuela; Johnson, Jeffrey H.; Falsetti, Lorenzo; Nitti, Cinzia; Salvi, Aldo

    2014-01-01

    Background Hypernetworks are based on topological simplicial complexes and generalize the concept of two-body relation to many-body relation. Furthermore, Hypernetworks provide a significant generalization of network theory, enabling the integration of relational structure, logic and analytic dynamics. A pulmonary embolism is a blockage of the main artery of the lung or one of its branches, frequently fatal. Results Our study uses data on 28 diagnostic features of 1427 people consid...

  9. Plasma cross linked fibrin degradation products in pulmonary embolism.

    OpenAIRE

    Rowbotham, B J; Egerton-Vernon, J; Whitaker, A. N.; Elms, M J; Bunce, I H

    1990-01-01

    Plasma concentrations of cross linked fibrin degradation products, a marker of intravascular thrombosis and fibrinolysis, were measured in 495 patients with suspected pulmonary embolism referred for ventilation-perfusion lung scanning to determine whether concentrations are increased in pulmonary embolism and their potential use in diagnosis. Lung scans were described as normal (n = 66) or as showing a low (n = 292), indeterminate (n = 58), or high probability (n = 79) of pulmonary embolism. ...

  10. Deep vein thrombosis and pulmonary embolism in the Chinese population

    OpenAIRE

    Nandi, PL; Li, WS; Leung, R.; Chan, HT; Chan, J

    1998-01-01

    Deep vein thrombosis and pulmonary embolism is a well-recognised major health problem in the West. There is a deep-rooted belief among clinicians that deep vein thrombosis is rare in Asians, particularly in the Chinese population. However, it appears that the incidence of venous thrombosis and pulmonary embolism is increasing in Chinese patients. Prophylaxis reduces the incidence of venous thrombosis by 66% and of pulmonary embolism by 50%Ը? prophylaxis should therefore be considered for Chin...

  11. Lung scan perfusion defects limited to matching pleural effusions: low probability of pulmonary embolism

    International Nuclear Information System (INIS)

    Patients with a new pleural effusion are often sent for a ventilation-perfusion scan to exclude a pulmonary embolism. This retrospective study assessed the probability of pulmonary embolism when a pleural effusion and a perfusion defect of similar size are the only significant imaging abnormalities. In 451 reports of patients who were scanned for suspected pulmonary embolism, 53 had perfusion defects secondary to pleural effusion without other significant perfusion defects. Using pulmonary angiography, venography, analysis of pleural fluid, clinical course, and other radiographic and laboratory studies to establish the final diagnosis, only two patients had documented venous thrombotic disease: one had pulmonary emboli, the other thrombophlebitis. Lung scans having significant perfusion defects limited to pleural effusions and matching them in size have a low probability for pulmonary embolism

  12. SPECT/CT and pulmonary embolism

    OpenAIRE

    Mortensen, Jann; Gutte, Henrik

    2013-01-01

    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 i...

  13. Radionuclide venography of the lower limbs in pulmonary embolism

    International Nuclear Information System (INIS)

    In 62 unselected patients affected by pulmonary embolism, radionuclide venography of the lower limbs was performed in order to detect the source of the emboli. Vascular obstruction were found in the deep veins in 13 cases, in the superficial veins in another 13, while in 3 patients both veneous systems were affected. These results suggest that a relationship between superficial vein thrombosis and pulmonary embolism exists. Radionuclide venography allowed us to detect venous obstruction in 6 out of 15 patients with pulmonary embolism but without both anamnesic and clinical evidence of venous thrombosis; hence, this technique may be useful in all cases of pulmonary embolism of unknown origin

  14. Pulmonary embolism and cor pulmonale in a cat

    International Nuclear Information System (INIS)

    A 14-year-old male neutered cat experienced pulmonary embolism 15 days following surgical debridement of a recurrent dorsolumbar abscess. Clinical signs were dominated by respiratory distress. Pulmonary embolism was suggested from the lateral thoracic radiograph by the presence of an abruptly attenuated lobar artery and a contiguous oligaemic area in the caudal lung lobe. Pulmonary hypertension was demonstrated on Doppler echocardiography by right pulmonary artery dilation and tricuspid regurgitation raising the pulmonary arterial pressure to 56 mmHg. Chronic pulmonary hypertension, assumed from right ventricular wall hypertrophy, and hypokinesia, indicating chronic cor pulmonale, was suggestive of chronic rather than acute pulmonary embolism. Postmortem histological evidence of pulmonary arteriolar occlusion confirmed the diagnosis of pulmonary embolism

  15. Pulmonary embolism: are we there yet?

    International Nuclear Information System (INIS)

    Clinical prediction rules (such as Wells model) are a reliable assessment tool for diagnostic work-up of suspected pulmonary embolism (PE). When used as part of a clinical algorithm and in combination with a D-Dimer, the model can safely exclude PE in low-risk groups and indicate when further investigations are unnecessary. The purpose of this study was to investigate the level of adherence to local diagnostic imaging guidelines for suspected PE and to ascertain the impact of interventions. Retrospective search of all patients referred from the Emergency Department (ED) of Royal Perth Hospital for computed tomography pulmonary angiography (CTPA) or V/Q scan between 11 September 2005 to 10 March 2006 (pre-intervention) and 1 January 2008 to 31 March 2008 (post-intervention) was conducted. The guidelines on ‘Diagnostic Imaging Pathways’ were considered as gold standard. Interventions included orienting ED doctors to guidelines and modified request forms for mandatory completion of Wells score. A prevalence- and bias-adjusted kappa (PABAK) score analysed the level of agreement between documentation on notes (R-score) and stamp (S-score). Thirty-five per cent (n = 187) and 22% (n = 109) deviated from the pathway pre-intervention and post-intervention, respectively (13% absolute reduction; P = 0.017). Stamp compliance was only 55% despite mandatory filling requirement. PABAK for ‘PE as most likely diagnosis’ was 0.25 for V/Q group and – 0.26 for CTPA. In addition, 44/60 (73%) had an intermediate or high S-score, yet only 11 of those 44 had a matched intermediate to high R-Score. Interventions reduced inappropriate practice but did not eliminate it completely. Compliance issues may be managed in the future via the introduction of electronic request linked to decision support.

  16. Comparative imaging study in experimental acute pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To evaluate the diagnostic characteristics of radionuclide pulmonary perfusion imaging, enhanced spiral computed tomography, and digital subtraction pulmonary angiography in acute experimental segmental pulmonary embolism (corresponding to human subsegmental pulmonary embolism). Methods: Acute pulmonary embolism model was established in thirteen Chinese small type pigs by injecting glutin embolus (the diameter of the embolus was 3.8 to 4.2 mm) into pulmonary artery via jugular vein, and then radionuclide pulmonary perfusion imaging, enhanced spiral computed tomography and digital subtraction pulmonary angiography were performed. The results of sensitivity and specificity of three kinds of imaging methods were compared with the pathological findings. Results: Out of 195 segmental pulmonary arteries, abnormalities were found in forty-six segmental pulmonary arteries by pathological study. Abnormalities were detected in fifty-one segmental pulmonary arteries by pulmonary perfusion imaging, with sensitivity of 87%, specificity 93%. Filling defect was demonstrated in forty-four segmental pulmonary arteries by enhanced spiral computed tomography, with sensitivity of 63%, specificity 89%. Abnormalities were displayed in forty-seven segmental pulmonary arteries by digital subtraction pulmonary angiography, with sensitivity of 98%, specificity 99%. Pulmonary perfusion imaging was superior to enhanced spiral computed tomography (P0.05). Conclusions: Pulmonary perfusion imaging is a noninvasive technique for diagnosis of pulmonary embolism which is superior to enhanced spiral computed tomography in detecting of experimental acute segmental pulmonary embolism (corresponding to human subsegmental pulmonary embolism), but the localization of embolus is more accurate by enhanced spiral computed tomography. Combination of three kinds of imaging methods may significantly improve the diagnostic accuracy for pulmonary embolism

  17. How Is Pulmonary Embolism Diagnosed?

    Science.gov (United States)

    ... are available shortly after the scan is done. Lung Ventilation/Perfusion Scan A lung ventilation/perfusion scan , or VQ scan, uses a radioactive substance to show how well oxygen and blood are flowing to all areas of your lungs. This test can help detect PE. Pulmonary Angiography ...

  18. Lung ventilation-perfusion scintigraphy in pulmonary embolism

    International Nuclear Information System (INIS)

    In 53 patients with possible pulmonary embolism, pulmonary abnormalities of 133Xe ventilation and 99Tcsup(m) albumin microsphere perfusion scintigraphy were compared with absence or presence of pulmonary emboli documented by concurrent pulmonary angiography. It was found that patients with combined scintigraphy considered as unlikely for pulmonary embolism (ventilation defect larger than perfusion defect) or indicative of pulmonary embolism (ventilation defect smaller than perfusion defect) provide high diagnostic specificity. Patients with equal ventillation-perfusion abnormalities (possible pulmonary embolism) require further evaluation by pulmonary angiography to ascertain diagnosis. Importantly, diagnostic accuracy, using ventilation-perfusion scintigraphy and the quantified method of evaluation delineated, is preserved in patients with severe congestive heart failure. (Auth.)

  19. 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...

  20. 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...

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

    Directory of Open Access Journals (Sweden)

    Nishant Sinha

    2015-01-01

    Full Text Available 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.

  2. Alteration in pulmonary perfusion due to iatrogenic pulmonary vein stenosis: A mimicker of pulmonary embolism

    OpenAIRE

    Ostwani, Wesam; Arabi, Mohammad

    2011-01-01

    Iatrogenic pulmonary vein stenosis (PVS) is a known, yet rare, complication of atrial radiofrequency ablation. Alterations in pulmonary perfusion may mimic massive pulmonary embolism on a ventilation/perfusion (V/Q) scintigraphy. This is particularly important due to the overlap in presenting clinical symptoms. The present case illustrates the functional significance of PVS and the changes in perfusion in response to angioplasty.

  3. Pulmonary embolism. A case report

    Directory of Open Access Journals (Sweden)

    Pedro J. Barrios Fuentes

    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.

  4. Cross sectional Doppler echocardiography as the initial technique for the diagnosis of acute pulmonary embolism.

    OpenAIRE

    Cheriex, E. C.; Sreeram, N.; Eussen, Y F; Pieters, F A; Wellens, H J

    1994-01-01

    OBJECTIVE--To determine the value of cross sectional Doppler echocardiography and derived indices of right ventricular pressure and function in the initial diagnosis of pulmonary embolism. BACKGROUND--Most deaths from acute pulmonary embolism occur because of a delay in diagnosis. Ventilation-perfusion scans are not sufficiently sensitive, whereas angiography is invasive and associated with complications. The use of cross sectional Doppler echocardiography to assess acute changes in right ven...

  5. 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)

  6. 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.

  7. A comparative analysis of pulmonary ventilation-perfusion imaging with pulmonary angiography in the diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To assess the value of ventilation-perfusion imaging in the diagnosis of pulmonary embolism (PE). Methods: Thirty consecutive patients with clinically suspected pulmonary embolism were studied, male: female 15:15, mean age was (36.2 +- 13.9) years. The chest radiograms were obtained in all 30 patients. All patients underwent radionuclide ventilation-perfusion imaging and pulmonary angiography. Results: Of the 30 patients, 22 with lobe, multiple segment or multi-subsegment perfusion defects and normal or nearly normal ventilation images were reported as PE. 20 of them were confirmed to be with PE by pulmonary angiography, 2 patients were not confirmed. Eight of 30 patients with multiple perfusion defects, ventilative abnormalities were reported as non-PE and the diagnoses were confirmed by pulmonary angiography. The sensitivity, specificity and accuracy of diagnosis of PE by ventilation-perfusion imaging was 100%, 80.0% and 93.3% respectively. Conclusions: (1) Ventilation-perfusion imaging is one of the most valuable methods in the diagnosis of PE. (2) The results suggest that pulmonary embolism can be diagnosed non-invasively in most patients on the basis of clinical manifestation, chest radiograms and ventilation-perfusion imaging findings. (3) Pulmonary angiography is required while clinical manifestation and ventilation-perfusion imaging findings are discordant with each other

  8. 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.)

  9. Comparative diagnostic value of pulmonary perfusion and ventilation scintigraphy and angiopneumography in pulmonary embolism

    International Nuclear Information System (INIS)

    Fourty-six patients suspected clinically of having a pulmonary embolism (PE) were investigated by angiopneumography (AGP) and perfusion (99m-Tc aggregates) and ventilation (99m-Tc colloid) scintigraohy (SPV Tc). Findings were assessed under blind conditions. A positive diagnosis of pulmonary embolism was made in 19 patients. The SPV Tc was considered as positive if perfusional deficiencies were greater than ventilatory defects, and this was evaluated as such in 23 cases (19 true and 4 false positives). False negatives were not observed. The 4 false positive results corresponded to scintigraphic anomalies suggestive of pulmonary emboli subsegmental in size; true positives were either subsegmental (8), segmental (6) or lobar (5). Sensitivity of the SPV Tc was therefore 100 %; its specificity, all results considered was 76 %, but was 100 % if only images of lobar or segmental lesions are considered

  10. Evaluation of meteorological and epidemiological characteristics of fatal pulmonary embolism

    Science.gov (United States)

    Törő, Klára; Pongrácz, Rita; Bartholy, Judit; Váradi-T, Aletta; Marcsa, Boglárka; Szilágyi, Brigitta; Lovas, Attila; Dunay, György; Sótonyi, Péter

    2016-03-01

    The objective of the present study was to identify risk factors among epidemiological factors and meteorological conditions in connection with fatal pulmonary embolism. Information was collected from forensic autopsy records in sudden unexpected death cases where pulmonary embolism was the exact cause of death between 2001 and 2010 in Budapest. Meteorological parameters were detected during the investigated period. Gender, age, manner of death, cause of death, place of death, post-mortem pathomorphological changes and daily meteorological conditions (i.e. daily mean temperature and atmospheric pressure) were examined. We detected that the number of registered pulmonary embolism (No 467, 211 male) follows power law in time regardless of the manner of death. We first described that the number of registered fatal pulmonary embolism up to the nth day can be expressed as Y( n) = α ṡ n β where Y denotes the number of fatal pulmonary embolisms up to the nth day and α > 0 and β > 1 are model parameters. We found that there is a definite link between the cold temperature and the increasing incidence of fatal pulmonary embolism. Cold temperature and the change of air pressure appear to be predisposing factors for fatal pulmonary embolism. Meteorological parameters should have provided additional information about the predisposing factors of thromboembolism.

  11. 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.)

  12. 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.

  13. SPECT/CT and pulmonary embolism.

    Science.gov (United States)

    Mortensen, Jann; Gutte, Henrik

    2014-05-01

    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 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. PMID:24213621

  14. 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.

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

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Endovascular embolization through pulmonary artery access for refractory massive hemoptysis

    International Nuclear Information System (INIS)

    Objective: To determine the effectiveness of endovascular embolization through pulmonary artery access in patients with refractory massive hemoptysis in whom systemic artery (SA) embolization is ineffective or contraindicated. Methods: A total of 102 patients were treated with SA embolization for hemoptysis. Of the 102 patients,6 patients had severe persistent hemoptysis despite complete SA embolization and 1 patient had severe hemoptysis following complete bronchial artery embolization and other SA embolization was contraindicated. The underlying diseases were chronic cavitary pulmonary tuberculosis (n=3), chronic cavitary pulmonary tuberculosis complicated with aspergilloma (n=1), tuberculous bronchiectasis (n=1), severe necrotizing pneumonia (n=1) and bronchiectasis complicated with pneumatocele (n=1). The findings of SA angiography, main pulmonary angiography and selective pulmonary angiography were analyzed. Endovascular embolization was performed in patients with the detectable pathology in PA and the clinical results were observed. Results: The findings of SA angiography showed bronchopulmonary shunting in all cases, and pseudoaneurysm of PA in 2 cases and hypertrophy of peripheral PA in 2 cases. The main PA angiography demonstrated pseudoaneurysm of PA in 1 case and hypoperfusion of the diseased PA in other case. The selective PA angiography demonstrated pseudoaneurysm of PA in 4 cases (1 case with extravasation of contrast medium) and hypertrophy of peripheral PA in 2 cases. Coil embolization of the pathologic PA were successfully performed and bleeding ceased in all patients. During follow-up, 1 patient had episodic bloody sputum after embolization, and 2 died day 6 and 15 of severe infection and respiratory failure and the remaining patients were all stable, Conclusions: In patients with refractory massive hemoptysis after systemic embolization, the possibility of PA pathology, especially pseudoaneurysm of PA should be considered. Selective pulmonary

  18. 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.

  19. Follow-up of pulmonary perfusion recovery after embolism

    International Nuclear Information System (INIS)

    Blood flow recovery in a group of 69 patients with pulmonary embolism was followed by serial lung scans over a six month period. Each patient underwent perfusion lung scan at diagnosis then 7, 30 and 180 days later; i.v. heparin was systematically administered for one week after diagnosis, followed by oral warfarin for six months. Blood flow impairment was evaluated by assessing the total number of unperfused lung segments (ULS), as calculated on both lateral views at each scan. The number of ULS was significantly reduced at each interval (P<0.001), ranging from 8.4±3.3 at diagnosis to 3.6±2.7 six months later; most of the recovery (79%) occurred within the first month. No patient had complete restoration of pulmonary blood flow during the whole follow-up period. No difference was found between the number of ULS in right lung versus that in left lung at each interval. Recovery of blood flow was heavily affected by coexisting cardiac or pulmonary disease. In fact, those patients with underlying cardiopulmonary disease (49.2% of the total) showed significantly smaller perfusion improvement after six months (P<0.001). Eight patients (6 with and 2 without cardiopulmonary disease) had clinical and scintigraphic evidence of recurrent embolism during the follow-up period

  20. Fibrinolysis for patients with intermediate-risk pulmonary embolism

    OpenAIRE

    Meyer, Guy; Vicaut, Eric; Danays, Thierry; Agnelli, Giancarlo; Becattini, Cecilia; Beyer-Westendorf, Jan; Bluhmki, Erich; Bouvaist, Helene; Brenner, Benjamin; Couturaud, Francis; Dellas, Claudia; Empen, Klaus; Franca, Ana; Galiè, Nazzareno; Geibel, Annette

    2014-01-01

    BACKGROUND The role of fibrinolytic therapy in patients with intermediate-risk pulmonary embolism is controversial. METHODS In a randomized, double-blind trial, we compared tenecteplase plus heparin with placebo plus heparin in normotensive patients with intermediate-risk pulmonary embolism. Eligible patients had right ventricular dysfunction on echocardiography or computed tomography, as well as myocardial injury as indicated by a positive test for cardiac troponin I or troponin ...

  1. Evolving imaging techniques in diagnostic strategies of pulmonary embolism.

    Science.gov (United States)

    Robert-Ebadi, Helia; Le Gal, Grégoire; Righini, Marc

    2016-04-01

    Modern non invasive diagnostic strategies for pulmonary embolism (PE) rely on the sequential use of clinical probability assessment, D-dimer measurement and thoracic imaging tests. Planar ventilation/perfusion (V/Q) scintigraphy was the cornerstone for more than two decades and has now been replaced by computed tomography pulmonary angiography (CTPA). Diagnostic strategies using CTPA are very safe to rule out PE and have been well validated in large prospective management outcome studies. With the widespread use of CTPA, concerns regarding radiation and overdiagnosis of PE have paved the way for investigating new diagnostic modalities. V/Q single photon emission tomography has arisen as a highly accurate test and a potential alternative to CTPA. However, prospective management outcome studies are still lacking and are warranted before implementation in everyday clinical practice. PMID:26691634

  2. 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.

  3. Negative spiral CT in acute pulmonary embolism

    International Nuclear Information System (INIS)

    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

  4. 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.)

  5. The role of lung imaging in pulmonary embolism

    Science.gov (United States)

    Mishkin, Fred S.; Johnson, Philip M.

    1973-01-01

    The advantages of lung scanning in suspected pulmonary embolism are its diagnostic sensitivity, simplicity and safety. The ability to delineate regional pulmonary ischaemia, to quantitate its extent and to follow its response to therapy provides valuable clinical data available by no other simple means. The negative scan effectively excludes pulmonary embolism but, although certain of its features favour the diagnosis of embolism, the positive scan inherently lacks specificity and requires angiographic confirmation when embolectomy, caval plication or infusion of a thrombolytic agent are contemplated. The addition of simple ventilation imaging techniques with radioxenon overcomes this limitation by providing accurate analog estimation or digital quantitation of regional ventilation: perfusion (V/Q) ratios fundamental to understanding the pathophysiologic consequences of embolism and other diseases of the lung. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7p495-bFig. 8Fig. 9Fig. 10Fig. 11Fig. 12Fig. 13 PMID:4602128

  6. Multiple myeloma with pulmonary embolism: a case report

    Institute of Scientific and Technical Information of China (English)

    YING Ke-jing; ZHOU Yong; JIANG Hao; CHEN En-guo; ZHOU Pan

    2006-01-01

    @@ We report a rare case of a patient who died suddenly, in whom bilateral pulmonary artery thrombosis with multiple myeloma was found at autopsy. An estimate of the incidence of pulmonary embolism in myeloma patients based on postmortem examinations is about 3.2%. Hypercoagulability and decreased fibrinolytic capacity due to multiple myeloma were the probable causes of multiple thromboses.

  7. Single-perfusion defect and pulmonary embolism

    International Nuclear Information System (INIS)

    One hundred thirty-three ventilation-perfusion scans with angiographic correlation were retrospectively reviewed in a double-blind study to evaluate the frequency of pulmonary embolism (PE) in single perfusion defects (SPDs) regardless of ventilation or chest radiographic abnormalities. Of 28 SPDs, PE was present in 46% (13 cases). Ten of 13 SPDs were located in the basal segments of the right lower lobe, one in the right middle lobe, and two in the left lower lobe, seven of 13 patients had undergone recent surgery. in contrast, in the non-PE group, seven of 15 SPDs were in the right lung and eight in the left lower lobe, only one of 15 patients had undergone recent surgery. In ten of 13 PE and ten of 15 non-PE cases, the ventilation-perfusion and chest radiographic findings showed matching abnormalities. Two of six cases with ventilation-perfusion mismatch had PE and abnormal radiographs. One of two cases with ventilation-perfusion match and normal radiographs had PE

  8. 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.

  9. Combination of clinical and v/q scan assessment for the diagnosis of pulmonary embolism: a 2-year outcome prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Barghouth, G.; Boubaker, A.; Delaloye, A.B. [Univ. Hospital, Lausanne (Switzerland). Dept. of Nuclear Medicine; Yersin, B. [Dept. of Internal Medicine, Univ. Hospital, Lausanne (Switzerland); Doenz, F.; Schnyder, P. [Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland). Dept. of Radiology

    2000-09-01

    With the aim of evaluating the efficiency of our diagnositc approach in patients with suspected acute pulmonary embolism (PE), we prospectively studied 143 patients investigated by means of a ventilation/perfusion (V/Q) lung scan. A pre-test clinical probability of PE (P{sub clin}) was assigned to all patients by the clinicians and scans were interpreted blinded to clinical assessment. A 2-year follow-up of our patients was systematically performed and possible in 134 cases. Distribution of clinical probabilities was high P{sub clin} in 22.5%, intermediate P{sub clin} in 24% and low P{sub clin} in 53.5%, whereas the distribution of scan categories was high P{sub scan} in 14%, intermediate P{sub scan} in 18%, low P{sub scan} in 57% and normal P{sub scan} in 11%. The final prevalence of PE was 24.5%. High P{sub scan} and normal P{sub scan} were always conclusive (19 and 15 cases respectively). Low P{sub scan} associated with low P{sub clin} could exclude PE in 43/45 cases (96%). Noe of the patients in whom the diagnosis of PE was discarded had a major event related to PE during the 2-year follow-up. Overall, the combined assessment of clinical and scintigraphic probabilities allowed confirmation or exclusion of PE in 80% of subjects (107/134) and proved to be a valuable tool for selecting patients who needed pulmonary angiography, which was required in 20% of our patients (27/134). (orig.)

  10. Lung scintigraphy and helical computed tomography for the diagnosis of pulmonary embolism : A meta-analysis

    NARCIS (Netherlands)

    van Beek, EJR; Brouwers, EMJ; Song, B; Bongaerts, AHH; Oudkerk, M

    2001-01-01

    To assess the diagnostic value of lung scintigraphy and helical computed tomography (hCT) in patients with suspected pulmonary embolism (PE), all English-language articles that described lung scintigraphy and hCT in patients with suspected PE were retrieved. Articles were assessed for strength of me

  11. Diagnosis of atypical subsegmental pulmonary embolism using pulmonary ventilation/perfusion imaging

    International Nuclear Information System (INIS)

    Objective: Pulmonary ventilation/perfusion (V/Q) imaging was used in the diagnosis of atypical subsegmental pulmonary embolism(PE) and monitoring the response to anti-coagulation. Methods: A total of 141 patients (58 men, 83 women, 40-83 years) underwent 99Tcm-MAA and 99Tcm-Technegas pulmonary V/Q imaging, and then underwent pulmonary perfusion imaging after 1-24 months oral anticoagulative therapy. Fourteen cases had lower limbs venous lesions, 45 diabetes mellitus or hyperlipaemia, and 63 the history of invasive diagnosis or therapy management recently. Pre- and post-anticoagulation images were compared and combined with clinical information and other imaging modalities to assess the subsegmental PE. Results: All pulmonary perfusion images showed defects in different sizes with normal pulmonary ventilation images. After therapy, the radioactive uptake and distribution in both lungs improved in 118/141 (83.69%) cases. The post-treatment scans were judged normal in 35 patients, obviously improved in 49, mildly improved in 34. Conclusion: Pulmonary V/Q imaging provided accurate information in both diagnosis and post-therapy monitoring of atypical subsegmental PE. (authors)

  12. Investigating suspected acute pulmonary embolism - what are hospital clinicians thinking?

    Energy Technology Data Exchange (ETDEWEB)

    McQueen, A.S. [Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne (United Kingdom)], E-mail: andrewmcqueen7@hotmail.com; Worthy, S. [Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne (United Kingdom); Keir, M.J. [Department of Medical Physics, Royal Victoria Infirmary, Newcastle upon Tyne (United Kingdom)

    2008-06-15

    Aims: To assess local clinical knowledge of the appropriate investigation of suspected acute pulmonary embolism (PE) and this compare with the 2003 British Thoracic Society (BTS) guidelines as a national reference standard. Methods: A clinical questionnaire was produced based on the BTS guidelines. One hundred and eight-six participants completed the questionnaires at educational sessions for clinicians of all grades, within a single NHS Trust. The level of experience amongst participants ranged from final year medical students to consultant physicians. Results: The clinicians were divided into four groups based on seniority: Pre-registration, Junior, Middle, and Senior. Forty-six point eight percent of all the clinicians correctly identified three major risk factors for PE and 25.8% recognized the definition of the recommended clinical probability score from two alternatives. Statements regarding the sensitivity of isotope lung imaging and computed tomography pulmonary angiography (CTPA) received correct responses from 41.4 and 43% of participants, respectively, whilst 81.2% recognized that an indeterminate ventilation-perfusion scintigraphy (V/Q) study requires further imaging. The majority of clinicians correctly answered three clinical scenario questions regarding use of D-dimers and imaging (78, 85, and 57.5%). There was no statistically significant difference between the four groups for any of the eight questions. Conclusions: The recommended clinical probability score was unfamiliar to all four groups of clinicians in the present study, and the majority of doctors did not agree that a negative CTPA or isotope lung scintigraphy reliably excluded PE. However, questions based on clinical scenarios received considerably higher rates of correct responses. The results indicate that various aspects of the national guidelines on suspected acute pulmonary embolism are unfamiliar to many UK hospital clinicians. Further research is needed to identify methods to improve

  13. Spiral CT in the diagnosis of acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Hartmann, I.J.C.; Prokop, M. [Univ. Medical Center Utrecht, Utrecht (Netherlands)

    2002-07-01

    The traditional approach in patients with clinically suspected pulmonary embolism includes ventilation-perfusion (V/Q) scintigraphy as the first step. This relatively fast and noninvasive technique allows diagnosis or exclusion of pulmonary embolism in a considerable proportion of patients. However, depending on the patient group and evaluation criteria, the results of the V/Q lung scan are nondiagnostic in 40 to 70% of cases. Further testing is needed because pulmonary embolism will be present in only about a quarter of these patients. In order to find a non-invasive strategy for the diagnostic work-up of PE, several promising developments have been made, e.g. D-dimer analysis and spiral CT angiography. Both techniques are fast, noninvasive, and easy to perform and are now conquering the medical world. In this overview we will focus on Spiral CT: what is its role now and what might be expected in the near future? (orig.)

  14. Spiral CT in the diagnosis of acute pulmonary embolism

    International Nuclear Information System (INIS)

    The traditional approach in patients with clinically suspected pulmonary embolism includes ventilation-perfusion (V/Q) scintigraphy as the first step. This relatively fast and noninvasive technique allows diagnosis or exclusion of pulmonary embolism in a considerable proportion of patients. However, depending on the patient group and evaluation criteria, the results of the V/Q lung scan are nondiagnostic in 40 to 70% of cases. Further testing is needed because pulmonary embolism will be present in only about a quarter of these patients. In order to find a non-invasive strategy for the diagnostic work-up of PE, several promising developments have been made, e.g. D-dimer analysis and spiral CT angiography. Both techniques are fast, noninvasive, and easy to perform and are now conquering the medical world. In this overview we will focus on Spiral CT: what is its role now and what might be expected in the near future? (orig.)

  15. Relationship between deep venous thrombosis and pulmonary embolism by radionuclide techniques in 150 patients

    International Nuclear Information System (INIS)

    Objective: This study was to evaluate the relationship between deep venous thrombosis and pulmonary embolism assessed by radionuclide imaging. Methods: One hundred and fifty patients with pulmonary embolism from September 1997 to September 2001 were included. Pulmonary perfusion/ventilation imaging and deep venous radionuclide venography was performed in all patients. There were 87 men, and 63 women, with an average age 39±18 years. Of them, 26 underwent pulmonary arteriography. Eleven patients had X Ray phleography of lower extremities, 18 patients had Impedence plethymography (IPG), and 36 patients had lower limb ultrasound study. Results: Out of 150 patients with pulmonary embolism, 128 (85.5%) had lower limb venous pathological changes. Among them, 100 patients had risk factors of deep venous thrombosis (78.3%). 120 patients had proximal vein (80.0%). The agreement between radionuclide venography and X Ray phleography of lower extremities UCG and IPG was 90.9%, 70.2% and 80.0% respectively. Conclusions: Our results indicate that DVT was one of most important cause for acute pulmonary embolism, and thrombosis is mostly located in the proximal veins

  16. Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism, Thrombolysis, Catheter Fragmentation, and Embolectomy

    OpenAIRE

    Wiedenroth, Christoph B.; Guth, Stefan; Rolf, Andreas; Mayer, Eckhard

    2014-01-01

    A 21-year-old male patient with massive acute pulmonary embolism was treated by thrombolysis, interventional thrombus fragmentation, and surgical pulmonary embolectomy. Within the following 2 years, the patient developed progressive dyspnea at exertion. Chronic thromboembolic pulmonary hypertension was diagnosed by right-heart catheter, VQ scan, magnetic resonance, and conventional pulmonary angiography. A normalization of the patient's exercise capacity and pulmonary hemodynamics could be ac...

  17. 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

  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--incidence and prognosis in hospitalized elderly.

    OpenAIRE

    Mangion, D. M.

    1989-01-01

    In a retrospective study of 210 patients with pulmonary embolism diagnosed by ventilation perfusion lung scan or at post-mortem, the incidence of pulmonary embolism was greater in patients over 50 years old (1.4%; P less than 0.05). This was largely due to an increased prevalence of serious associated disease (53%; P less than 0.05). Mortality in elderly patients (70 years and older) diagnosed by ventilation perfusion lung scan was similar to that in younger age groups (P greater than 0.05). ...

  20. Acute pulmonary embolism%急性肺栓塞

    Institute of Scientific and Technical Information of China (English)

    Giancarlo Agnelli, M.D.; Cecilia Becattini, M.D., Ph.D.; 傅琳

    2010-01-01

    @@ 急性肺栓塞(acute pulmonary embolism, APE)的临床表现范围从休克(shock)或持续性低血压(sustained hypotension)到轻度呼吸困难(dyspnea).肺栓塞(pulmonary embolism)甚至有可能是无症状的,并且是在基于其他目的而实施的影像学操作中被诊断出来.APE的病死率范围从60%到<1%,取决于临床表现[1].抗凝是肺栓塞治疗的基础.

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Pulmonary imaging in fat embolism syndrome.

    Science.gov (United States)

    Park, H M; Ducret, R P; Brindley, D C

    1986-07-01

    Ventilation/perfusion lung scanning can be used to effectively detect fat embolism following skeletal trauma. Typical ventilation/perfusion findings may be present when the chest radiograph is normal, and clinical findings are equivocal. PMID:3731656

  5. Quantitative pulmonary perfusion and ventilation scintigraphy in patients with pulmonary embolism

    International Nuclear Information System (INIS)

    In 52 patients who were suspected of having pulmonary embolism, functional and static scintigrams obtained during perfusion and ventilation analysis of the lungs were quantified by calculating the counts per pixel within regions of interest. This procedure was valuable especially in patients with bordeline findings and during follow-up. It assisted to establish the diagnosis of pulmonary embolism in 45 patients so that rapid treatment could be initiated

  6. Post-traumatic pulmonary embolism in the intensive care unit

    OpenAIRE

    Mabrouk Bahloul; Anis Chaari; Hassen Dammak; Fatma Medhioub; Leila Abid; Hichem Ksibi; Sondes Haddar; Hatem Kallel; Hedi Chelly; Chokri Ben Hamida; Mounir Bouaziz

    2011-01-01

    Objective: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE) admitted in the intensive care unit (ICU). Methods: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients ...

  7. Symptomatic subsegmental pulmonary embolism: what is the next step?

    OpenAIRE

    M.; Carrier; Righini, Marc Philip; Le Gal, G

    2012-01-01

    The introduction of computed tomography pulmonary angiography (CTPA) has led to an increase in the incidence of pulmonary embolism (PE) diagnosis. However, the case fatality rate is lower and the mortality rates of PE have remained unchanged, suggesting a lower severity of illness. Specifically, the multiple-detector CTPA increased the rate of subsegmental filling defect reported in patients with suspected PE. Whether these filling defects reported on CTPA would correlate with true subsegment...

  8. Ventilation-perfusion scintigraphy in suspected pulmonary embolism

    International Nuclear Information System (INIS)

    This paper defines the frequency of pulmonary embolism (PE) within the various scintigraphic patterns. The results of ventilation/perfusion (V-Q) imagining and pulmonary angiography were retrospectively analyzed in 151 patients with suspected PE. The study population consisted of 65 men and 86 women, aged 19--91 years. All scans were interpreted by an experienced nuclear medicine physician who knew each patient's clinical history. The V/Q studies were interpreted in accordance with the criteria established by previous work

  9. Pulmonary embolism and stroke associated with mechanical thrombectomy

    Directory of Open Access Journals (Sweden)

    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.

  10. A comparative analysis of pulmonary ventilation-perfusion imaging with helical CT pulmonary angiography in the diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To assess the value of radionuclide pulmonary ventilation-perfusion imaging, helical CT pulmonary angiography (HCTPA) and D-dimer assay in the diagnosis of pulmonary embolism (PE). Methods: Forty-two patients with clinically suspected PE were studied, male: female=26:16, mean age was (49.18 ± 16.56) years. All the patients underwent radionuclide pulmonary ventilation-perfusion imaging, HCTPA and D-dimer assay. The lower extremity deep vein imaging was performed on 32 patients. Results: Of the 42 patients, 34 patients were clinically diagnosed with PE. The sensitivity , accuracy and positive predictive rate of diagnosis of PE by pulmonary ventilation-perfusion imaging was 94.12%, 90.48%, 94.12%. The sensitivity, accuracy and positive predictive rate of diagnosis of PE by HCTPA was 85.29%, 83.33%, 93.55%. The sensitivity, accuracy and positive predictive rate of diagnosis of PE by D-dimer assay was 52.94%, 57.14%, 90.00%. Of the 32 patients with lower extremity deep vein imaging, 20 patients were found with deep vein thrombosis. Conclusions: Radionuclide pulmonary ventilation-perfusion imaging is one of the most valuable methods in the diagnosis of PE, and it is non-injury, safe, simple to use. The capacity of radionuclide pulmonary imaging in diagnosis of subsegmental PE is higher than that of HCTPA. (authors)

  11. Acute pulmonary embolism. Part 1: epidemiology and diagnosis

    NARCIS (Netherlands)

    R.A. Douma; P.W. Kamphuisen; H.R. Büller

    2010-01-01

    Pulmonary embolism (PE) is a frequently occurring, acute, and potentially fatal condition. Numerous risk factors for PE, both inherited and acquired, have been identified. Adequate diagnosis is mandatory to prevent PE-related morbidity and mortality on the one hand, and unnecessary treatment on the

  12. Acute pulmonary embolism. Part 1: Epidemiology and diagnosis

    NARCIS (Netherlands)

    Douma, Renée A.; Kamphuisen, Pieter W.; Büller, Harry R.

    2010-01-01

    Pulmonary embolism (PE) is a frequently occurring, acute, and potentially fatal condition. Numerous risk factors for PE, both inherited and acquired, have been identified. Adequate diagnosis is mandatory to prevent PE-related morbidity and mortality on the one hand, and unnecessary treatment on the

  13. Bullet embolism of pulmonary artery: a case report

    Directory of Open Access Journals (Sweden)

    Mauricio Gustavo Ieiri Yamanari

    2014-04-01

    Full Text Available 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.

  14. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism

    OpenAIRE

    Büller, Harry R; Prins, Martin H.; Lensing, Anthonie W. A.; Decousus, Hervé; Jacobson, Barry F; Minar, Erich; Chlumsky, Jaromir; Verhamme, Peter; Wells, Phil; Agnelli, Giancarlo; Cohen, Alexander; Berkowitz, Scott D.; Bounameaux, Henri; Davidson, Bruce L; Misselwitz, Frank

    2012-01-01

    A fixed-dose regimen of rivaroxaban, an oral factor Xa inhibitor, has been shown to be as effective as standard anticoagulant therapy for the treatment of deep-vein thrombosis, without the need for laboratory monitoring. This approach may also simplify the treatment of pulmonary embolism.

  15. 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.

  16. Adjustments in the diagnostic work-up, treatment and prognosis of pulmonary embolism

    OpenAIRE

    Middeldorp, S.; Kamphuisen, P.W.; Gerdes, V.E.A.; Douma, R.A.; Es, van, Bert

    2013-01-01

    Pulmonary embolism is a potentially fatal condition, in which an embolus, usually a thrombus originating from one of the deep veins of the legs, blocks one or more pulmonary arteries. This leads to impaired blood flow through the lungs. Pulmonary embolism is the third most common cardiovascular disorder in Western society, affecting 1-2 per 1000 patients per year. The clinical presentation of patients with suspected acute pulmonary embolism varies from only mild symptoms to severe dyspnoea, p...

  17. Reporting of ventilation perfusion images for pulmonary embolism

    International Nuclear Information System (INIS)

    Thirty-four hospital patients with suspected pulmonary embolism (PE) had ventilation perfusion (VP) imaging after pulmonary angiography to assess the performance of highly specific criteria for diagnosis of PE and to evaluate the precision of image reporting. A diagnostic result was obtained from VP imaging in 21 of 34 patients giving a sensitivity for PE of 80% and a specificity of 100% in this subgroup. Six of 11 patients with PE had an indeterminate study which reduced the overall sensitivity of the technique for PE in the whole group. A critical analysis of image reporting by two readers gave an 85% inter-observer agreement on ranking as diagnostic or indeterminate for PE (kappa 0.69) and 91%-94% agreement for consensus reproducibility (kappa 0.82). We conclude that the degree of accuracy and precision of reporting that can be obtained using specific criteria will provide a reliable diagnosis in a significant number of patients suspected of having PE. Consensus reporting by two readers is shown to be more reliable than individual reporting. (orig.)

  18. Clot resolution after 3 weeks of anticoagulant treatment of pulmonary embolism: Comparison of computed tomography and perfusion scintigraphy

    NARCIS (Netherlands)

    Van Es, J.; Douma, Renee; Kamphuisen, P.W.; Gerdes, V.E.A.; Verhamme, P.; Wells, P.S.; Bounameaux, H.; Lensing, A.W.A.; Büller, 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). Aim: To assess clot resolution of acute PE with either computed tomography pulmonary angiography (CT-scan) or perfusion scintigraph

  19. 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

  20. 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

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

    International Nuclear Information System (INIS)

    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

  2. Serial follow up V/P scanning in assessment of treatment response in high probability scans for pulmonary embolism

    International Nuclear Information System (INIS)

    138 patients proved with V/P scan to have different probabilities of pulmonary emboli event. Serial follow up scanning after 3 days, 2 weeks, 1 month and 3 months was done, with anticoagulant therapy. Out of the remaining 10 patients, 6 patients died with documented P.E. by P.M. study and lost follow up recorded in 4 patients. Complete response with disappearance of all perfusion defects after 2 weeks was detected in 37 patients (49.3%), partial improvement of lesions after 3 months was elicited in 32%. The overall incidence of response was (81.3%) such response was complete in low probability group (100%), (84.2%) in intermediate group and (79.3%) in high probability group with partial response in 45.3%. New lesions were evident in 18.7% of this series. To conclude that serial follow up V/P scan is mandatory for evaluation of response to anticoagulant therapy specially in first 3 months. 2 figs., 3 tabs

  3. Ventilation-perfusion scanning and pulmonary angiography: correlation in clinical high-probability pulmonary embolism

    International Nuclear Information System (INIS)

    During a 3-year period, 173 clinically selected patients underwent pulmonary angiography to confirm or exclude acute pulmonary embolism. All patients had undergone ventilation-perfusion (V/Q) scanning (167 patients) or perfusion scanning alone (six) before angiography. Angiography was done because the results of the V/Q scanning did not satisfy the clinician's needs for certainty. The results of the V/Q and studies were compared to determine the relative accuracy of V/Q scanning in this clinical setting. Pulmonary embolism was found in seven (15%) of 47 patients with low-probability scans, 11 (32%) of 34 patients with intermediate-probability scans, 22 (39%) of 57 patients with indeterminate scans, and 23 (66%) of 35 patients with high-probability scans. In this clinically selected population, low-probability scans were more accurate in excluding pulmonary embolism than were high-probability scans in establishing that diagnosis

  4. 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.

  5. The pulmonary embolism diagnostic in relation with of the Pioped II and with the new isotopics technic

    International Nuclear Information System (INIS)

    On June the first of 2006, the New England Journal of Medicine Published the results of Pioped II study about the utility of multidetector computed tomographic angiography (CTA )alone and in combination with Venous-phase multidetector CT venography (CTA-CTV) for diagnosis of acute pulmonary embolism. From 7284 patients screened, 824 completed test and reference examinations, 51 and 87 patients were excluded because the CTA and CTA-CVT were s inconclusive for interpretation. On 773 patients with interpretable CTA, sensibility was 83%,specificity 96% . On 737 patients with interpretable CTA-CVT the sensitivity was 90% and specificity was 95%.However the predictive value of CTA and CTA-CTV varied substantially when the clinical assessment was taken into account. In patients with a low clinical probability of pulmonary embolism, 42 percent of the CTA and 43% of the CTA-CVT readings were false positive. In patients with a high clinical probability, 40 percent of results on CTA and 18 percent of results on CTA-CTV were false negative. Then CTA and CTV-CTV per se don't rule out pulmonary embolism and don't have the transcendence of a normal ventilation-perfusion scanning. Is so important that they used a composite reference standard to diagnose or rule out pulmonary embolism where the ventilation perfusion scanning was the higher protagonist. Pulmonary embolism was established with a ventilation-perfusion lung scanning showing a high probability of pulmonary embolism, positive findings on pulmonary digital subtraction angiography (DSA), or positive findings on sonogram in a patient and non diagnostic results on ventilation-perfusion scanning . Exclusion of pulmonary embolism was established with a normal findings on DSA, normal findings on ventilation-perfusion scanning, or ventilation-perfusion scanning showing either a low or very low probability of pulmonary embolism with a clinical Wells score of less than 2 and normal findings on venous sonogram. Considering results

  6. Ventilation-perfusion studies in suspected pulmonary embolism

    International Nuclear Information System (INIS)

    The results of ventilation-perfusion (V-Q) imaging and pulmonary angiography were retrospectively analyzed in 146 patients with suspected pulmonary embolism (PE) to define the frequency of PE associated with various scintigraphic patterns. When the radionuclide images demonstrated at least two moderate-sized or one large area of V-Q mismatch, the probability of PE was 92%. However, only one of three patients with a single moderate-sized V-Q mismatch had PE, while small V-Q mismatches were not associated with PE in any of 19 patients. Matched V-Q abnormalities in lung regions that were radiographically normal were infrequently due to PE (4.8%). When a perfusion defect was substantially smaller than a corresponding radiograpic abnormality, frequency of PE was low (7.7%). Conversely, when a perfusion defect was substantially larger than the corresponding radiographic abnormality, there was a high probability of PE (87%). Matched perfusion and radiographic abnormalities indicated an intermediate probability of PE (27%). Patients with suspected pulmonary embolism may be classified into groups with low, intermediate, or high probability of pulmonary embolism on the basis of size and number of perfusion defects and a careful comparison of perfusion defects with ventilatory and radiographic findings

  7. Malignant fibrous histiocytoma mimicking pulmonary embolism.

    OpenAIRE

    Sleyster, T J; Heystraten, F M

    1988-01-01

    A rare case of malignant fibrous histiocytoma occurring in the pulmonary artery is reported. Such primary pulmonary artery sarcomas may have the diagnosis suggested by angiography or echocardiography; radiographically and in perfusion-ventilation scanning their usual unilateral origin (with later spread) and the persistence of the perfusion defect are among the features normally distinguishing them from thromboembolism.

  8. Pulmonary fat embolism induced intravenous injection of autologous bone marrow in rabbit: CT and pathologic correlation

    International Nuclear Information System (INIS)

    To evaluate the correlation between CT and pathologic findings of pulmonary fat embolism in rabbits. In 16 rabbits, pulmonary fat embolism was induced by intravenous injection of autologous bone marrow(mean 3.3 mL). Chest CT scans were obtained immediately(within 1 hour), and 1, 3, and 7 days after embolization. The rabbits were divided into four groups. Group 1 underwent CT scanning immediately after embolization, group 2 immediately and 1 day after embolization, group 3 immediately, 1 day and 3 days after embolization, group 4 immediately, 1 day, 3 days and 7 days after embolization. Pathologic specimens were obtained immediately after the last CT scan. The earliest CT findings of pulmonary fat embolism in rabbits were peripheral lung lucency(16/16, 100%), perivascular ground-glass(12/16, 75.0%) and enlargement of the central pulmonary artery(11/16, 68.8%). Pathologically, perivascular ground-glass opacity correlated with extensive perivascular alveolar congestion and enlargement of the central pulmonary artery correlated with perivascular connective tissue edema and reactive pulmonary arterial engorgement. Peripheral lung lucency was probably caused by embolic occlusion of the pulmonary artery and decreased perfusion and air trapping induced by arterial and bronchial spasm associated with hypoxia. CT scans obtained 1 and 3 days after embolization showed nodules and patchy ground-glass opacity and consolidation. Aggregation of nodules resulted in patch opacities. Pathologically, pulmonary nodules correlated with focal inflammation surrounding an artery and parenchymal opacity correlated with parenchymal consolidation and hemorrhagic edema. CT scans and pathologic specimens obtained 7 days after embolization showed improvement of parenchymal lung abnormalities. Pulmonary fat embolism in rabbits show CT and pathologic findings which vary with dynamic change. Typical earliest findings of pulmonary fat embolism were peripheral lung lucency, perivascular ground

  9. 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.

  10. 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.

  11. 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.

  12. Developments in the management and treatment of pulmonary embolism

    OpenAIRE

    Rachel Limbrey; Luke Howard

    2015-01-01

    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 be...

  13. The role of lung perfusion and ventilation study in the evaluation of pulmonary embolism

    International Nuclear Information System (INIS)

    The role of lung perfusion and ventilation study (Lung scintigraphy), in the diagnosis of management of patients with clinically suspected pulmonary embolism, will be reviewed. Evidence will be provided,that a normal perfusion scan excludes clinically relevant pulmonary embolism, and that a high probability lung scan, defined as a segmented perfusion defect with locally normal ventilation, sufficiently confirms the presence of pulmonary embolism in the majority of patients carried out in the study

  14. 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.

  15. 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.

  16. [Acute massive pulmonary embolism in a patient using clavis panax].

    Science.gov (United States)

    Yüksel, Isa Oner; Arslan, Sakir; Cağırcı, Göksel; Yılmaz, Akar

    2013-06-01

    In recent years, the use of herbal combinations, plant extracts or food supplements has increased in our country and all over the world. However, there is not enough data to determine the effective doses of these substances in the composition of herbal preparations, or their effects on metabolism and drug interactions. With the widespread use of herbal combinations, life-threatening side effects and clinical manifestations that arise from them have been reported. Herein we present a case with acute massive pulmonary embolism while using an herbal combination in the context of Tribulus terrestris, Avena sativa and Panax ginseng. A 41-year-old man was admitted to the emergency department with the complaint of sudden onset of dyspnea and syncope. As a result of investigations (blood gases, echocardiography, ventilation-perfusion scintigraphy) he was diagnosed with an acute massive pulmonary embolism. The patient's use of panax did not pose as a risk factor for the pulmonary embolism. He was given thrombolytic therapy and shortness of breath improved. At the pre-discharge the patient was informed of the risks associated with the herbal combination, especially panax. Coumadin was started and he was discharged for the INR checks to come. PMID:23760126

  17. Modified PISAPED Criteria in Combination with Ventilation Scintigraphic Finding for Predicting Acute Pulmonary Embolism.

    Science.gov (United States)

    Watanabe, Naoyuki; Fettich, Jure; Küçük, Nurie Özlem; Kraft, Otakar; Mut, Fernando; Choudhury, Partha; Sharma, Surendra K; Endo, Keigo; Dondi, Maurizio

    2015-01-01

    This prospective clinical study aimed at assessing three pulmonary scintigraphic algorithms to detect acute pulmonary embolism (PE): Lung ventilation/perfusion (V/Q) scintigraphy along with modified prospective investigation of pulmonary embolism diagnosis (PIOPED) criteria; lung perfusion scintigraphy along with prospective investigative study of acute pulmonary embolism diagnosis (PISAPED) criteria; and lung perfusion scan in combination with ventilation scan, along with modified PISAPED criteria, which were newly developed. Patients with suspicion of PE were eligible for this study if they had no abnormal chest x-ray. Their diagnostic workup included a clinical assessment, a pulmonary V/Q scintigraphy, and CT pulmonary angiography (CTPA), as well as a clinical outcome assessment over a period of 24 weeks. Referred to the final clinical diagnosis of patients, the sensitivity and specificity of each algorithm were evaluated. The diagnostic performance of each algorithm by the area under the maximum likelihood fitted receiver operating characteristic (ROC) curve was determined. With respect to the PISAPED criteria, the sensitivity was 60.8% and specificity was 87.3%. No patient was classified into nondiagnostic category. The PIOPED criteria showed that the sensitivity was 95.0% and specificity was 88.2%, while 57.4% of the patients were in nondiagnostic category. The areas under the ROC curve constructed from the PISAPED criteria results and the modified PIOPED criteria results were 0.734 and 0.859 (P < 0.01), respectively. The modified PISAPED criteria demonstrated that the sensitivity was 83.8% and specificity was 89.1%. No patient was classified into nondiagnostic category. The area under the ROC curve constructed from modified PISAPED criteria was 0.864 (P < 0.01). Perfusion scans used with ventilation scans and modified PISAPED criteria may increase the diagnostic accuracy of pulmonary scintigraphy for acute PE, compared with the two major algorithms. PMID

  18. Anticoagulant treatment for acute pulmonary embolism: a pathophysiology-based clinical approach.

    Science.gov (United States)

    Agnelli, Giancarlo; Becattini, Cecilia

    2015-04-01

    The management of patients with acute pulmonary embolism is made challenging by its wide spectrum of clinical presentation and outcome, which is mainly related to patient haemodynamic status and right ventricular overload. Mechanical embolic obstruction and neurohumorally mediated pulmonary vasoconstriction are responsible for right ventricular overload. The pathophysiology of acute pulmonary embolism is the basis for risk stratification of patients as being at high, intermediate and low risk of adverse outcomes. This risk stratification has been advocated to tailor clinical management according to the severity of pulmonary embolism. Anticoagulation is the mainstay of the treatment of acute pulmonary embolism. New direct oral anticoagulants, which are easier to use than conventional anticoagulants, have been compared with conventional anticoagulation in five randomised clinical trials including >11 000 patients with pulmonary embolism. Patients at high risk of pulmonary embolism (those with haemodynamic compromise) were excluded from these studies. Direct oral anticoagulants have been shown to be as effective and at least as safe as conventional anticoagulation in patients with pulmonary embolism without haemodynamic compromise, who are the majority of patients with this disease. Whether these agents are appropriate for the acute-phase treatment of patients at intermediate-high risk pulmonary embolism (those with both right ventricle dysfunction and injury) regardless of any risk stratification remains undefined. PMID:25700388

  19. A case of septic pulmonary embolism associated with renal abscess mimicking pulmonary metastases of renal malignancy

    International Nuclear Information System (INIS)

    We report the case of a 46-year-old woman with acute febrile symptom who had multiple pulmonary nodules and a renal mass. She underwent 18F-fluorode-oxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to find a hidden malignancy and the cause of her fever. FDG PET/CT images demonstrated a renal mass and multiple lung nodules with intense FDG uptake, which was suspicious of a renal malignancy with multiple pulmonary metastatic lesions. CT-guided biopsies of the pulmonary and renal lesions only showed chronic inflammatory infiltrates without evidence of malignancy. She was diagnosed with septic pulmonary embolism from a renal abscess. One month after antibiotic treatment, the follow-up chest and abdomen CT showed improvement of the lung and renal lesions. This is the first case demonstrating the FDG PET/CT finding of septic pulmonary embolism associated with renal abscess in the published literature. (author)

  20. Pulmonary embolism: the role of emergency scan and intervening radiology in medium-high-risk patients with pulmonary embolism

    OpenAIRE

    Eleonora Arboscello; Irene Ponassi; Agnese Lomeo; Maria Nives Parodi; Paolo Barbera; Michela Morfino; Nicoletta Pollicardo; Roberto Delfino; Dahane Mhamed; Roberto Tallone

    2010-01-01

    Pulmonary embolism (PE) is a relative common cardiovascular emergency. Computed tomography (CT) angiography has became the method of choice for suspected PE in routine clinical practice but CT should not be the first-line test for all patients, except suspected high-risk patients and high clinical probability or “PE likely” patients. In these situations emergency phisician ‘s echographic cardiac study can be particularly helpful for a rapid patient management. The two cases ...

  1. Contrast enhanced pulmonary magnetic resonance angiography for pulmonary embolism: Building a successful program.

    Science.gov (United States)

    Nagle, Scott K; Schiebler, Mark L; Repplinger, Michael D; François, Christopher J; Vigen, Karl K; Yarlagadda, Rajkumar; Grist, Thomas M; Reeder, Scott B

    2016-03-01

    The performance of contrast enhanced pulmonary magnetic resonance angiography (MRA) for the diagnosis of pulmonary embolism (PE) is an effective non-ionizing alternative to contrast enhanced computed tomography and nuclear medicine ventilation/perfusion scanning. However, the technical success of these exams is very dependent on careful attention to the details of the MRA acquisition protocol and requires reader familiarity with MRI and its artifacts. Most practicing radiologists are very comfortable with the performance and interpretation of computed tomographic angiography (CTA) performed to detect pulmonary embolism but not all are as comfortable with the use of MRA in this setting. The purpose of this review is to provide the general radiologist with the tools necessary to build a successful pulmonary embolism MRA program. This review will cover in detail image acquisition, image interpretation, and some key elements of outreach that help to frame the role of MRA to consulting clinicians and hospital administrators. It is our aim that this resource will help build successful clinical pulmonary embolism MRA programs that are well received by patients and physicians, reduce the burden of medical imaging radiation, and maintain good patient outcomes. PMID:26860667

  2. Active implementation of a consensus strategy improves diagnosis and management in suspected pulmonary embolism

    NARCIS (Netherlands)

    A. Berghout (Arie); M. Oudkerk (Matthijs); S.G. Hicks; T.H. Teng; M. Pillay; H.R. Büller (Harry)

    2000-01-01

    textabstractOur consensus-based strategy in the diagnostic management of patients with pulmonary embolism involves a perfusion lung scan, a ventilation lung scan, compression ultrasonography and pulmonary angiography, in sequence. We compared the diagnostic approach in

  3. The study on dual-energy lung perfusion imaging in the diagnosis of pulmonary embolism using dual-source CT

    International Nuclear Information System (INIS)

    Objective: To explore the diagnostic values of dual energy lung perfusion in the diagnosis of pulmonary embolism by using dual-source CT (DSCT). Methods: Thirty patients with clinically suspected pulmonary embolism underwent dual-energy scanning with dual-source CT. The scanned data were integrated into three groups including 140, 80 kV and coefficient of 0.3. According to the CT pulmonary angiography (CTPA) of the fusion data, the patients were divided into pulmonary embolism group and normal group. The thin-slice reconstruction of data was analyzed using dual-energy perfusion imaging analysis software. The lung field was divided into upper, middle and lower part to make quantitative analysis of lung tissue perfusion. Paired t-tests were used in the normal patients to compare bilateral lungs, and, independent samples t-tests were applied to compare the embolism group and normal group, while minimum intensity projection images (MinIP) were utilized in the assessment of lung ventilation. Results: Dual energy CT showed symmetrical homogeneous perfusion in 16 normal cases, without significant perfusion defects. Quantitative analysis showed that left and right lung perfusion were (27±7) and (28±8) HU respectively, and no significant difference was found between the two sides (t=-1.73, P>0.05). Perfusion of the left upper, middle and lower lung was (23±6), (24±6), and (28±8) HU respectively, while the perfusion of right upper, middle and lower lung was (26±8), (27±8), and (28±9) HU respectively, showing no statistical significant difference between the two sides (t=-1.91, -1.96, -1.73, P>0.05). Angiography of pulmonary embolism group (14 cases) showed filling defects in the pulmonary trunk, segments and sub-segments. Pulmonary perfusion imaging showed low perfusion or defects in lung field that dominated by embolic vessels. Quantitative analysis showed that the perfusion of the whole lung and the middle and lower lung were (22±5), (22±8), and (21±8) HU in the

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

    International Nuclear Information System (INIS)

    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

  5. Splendors and miseries of expired CO2 measurement in the suspicion of pulmonary embolism

    OpenAIRE

    Verschuren, Franck; Perrier, Arnaud

    2010-01-01

    Capnography has been studied for decades as a potential diagnostic tool for suspected pulmonary embolism. Despite technological refinements and its combination with other non-invasive instruments, no evidence to date allows recommending the use of expired carbon dioxide measurement as a rule-out test for pulmonary embolism without additional radiological testing. Further investigations are, however, still warranted.

  6. Pulmonary embolism: the role of emergency scan and intervening radiology in medium-high-risk patients with pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Eleonora Arboscello

    2010-03-01

    Full Text Available Pulmonary embolism (PE is a relative common cardiovascular emergency. Computed tomography (CT angiography has became the method of choice for suspected PE in routine clinical practice but CT should not be the first-line test for all patients, except suspected high-risk patients and high clinical probability or “PE likely” patients. In these situations emergency phisician ‘s echographic cardiac study can be particularly helpful for a rapid patient management. The two cases prove the helpful use of echografic cardiac study in emergency room and rivet the necessity of an aggressive therapeutic management with primary aim of flow restoration through occluded pulmonary arteries. Percutaneous catheter embolectomy and fragmentation of proximal pulmonary arterial clots may be considerer, with multidisciplinary approach, as an alternative when thrombolysis is absolutely contraindicated or has failed, or as an alternative to surgical treatment.

  7. [Nephrotic syndrome revealed by pulmonary embolism: about four cases].

    Science.gov (United States)

    Chaudesaygues, E; Grasse, M; Marchand, L; Villar, E; Aupetit, J-F

    2014-11-01

    Nephrotic syndrom is an association of proteinuria>3g/d or 50mg/kg/d, an hypoalbuminemiadiabetes, high blood pressure and amyloidosis. We present four cases about nephrotic syndrome after thromboembolic disease. In every case, patients show a pulmonary embolism symptomatic of a nephrotic syndrom, whose diagnostic could be delayed up to six months after first pulmonary symptoms. This raised the problem of renal biopsy in these patients who need anticoagulation. In minimal change nephrosis, without hematuria, high blood pressure or renal dysfonction, a corticosteroid therapy test could be done assuming that is corticosensitive minimal glomerular injury. In every case, anticoagulation course must be completed and maintained in case of patent nephrotic syndrom with an albuminemia under 20g/L. In case of pulmonary embolism or deep vein thrombosis, idiopathic-looking, a nephrotic syndrome must be sought-after. The two diagnosis ways are the proteinuria on the urine dipstick and the hypoproteinemia on usual biology. The main mechanism is the coagulation factor leak, side effect of the nephrotic syndrom, notably because of the antithrombin III. PMID:25281996

  8. Current role of lung scintigraphy in pulmonary embolism

    International Nuclear Information System (INIS)

    The pivotal role of lung scintigraphy in the diagnosis of pulmonary embolism (PE) has been questioned in recent years due to the introduction of spiral computed tomography. However, the scintigraphic results used for comparisons are often those of the authoritative PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) study, carried out in the 1980s. Pulmonary scintigraphy has progressed from those years both in the methodological and interpretative fields, although perhaps too slowly. Results better than those of PIOPED's have been presented by study groups who used: 1) perfusion-only approach; 2) SPET imaging; 3) new interpretative criteria; 4) different prediction rules to integrate clinical and scintigraphic probabilities of PE. These advances are still insufficiently recognised by the nuclear medicine community, possibly due to a sort of PIOPED-based cultural globalisation. This paper reviews the actual advantages and limitations of nuclear medicine techniques, the diagnostic role of scintigraphy within the diagnostic algorithms proposed by international working groups and scientific societies and the results obtained from SPET imaging in the diagnosis of PE

  9. Deep venous thrombosis and pulmonary embolism following physical restraint

    DEFF Research Database (Denmark)

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

    2005-01-01

    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...... 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...

  10. Utilization of CT Pulmonary Angiography in Suspected Pulmonary Embolism in a Major Urban Emergency Department

    Directory of Open Access Journals (Sweden)

    Adil Shujaat

    2013-01-01

    Full Text Available Objectives. We conducted a study to answer 3 questions: (1 is CT pulmonary angiography (CTPA overutilized in suspected pulmonary embolism (PE? (2 What alternative diagnoses are provided by CTPA? (3 Can CTPA be used to evaluate right ventricular dilatation (RVD? Methods. We retrospectively reviewed the clinical information of 231 consecutive emergency department patients who underwent CTPA for suspected PE over a one-year period. Results. The mean age of our patients was 53 years, and 58.4% were women. The prevalence of PE was 20.7%. Among the 136 patients with low clinical probability of PE, a d-dimer test was done in 54.4%, and it was normal in 24.3%; none of these patients had PE. The most common alternative findings on CTPA were emphysema (7.6%, pneumonia (7%, atelectasis (5.5%, bronchiectasis (3.8%, and congestive heart failure (3.3%. The sensitivity and negative predictive value of CTPA for (RVD was 92% and 80%, respectively. Conclusions. PE could have been excluded without CTPA in ~1 out of 4 patients with low clinical probability of PE, if a formal assessment of probability and d-dimer test had been done. In patients without PE, CTPA did not provide an alternative diagnosis in 65%. In patients with PE, CTPA showed the potential to evaluate RVD.

  11. Successful Treatment of a Large Pulmonary Arteriovenous Malformation by Repeated Coil Embolization

    OpenAIRE

    Park, Jimyung; Kim, Hyung-Jun; Kim, Jee Min; Park, Young Sik

    2015-01-01

    Pulmonary arteriovenous malformations (AVMs) are caused by abnormal vascular communications between the pulmonary arteries and pulmonary veins, which lead to the blood bypassing the normal pulmonary capillary beds. Pulmonary AVMs result in right-to-left shunts, resulting in hypoxemia, cyanosis, and dyspnea. Clinical signs and symptoms vary depending on the size, number, and flow of the AVMs. Transcatheter embolization is the treatment of choice for pulmonary AVMs. However, this method can fai...

  12. Non-traumatic thoracic emergencies: CT diagnosis of acute pulmonary embolism: the first 10 years

    Energy Technology Data Exchange (ETDEWEB)

    Ghaye, Benoit; Remy, Jacques; Remy-Jardin, Martine [Department of Radiology, Hospital Calmette, University Center of Lille, Blvd Jules Leclerq, 59037 Lille Cedex (France)

    2002-08-01

    Over the past 10 years, spiral CT angiography of the pulmonary arteries has reached a high accuracy in the evaluation of pulmonary embolism. Major advantages of CT compared with ventilation/perfusion lung scintigraphy and pulmonary angiography is direct visualization of clots in the pulmonary arteries, and to provide alternative findings or diagnosis. The recent introduction of multislice CT has improved the evaluation of peripheral pulmonary arteries, enabling high-resolution CT examinations over the entire thorax in a short breathhold. The examination techniques, imaging findings, pitfalls, and results of CT in the diagnosis of pulmonary embolism are reviewed in comparison with other diagnostic tests. (orig.)

  13. Evaluation of interventional angioplasty by using thrombolysis and balloon dilatation in treating pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To evaluate the interventional angioplasty by using thrombolysis and balloon dilatation in the treatment of pulmonary embolism. Methods: Eight patients with pulmonary embolism were treated with interventional management including fragmentation of the thrombus, thrombolysis with urokinase flush infusion, balloon dilatation and continuing low-dose infusion for 24 hours. Anticoagulation with heparin was given simultaneously. Results: The pulmonary artery was completely recanalized in three patients, and partially recanalized in five patients. The blood oxygen saturation reached 100% in 3 cases and was over 93% in 5 cases. Conclusion: Interventional angioplasty by means of thrombolysis or balloon dilatation is an effective therapy for pulmonary embolism in reopening the embolized pulmonary artery, bringing the pulmonary hemodynamics to normal condition and correcting the hypoxemia. (authors)

  14. Acute pulmonary embolism during an endoscopic retrograde cholangiopancreatography

    Directory of Open Access Journals (Sweden)

    Nate P Painter

    2014-01-01

    Full Text Available A 76-year-old female patient presented for an endoscopic retrograde cholangiopancreatography (ERCP for the removal of a biliary stent and lithotripsy. During the procedure, an acute drop in the end-tidal CO 2 , followed by cardiovascular collapse prompted the initiation of the advanced cardiac life support protocol. Transesophageal echocardiography (TEE demonstrated direct evidence of pulmonary embolism. The patient was promptly treated with thrombolytic therapy and subsequently discharged home on oral warfarin therapy, with no noted sequelae. Although, there have been case reports of air embolism during an ERCP presenting with cardiovascular collapse, to the best of our knowledge, there are no reported cases of acute pulmonary embolus during this procedure. While the availability of TEE in the operating suites is quite common, quick access and interpretation capabilities in remote locations may not be as common. With the expansion of anesthesia services outside of the operating rooms, it may be prudent to develop rapid response systems that incorporate resources such as TEE and trained personnel to deal with such emergent situations.

  15. Acute pulmonary embolism during an endoscopic retrograde cholangiopancreatography.

    Science.gov (United States)

    Painter, Nate P; Kumar, Priya A; Arora, Harendra

    2014-01-01

    A 76-year-old female patient presented for an endoscopic retrograde cholangiopancreatography (ERCP) for the removal of a biliary stent and lithotripsy. During the procedure, an acute drop in the end-tidal CO 2 , followed by cardiovascular collapse prompted the initiation of the advanced cardiac life support protocol. Transesophageal echocardiography (TEE) demonstrated direct evidence of pulmonary embolism. The patient was promptly treated with thrombolytic therapy and subsequently discharged home on oral warfarin therapy, with no noted sequelae. Although, there have been case reports of air embolism during an ERCP presenting with cardiovascular collapse, to the best of our knowledge, there are no reported cases of acute pulmonary embolus during this procedure. While the availability of TEE in the operating suites is quite common, quick access and interpretation capabilities in remote locations may not be as common. With the expansion of anesthesia services outside of the operating rooms, it may be prudent to develop rapid response systems that incorporate resources such as TEE and trained personnel to deal with such emergent situations. PMID:24732617

  16. Enoxaparin-associated giant retroperitoneal hematoma in pulmonary embolism treatment

    Directory of Open Access Journals (Sweden)

    Fahri Halit Besir

    2011-01-01

    Full Text Available Context: Retroperitoneal hematoma may usually occur as a result of trauma. A life threatening retroperitoneal hematoma is not expected complication of anticoagulation treatment and rarely reported. Low molecular weight heparins (Enoxaparin which are used as effective and safe medicine in the venous thromboemboly treatment have some major complications such as hematomas of different organs. We aim to present a giant spontaneous retroperitoneal hematoma after anticoagulant treatment of pulmonary embolism with enoxaparin. Case Report: A 73-year-old male patient with the diagnosis of pulmonary embolism underwent anticoagulant treatment (enoxaparin. In the second day of admission, the patient had an episode of abdominal and back pain. Abdominal ultrasonography and computerized tomographic scan revealed a giant retroperitoneal hematoma. Enoxaparin treatment was then stopped and the supportive treatment was started. In the following days, hemoglobin levels returned to normal and a control CT revealed regression of hematoma size. Conclusion: The anticoagulant treatment with enoxaparin may lead to severe hematomas. Therefore, the clinical suspicion is required especially in elderly patients and patients with impaired renal function for retroperitoneal hematoma, when they suffer from acute abdominal pain.

  17. Pulmonary bone cement embolism: CT angiographic evaluation with material decomposition using gemstone special imaging

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Sun; Lee, Heon [Dept. of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon (Korea, Republic of)

    2014-08-15

    We report a case of pulmonary bone cement embolism in a female who presented with dyspnea following multiple sessions of vertebroplasty. She underwent spectral CT pulmonary angiography and the diagnosis was made based on enhanced visualization of radiopaque cement material in the pulmonary arteries and a corresponding decrease in the parenchymal iodine content. Here, we describe the CT angiography findings of bone cement embolism with special emphasis on the potential benefits of spectral imaging, providing additional information on the material composition.

  18. Postoperative pulmonary embolism in a three year old with Klippel–Trenaunay syndrome

    OpenAIRE

    Hudcova, Jana; Kleinman, Monica; Talmor, Daniel

    2009-01-01

    Massive pulmonary embolism (PE) in a small child is a rare event and unified guidelines for its treatment are missing. Timely diagnosis and management of massive pulmonary embolism is of crucial importance for a good outcome. We describe a unique management of PE causing oxygenation failure using a combination of catheter extraction technique, and regional thrombolysis on top of systemic heparin administration and inferior vena cava filter placement. Pulmonary hypertension was treated with in...

  19. Diagnosis of pulmonary embolism: ventilation perfusion scintigraphy versus helical computed tomography pulmonary angiography

    International Nuclear Information System (INIS)

    The present study compared the accuracy of ventilation perfusion scintigraphy (VQS) and CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism. This was a prospective observational study of 112 patients with suspected pulmonary embolism (PE) who could be studied with both investigations within 24 h. Results were compared to final diagnosis at completion of 6-month follow up, using receiver operating characteristic (ROC) analysis. Pulmonary embolism was diagnosed in 27 referred patients (24%). The sensitivity and specificity of VQS and CTPA were similar to that reported from the literature. A normal VQ scan had the highest negative predictive value (100%), while a high-probability VQ scan had the highest positive predictive value (92%). There was no overall difference (area under the ROC curve (AUC)) between VQS (AUC (95% CI) = 0.82 (0.75,0.89)) and CTPA (AUC = 0.88 (0.81,0.94)) for the diagnosis of PE. Among patients with abnormal chest X-rays, CTPA (AUC 0.90 (0.83,0.97)) appeared somewhat better than VQS (AUC 0.78 (0.68,0.88)) but this difference did not reach statistical significance. In this instance, CTPA is at least as accurate as VQS and may provide an opportunity to make alternative diagnoses. Copyright (2005) Blackwell Publishing Asia Pty Ltd

  20. Clinical value of ventilation perfusion imaging for pulmonary embolism

    International Nuclear Information System (INIS)

    The results and clinical value of ventilation perfusion (VP) imaging in 434 patients is reported. Pulmonary arteriography has been performed independently in 47 of these patients. Pulmonary arteriography provides the only specific test for intraluminal thrombus in pulmonary vessels. It is, however, invasive, time consuming and expensive, and has a significant morbidity and occasional mortality. For these reasons, VP imaging has been widely adopted as a screening test for pulmonary embolism (PE). The non-specific nature of perfusion abnormalities of lung demonstrated by this technique are a drawback, and controversy has been generated concerning the value of VP imaging to clinicians who must make decisions on clinical management. It is found that VP imaging provides valuable information in two-thirds of all patients referred to Nuclear Medicine with a clinical suspicion of PE. Among these patients, VP imaging confirmed the clinical suspicion in one-third, clarified or corrected the clinical diagnosis in one-third, and was non-diagnostic in one-third. It is concluded that VP imaging is a safe, reliable and valuable screening test in a significant number of patients suspected of having PE

  1. Role of ventilation scintigraphy in diagnosis of acute pulmonary embolism: an evaluation using artificial neural networks

    International Nuclear Information System (INIS)

    The purpose of this study was to assess the value of the ventilation study in the diagnosis of acute pulmonary embolism using a new automated method. Either perfusion scintigrams alone or two different combinations of ventilation/perfusion scintigrams were used as the only source of information regarding pulmonary embolism. A completely automated method based on computerised image processing and artificial neural networks was used for the interpretation. Three artificial neural networks were trained for the diagnosis of pulmonary embolism. Each network was trained with 18 automatically obtained features. Three different sets of features originating from three sets of scintigrams were used. One network was trained using features obtained from each set of perfusion scintigrams, including six projections. The second network was trained using features from each set of (joint) ventilation and perfusion studies in six projections. A third network was trained using features from the perfusion study in six projections combined with a single ventilation image from the posterior view. A total of 1,087 scintigrams from patients with suspected pulmonary embolism were used for network training. The test group consisted of 102 patients who had undergone both scintigraphy and pulmonary angiography. Performances in the test group were measured as area under the receiver operation characteristic curve. The performance of the neural network in interpreting perfusion scintigrams alone was 0.79 (95% confidence limits 0.71-0.86). When one ventilation image (posterior view) was added to the perfusion study, the performance was 0.84 (0.77-0.90). This increase was statistically significant (P=0.022). The performance increased to 0.87 (0.81-0.93) when all perfusion and ventilation images were used, and the increase in performance from 0.79 to 0.87 was also statistically significant (P=0.016). The automated method presented here for the interpretation of lung scintigrams shows a significant

  2. Role of ventilation scintigraphy in diagnosis of acute pulmonary embolism: an evaluation using artificial neural networks

    Energy Technology Data Exchange (ETDEWEB)

    Evander, Eva [Department of Clinical Physiology, University Hospital, Lund University, 221 85, Lund (Sweden); Holst, Holger; Jaerund, Andreas; Wollmer, Per; Edenbrandt, Lars [Department of Clinical Physiology, Malmoe University Hospital, Malmoe (Sweden); Ohlsson, Mattias [Department of Theoretical Physics, Lund University, Lund (Sweden); Aastroem, Karl [Department of Mathematics, Lund Institute of Technology, Lund (Sweden)

    2003-07-01

    The purpose of this study was to assess the value of the ventilation study in the diagnosis of acute pulmonary embolism using a new automated method. Either perfusion scintigrams alone or two different combinations of ventilation/perfusion scintigrams were used as the only source of information regarding pulmonary embolism. A completely automated method based on computerised image processing and artificial neural networks was used for the interpretation. Three artificial neural networks were trained for the diagnosis of pulmonary embolism. Each network was trained with 18 automatically obtained features. Three different sets of features originating from three sets of scintigrams were used. One network was trained using features obtained from each set of perfusion scintigrams, including six projections. The second network was trained using features from each set of (joint) ventilation and perfusion studies in six projections. A third network was trained using features from the perfusion study in six projections combined with a single ventilation image from the posterior view. A total of 1,087 scintigrams from patients with suspected pulmonary embolism were used for network training. The test group consisted of 102 patients who had undergone both scintigraphy and pulmonary angiography. Performances in the test group were measured as area under the receiver operation characteristic curve. The performance of the neural network in interpreting perfusion scintigrams alone was 0.79 (95% confidence limits 0.71-0.86). When one ventilation image (posterior view) was added to the perfusion study, the performance was 0.84 (0.77-0.90). This increase was statistically significant (P=0.022). The performance increased to 0.87 (0.81-0.93) when all perfusion and ventilation images were used, and the increase in performance from 0.79 to 0.87 was also statistically significant (P=0.016). The automated method presented here for the interpretation of lung scintigrams shows a significant

  3. The diagnosis value of pulmonary perfusion/ventilation imaging for pulmonary embolism: in comparison with pulmonary artery angiography

    International Nuclear Information System (INIS)

    Objective: To evaluate the value of the pulmonary perfusion/ventilation imaging in diagnosis of pulmonary embolism (PE). Methods: Forty-five patients undergone pulmonary radionuclide imaging and pulmonary artery angiography in Fuwai Hospital were analyzed retrospectively. Results: Twenty-six patients were diagnosed as with PE by pulmonary angiography. For the pulmonary segments with complete filling defect on pulmonary artery angiography, the coincidence rate was 92.7% between the angiography and radionuclide pulmonary imaging, while the pulmonary segments with partial filling defect, the coincidence rate was 73.2% (P<0.01). The sensitivity and specificity were 92.3% and 84.2%, respectively. Both the positive predictive value and negative predictive value were 88.9%. Out of 26 patients with PE, 23 patients had also pulmonary ventilation imaging. The results showed mismatch between pulmonary perfusion and ventilation imaging in all of the 23 patients. Conclusion: The pulmonary perfusion plus pulmonary ventilation imaging plays an important role in diagnosing PE

  4. Diagnostic value of one-day protocol pulmonary ventilation/perfusion imaging in pulmonary embolic disease

    International Nuclear Information System (INIS)

    Full text: Objective: To evaluate the value of easy and fast one-day protocol pulmonary ventilation/perfusion(V/P) imaging in diagnosis of pulmonary embolic(PE).Methods:Applicating disposable ventilation kit, 132 patients with clinically suspected PE underwent pulmonary V/P imaging, performed with ADAC Vertex Dual-head SPECT with low energy high resolution collimator, set peak at 140 Kev, 20% window, 256 x 256 matrix, and 8 plane views: Anterior, Posterior, LAO, RPO, LL, RL, LPO, RAO. Pulmonary V imaging applicate disposable ventilation kit, inject 99Tcm- DTPA 1110MBq into aerosol unit, start oxygen flow at a low rate, gradually in to 10-14 liters/minute. Starting acquisition when the activity of labeled aerosol reaches 1k counts/s count rate, preset count is 100k, about 7 minute for completion of study; Right after V imaging, keep the patient in the exact same position, intravenously slowly inject 99Tcm-MAA 111MBq, count rate is about 6k counts/s, preset count is 500k, about 6 minute for completion of study.Results:According to the criteria of prospective investigation of the pulmonary embolism diagnosis (PIOPED), among the 184 patients , 85 were diagnosed with PE and 86 were excluded. simple fast one-day protocol pulmonary V/P imaging provided diagnostic interpretations for 171 patients, and non-diagnostic interpretations for 13 patients, by spiral CT, pulmonary angiography and clinical D-Dimer, 5 were diagnosed with PE and 8 were not PE. For diagnosing PE, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of pulmonary V/P imaging was 94.44%, 91.49%, 92.93%, 91.40% and 94.51%.Conclusions: Easy and fast one-day protocol pulmonary V/P imaging gave very high clinical value in the diagnosis of PE. (author)

  5. 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.

  6. Stand-alone performance of a computer-assisted detection prototype for detection of acute pulmonary embolism: a multi-institutional comparison.

    NARCIS (Netherlands)

    Wittenberg, R.; Peters, J.F.; Weber, M.; Lely, R.J.; Cobben, L.P.; Prokop, M.; Schaefer-Prokop, C.M.

    2012-01-01

    OBJECTIVE: To assess whether the performance of a computer-assisted detection (CAD) algorithm for acute pulmonary embolism (PE) differs in pulmonary CT angiographies acquired at various institutions. METHODS: In this retrospective study, we included 40 consecutive scans with and 40 without PE from 3

  7. 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.

  8. 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.

  9. 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.

  10. Extracorporeal membrane oxygenation with danaparoid sodium after massive pulmonary embolism.

    Science.gov (United States)

    Bauer, Christian; Vichova, Zuzana; Ffrench, Patrick; Hercule, Christiane; Jegaden, Olivier; Bastien, Olivier; Lehot, Jean-Jacques

    2008-04-01

    During extracorporeal membrane oxygenation, anticoagulation therapy is usually achieved with unfractionated heparin. We report on an extracorporeal membrane oxygenation with danaparoid sodium for a patient with severe respiratory failure due to massive pulmonary embolism and suspected type 2 heparin-induced thrombocytopenia. Danaparoid, a low molecular weight heparinoid, is an alternative to heparin for patients who develop type 2 heparin-induced thrombocytopenia. Danaparoid was given at 400 IU/h with an objective of antifactor Xa activity of 0.6-0.8 U/mL, which was monitored twice a day. No excessive bleeding or clotting of the circuit was noted. The patient was weaned from extracorporeal membrane oxygenation after 9 days of treatment. PMID:18349178

  11. Atypical Presentation of Massive Pulmonary Embolism, a Case Report

    Directory of Open Access Journals (Sweden)

    Alireza Majidi

    2014-03-01

    Full Text Available The lack of pathognomonic signs and symptoms makes the diagnosis of pulmonary embolism (PE difficult. Here, we report a case of a 42-year-old man presented to the emergency department with worsening epigastric pain, hypotension, frank bradycardia, and final diagnosis of PE. Although previous studies have indicated that abdominal pain was observed in 6.7% of patients with PE, the exact reason for abdominal pain in PE still remains unknown. Tension on the sensory nerve endings, hepatic congestion, and distention of Gilson’s capsule are some of the possible mechanisms of abdominal pain in PE. We conclude that emergency physicians should pay more attention to PE, which is an important differential diagnosis of shock state. In this context, rapid ultrasound in shock (RUSH should be considered as a vital sign that needs to be evaluated when recording the history of patients presented to the emergency department with signs and symptoms of shock.

  12. [Acute pulmonary embolism: beware of the wolf in sheep's clothing].

    Science.gov (United States)

    Klok, Frederikus A; Vahl, Jelmer E; Huisman, Menno V; van Dijkman, Paul R M

    2012-01-01

    Two male patients aged 57 and 73 were referred to the cardiologist because of progressive dyspnoea. In one patient, the general practitioner had previously adopted an expectative policy because of a clean chest X-ray. At presentation after 4 weeks, the patient was diagnosed with and treated for acute coronary syndrome because of minor ECG abnormalities. Additional CT scanning showed a large saddle embolus. Despite adequate treatment, the patient suffered an electrical asystole and died. The other patient underwent ECG, bicycle ergometry, MRI adenosine, echocardiography and lung function tests over a period of 5 weeks before pulmonary embolism (PE) was diagnosed. As the signs and symptoms of PE are largely non-specific, diagnostic delay is common, with risk of poor clinical outcome. PE should at least be considered whenever a patient presents with acute or worsening breathlessness, chest pain, circulatory collapse or coughing, particularly in the presence of known thrombotic risk factors or when there is no clear alternative. PMID:22296892

  13. Comparison of efficacy of different treatments for pulmonary embolism.

    Science.gov (United States)

    Fan, Yang; Huang, He; Xiong, Jun; Yang, Mei; Kong, Bin; Liao, Jia-fen; He, Wang-wei; Wang, Zhi-qiang

    2016-04-01

    An optimal therapy for pulmonary embolism (PE) was explored by comparing three different methods in order to alleviate the sufferings of PE patients and reduce the mortality. Eighty patients with PE diagnosed by computed tomography angiography (CTA) were treated with thrombolysis, anticoagulation only, or surgery/intervention. The clinical efficacy of different treatments were compared and analyzed. Twenty-four out of the 26 patients (92%) in anticoagulation only group showed improvement in CTA and clinical presentations, which was significantly higher than that in the thrombolysis group (87%, n=39, Pthrombolysis group and anticoagulation only group. In the surgery/interventional group (n=15), the success rate was 47%, and the mortality rate was 14%. Both of them were significantly different from those in thrombolysis and anticoagulation only groups (both Pimportance to choose the appropriate therapeutic regimen for PE patients. Mortality may be reduced and prognosis may be improved with anticoagulation only and thrombolysis therapy. PMID:27072972

  14. 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

  15. 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.)

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

    International Nuclear Information System (INIS)

    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.)

  17. 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.)

  18. 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....

  19. Right atrial thrombus and massive pulmonary embolism refractory to thrombolytic therapy: A case report

    Directory of Open Access Journals (Sweden)

    Simon De Freitas

    2016-01-01

    Conclusion: Although current data are insufficient to direct a high level of evidence-based care, this case report and others highlight the feasibility and safety of surgical embolectomy in complicated cases of massive pulmonary embolism.

  20. 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.

  1. Ventilation-perfusion patterns in lung diseases (with reference to those observed in pulmonary embolism)

    International Nuclear Information System (INIS)

    The frequency distributions of ventilation-perfusion (V-P) patterns in various lung diseases were compared to those observed in pulmonary embolism in order to determine whether the V-P patterns for pulmonary embolism constituted a frequent finding in these disorders. The results showed that a segmental or labor perfusion defect with normal ventilation, was associated with a high probability of thromboembolic lung disease, and was not present in any of the other lung diseases studied. (orig.)

  2. Acute pulmonary embolism caused by enlarged uterine leiomyoma: A rare presentation

    OpenAIRE

    Khademvatani, Kamal; Rezaei, Yousef; Kerachian, Abdollah; Seyyed-Mohammadzad, Mir Hossein; Eskandari, Ramin; Rostamzadeh, Alireza

    2014-01-01

    Patient: Female, 42 Final Diagnosis: Acute pulmonary embolism Symptoms: Chest pain • dyspnea Medication: Streptokinase • Warfarin Clinical Procedure: — Specialty: Cardiology and Neoplasm Objective: Management of emergency care Background: Deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) caused by pelvic vein compression are rare and life-threatening complications of leiomyoma of the uterus. Case Report: We report a 42-year-old virgin woman with a history of leiomyoma who pr...

  3. Pulmonary Embolism following Cessation of Infliximab for Treatment of Miliary Tuberculosis

    Directory of Open Access Journals (Sweden)

    Brian Lee

    2014-01-01

    Full Text Available We report a case of a 41-year-old male who presented with tachycardia and swelling of his left arm six weeks after he started antituberculosis treatment and stopped his rheumatoid arthritis infliximab treatment. He was diagnosed with pulmonary embolism by chest CT and initially treated with warfarin, which interacted with his antituberculosis treatment. This presentation of deep vein thrombosis and pulmonary embolism as part of immune reconstitution inflammatory syndrome has not been previously reported for infliximab treated patients.

  4. Pulmonary Embolism following Cessation of Infliximab for Treatment of Miliary Tuberculosis

    Science.gov (United States)

    Moosavy, Farid

    2014-01-01

    We report a case of a 41-year-old male who presented with tachycardia and swelling of his left arm six weeks after he started antituberculosis treatment and stopped his rheumatoid arthritis infliximab treatment. He was diagnosed with pulmonary embolism by chest CT and initially treated with warfarin, which interacted with his antituberculosis treatment. This presentation of deep vein thrombosis and pulmonary embolism as part of immune reconstitution inflammatory syndrome has not been previously reported for infliximab treated patients. PMID:25530902

  5. Pulmonary embolism after a single-stage, combined anterior and posterior approach lumbar surgery

    OpenAIRE

    2013-01-01

    Pulmonary embolism is a fatal complication in orthopaedics surgery. While, the incidence of this life-threatening condition is low in spine surgery and few detailed reports have been published in English literatures. We present a case of pulmonary embolism which occurred after a single-stage, combined anterior and posterior approach surgery for L2 burst fracture. Although positive and timely rescue measures were performed, the patient died finally. We report the case to help spine surgeons to...

  6. Limited value of novel pulmonary embolism biomarkers in patients with coronary atherosclerosis

    DEFF Research Database (Denmark)

    Borgwardt, Henrik Gutte; Mortensen, Jann; Hag, Anne Mette Fisker;

    2011-01-01

    Recent research supports the efficacy of various plasma biomarkers in diagnosing pulmonary embolism (PE) including E-selectin, MMP-9, MPO, sVCAM-1, sICAM-1, adiponectin, hs-CRP and tPAI-1.......Recent research supports the efficacy of various plasma biomarkers in diagnosing pulmonary embolism (PE) including E-selectin, MMP-9, MPO, sVCAM-1, sICAM-1, adiponectin, hs-CRP and tPAI-1....

  7. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

    OpenAIRE

    Gerard O’Connor; Gareth Fitzpatrick; Ayman El-Gammal; Peadar Gilligan

    2015-01-01

    More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scena...

  8. Observations on the mechanism of hypoxaemia in acute minor pulmonary embolism.

    OpenAIRE

    Burton, G H; Seed, W A; Vernon, P.

    1984-01-01

    An automated computer analysis of ventilation-perfusion lung scans was used to derive graphical data from lung scans of 11 patients with acute minor pulmonary embolism, free of pre-existing cardiorespiratory disease, and with no evidence of intrapulmonary complication or pleural effusion. In each case the analysis showed the presence of areas of lung, remote from those affected by the pulmonary embolism, that had a pathological disturbance of ventilation-perfusion matching with relative overp...

  9. A Single Imaging Modality in the Diagnosis, Severity, and Prognosis of Pulmonary Embolism

    Directory of Open Access Journals (Sweden)

    Hadice Selimoglu Sen

    2014-01-01

    Full Text Available Introduction. This study aimed to investigate the currency of computerized tomography pulmonary angiography-based parameters as pulmonary artery obstruction index (PAOI, as well as right ventricular diameters for pulmonary embolism (PE risk evaluation and prediction of mortality and intensive care unit (ICU requirement. Materials and Methods. The study retrospectively enrolled 203 patients hospitalized with acute PE. PAOI was calculated according to Qanadli score. Results. Forty-three patients (23.9% were hospitalized in the ICU. Nineteen patients (10.6% died during the 30-day follow-up period. The optimal cutoff value of PAOI for PE 30th day mortality and ICU requirement were found as 36.5% in ROC curve analysis. The pulmonary artery systolic pressure had a significant positive correlation with right/left ventricular diameter ratio (r=0.531, P<0.001, PAOI (r=0.296, P<0.001, and pulmonary artery diameter (r=0.659, P<0.001. The patients with PAOI values higher than 36.5% have a 5.7-times increased risk of death. Conclusion. PAOI is a fast and promising parameter for risk assessment in patients with acute PE. With greater education of clinicians in this radiological scoring, a rapid assessment for diagnosis, clinical risk evaluation, and prognosis may be possible in emergency services without the need for echocardiography.

  10. Pulmonary embolism with acute pancreatitis: A case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Qing Zhang; Qing-Xia Zhang; Xiao-Ping Tan; Wei-Zheng Wang; Chang-Hua He; Li Xu; Xiao-Xia Huang

    2012-01-01

    Acute pancreatitis is an inflammatory disease characterized by local tissue injury which can trigger a systemic inflammatory response. So vascular complications of pancreatitis are a major cause of morbidity and mortality. Pulmonary embolism in acute pancreatitis has been reported to be very rare. We reported a case of pulmonary embolism with acute pancreatitis. A 38-year-old woman broke out upper abdomen pain without definite inducement. She had no nausea and vomiting, fever, dyspnea, cough and expectoration, chest pain. The patient had been diagnosed with acute pancreatitis in local hospital. The patient was treated with antibiotics and proton pump inhibitors, and the abdomen pain was alleviated slightly. But the patient came forth cough and expectoration with a little blood, progressive dyspnea. A computed tomographic scan of the abdomen revealed pancreatitis. Subsequent computer tomography angiography of chest revealed pulmonary embolism (both down pulmonary arteries, left pulmonary artery and branch of right pulmonary artery). Dyspnea of the patient got well with thrombolytic treatment and anti-coagulation therapy. Pulmonary embolism is a rare but potentially lethal complication of pancreatitis. Familiarity with this complication will aid in its early diagnosis, therapy and prevent pulmonary embolism, a rare but catastrophic phenomenon.

  11. 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.

  12. Analysis of risk factors of pulmonary embolism in diabetic patients

    International Nuclear Information System (INIS)

    Objective: To study the related risk factors in diabetic patients with pulmonary embolism (PE). Methods: 58 diabetic cases underwent lower limbs 99mTc-MAA veins imaging (and/or ultrasonography) and pulmonary perfusion imaging. The related laboratory data [fasting blood glucose (FBG), blood cholesterol, blood long chain triglycerides (LCT)] and clinic information [age, disease courses, chest symptoms (chest pain and short of breathe), lower limbs symptoms (swelling, varicose veins and diabetic foot) and acute complication (diabetic ketoacidosis and hyperosmolar non ketotic diabetic coma)] were collected simultaneously. SPSS was used for χ2-test and Logistic regression analysis. Results: (1) 28 patients (48.3%) were showed to be with lower limbs deep vein thrombosis (DVT) and by 99mTc-MAA imaging, 10 cases (17.2%) with PE. The PE ratios (32.1%) of the patients with DVT was more higher than no DVT (3.3%) (χ2 =6.53, P2≥4.23, P2≤2.76, P>0.05), respectively. (3) Multiplicity analysis indicated: the related risk factors for PE included chest symptoms (Score=13.316, P=0.000) and lower limbs symptoms (Score=7.780, P=0.005). No significant difference to other factors (Score≤2.494, P>0.114), respectively. Conclusion: The serious DM with chest symptoms, lower limbs symptoms and/or DVT must be controlled as early as possible by all kinds of treatment. It will decrease the PE complication. (authors)

  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. Widening of coronary sinus in CT pulmonary angiography indicates right ventricular dysfunction in patients with acute pulmonary embolism

    International Nuclear Information System (INIS)

    Right ventricular dysfunction (RVD) may occur in the course of acute pulmonary embolism (PE). Patients with RVD need more intensive treatment, and the prognosis is more severe. The aim of this study was to evaluate the usefulness of the measurement of the coronary sinus in the assessment of RVD in patients with acute PE and to compare it with other indicators of RVD. Retrospective assessment of 55 CT pulmonary angiography examinations with signs of acute PE was performed. Pulmonary artery systolic pressure (PASP) was echocardiographically assessed in all patients, and RVD was defined as PASP values greater than 30 mmHg. CT measurements included the size of the heart ventricles, mediastinal vessels and the width of the coronary sinus. Median width of the coronary sinus was 16 mm (range 12-24 mm) in patients with increased PASP and 10 mm (range 7-22 mm) in patients with normal PASP (p = 0.001). Best cut-off value was assessed to be 12.5 mm, with sensitivity 94% and specificity 75%. It was characterised by the largest area under ROC curve (0.82) among analysed parameters. Width of the coronary sinus seems to be a promising parameter for identification of RVD in patients with acute PE. A prospective study should be undertaken to further assess its clinical and prognostic applicability. (orig.)

  15. Blood flow redistribution and ventilation-perfusion mismatch during embolic pulmonary arterial occlusion

    OpenAIRE

    Burrowes, K. S.; Clark, A. R.; Tawhai, M.H

    2011-01-01

    Acute pulmonary embolism causes redistribution of blood in the lung, which impairs ventilation/perfusion matching and gas exchange and can elevate pulmonary arterial pressure (PAP) by increasing pulmonary vascular resistance (PVR). An anatomically-based multi-scale model of the human pulmonary circulation was used to simulate pre- and post-occlusion flow, to study blood flow redistribution in the presence of an embolus, and to evaluate whether reduction in perfused vascular bed is sufficient ...

  16. Arterial embolization for management of hemoptysis in pulmonary tuberculosis : factors of rebleeding

    International Nuclear Information System (INIS)

    To evaluate the effectiveness of arterial embolization in reducing hemoptysis in pulmonary tuberculosis, and rebleeding factors after embolization. Fifty-nine patients with massive or recurrent hemoptysis from pulmonary tuberculosis were underwent percutaneous transcatheter embolotherapy and thirteen were subsequently operated on. In 46 patients, we retrospectively analyzed on plain chest PA the extent of pulmonary tuberculosis lesions, the period from initial diagnosis to embolization, and angiographic findings. The extent of lesions shown on plain chest PA were classified into minimal, moderately advanced, and far advanced. If there was no evidence of rebleeding after the first embolization,this was regarded as initial success in the control of hemoptysis. Angiographic findings were classified into hypervascularity, shunt, aneurysmal dilatation, and extravasation. Using the chi-square test, differences in these findings between rebleedig and non-rebleeding cases were anlysed. Immediate control of hemoptysis was achieved in 27 (58.7%) of 46 patients. Hemoptysis recurred in 19 (41.3%) of 46 patients followed up. Rebleeding cases showed more nonbronchial systemic collateral vessels and shunt than non-rebleeding cases (p<0.05). More advanced lesions of pulmonary tuberculosis on plain chest PA showed an increased rebleeding rate after embolization, but this was not statistically significant. There was no correlation between the period from initial diagnosis of pulmonary tuberculosis to embolization and the rate of rebleeding. But the longer the period, the greater the number of nonbronchial systemic collateral vessels. In cases with more advanced lesions of pulmonary tuberculosis on plain chese PA and a long period from initial diagnosis of pulmonary tuberculosis to embolization, angiographic findings showed numerous nonbronchial systemic collateral vessels but increases in the rebleeding rate were statistically not significant. The greater the number of nonbronchial

  17. Changes in perfusion scintigraphy in the first days of heparin therapy in patients with acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Groot, M.R. de [Dept. of Vascular Medicine, Academic Medical Centre, Amsterdam (Netherlands); Dept. of Internal Medicine, Sophia Hospital, Zwolle (Netherlands); Oostdijk, A.H.J.; Engelage, A.H. [Dept. of Nuclear Medicine, Sophia Hospital, Zwolle (Netherlands); Marwijk Kooy, M. van [Dept. of Internal Medicine, Sophia Hospital, Zwolle (Netherlands); Bueller, H.R. [Dept. of Vascular Medicine, Academic Medical Centre, Amsterdam (Netherlands)

    2000-10-01

    Patients with suspected pulmonary embolism often receive heparin therapy for hours to days before ventilation/perfusion scintigraphy is completed. We assessed to what extent the lung scan classification and pulmonary vascular perfusion changed over a period of 2-4 days of full anticoagulant therapy. In 312 consecutive patients with at least one segmental perfusion defect on the initial perfusion scan, classification of both the initial and the final lung scan allowed us to study alteration in scan classification. Changes in pulmonary perfusion were assessed scintigraphically in a subgroup of 64 patients with proven pulmonary embolism. Among 79 patients with an initial high-probability lung scan, the final scan remained high probability in 77 whereas it became non-diagnostic and normal in one patient each. The lung scan classification did not change in any of the 233 patients who initially had a non-diagnostic scan. Thus, a different lung scan category was observed in only 2 out of 312 patients (0.6%; 95% CI 0.1%-2.3%). The mean pulmonary perfusion at baseline in the subgroup of 64 patients with pulmonary embolism was 62% (SD {+-}17%; range 26%-89%). A mean absolute improvement in pulmonary perfusion of only 4%{+-}11% (NS) was observed in the 2-4 days of observation. It is concluded that intravenous heparin therapy for a period of 2-4 days has only a minimal influence on the diagnostic lung scan classification and induces only minor changes in pulmonary vascular obstruction in the majority of patients. (orig.)

  18. 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

  19. Hypoxic pulmonary vasoconstriction as a contributor to response in acute pulmonary embolism.

    Science.gov (United States)

    Burrowes, K S; Clark, A R; Wilsher, M L; Milne, D G; Tawhai, M H

    2014-08-01

    Hypoxic pulmonary vasoconstriction (HPV) is an adaptive response unique to the lung whereby blood flow is diverted away from areas of low alveolar oxygen to improve ventilation-perfusion matching and resultant gas exchange. Some previous experimental studies have suggested that the HPV response to hypoxia is blunted in acute pulmonary embolism (APE), while others have concluded that HPV contributes to elevated pulmonary blood pressures in APE. To understand these contradictory observations, we have used a structure-based computational model of integrated lung function in 10 subjects to study the impact of HPV on pulmonary hemodynamics and gas exchange in the presence of regional arterial occlusion. The integrated model includes an experimentally-derived model for HPV. Its function is validated against measurements of pulmonary vascular resistance in normal subjects at four levels of inspired oxygen. Our results show that the apparently disparate observations of previous studies can be explained within a single model: the model predicts that HPV increases mean pulmonary artery pressure in APE (by 8.2 ± 7.0% in these subjects), and concurrently shows a reduction in response to hypoxia in the subjects who have high levels of occlusion and therefore maximal HPV in normoxia. PMID:24770844

  20. Pulmonary Artery Access Embolization in Patients with Massive Hemoptysis in Whom Bronchial and/or Nonbronchial Systemic Artery Embolization Is Contraindicated

    International Nuclear Information System (INIS)

    The objective of this paper is to present an alternative therapeutic approach for the treatment of patients with massive hemoptysis in whom bronchial and/or nonbronchial systemic arterial embolization is not possible. We describe a percutaneous procedure for pulmonary segmental artery embolization. Between May 2000 and July 2006, 27 adult patients with hemoptysis underwent percutaneous treatment at our department; 20 of 27 patients were embolized via bronchial and or nonbronchial systemic arteries and 7 patients were embolized via pulmonary artery. Femoral arterial access for systemic artery catheterization and femoral vein access for pulmonary arterial catheterization were used. Gelfoam particles and coils were used for embolization. In this study, we report on three cases of massive hemoptysis from a systemic arterial source in whom bronchial and/or nonbronchial arteries embolization was not possible. Percutaneous embolization via the pulmonary artery access was successful in all three patients. In conclusion, embolization via pulmonary artery is presented as an alternative approach for the management of hemoptysis in patients in whom bronchial arterial embolization is not possible

  1. 99m Tc scans in the diagnosis of pulmonary thrombosis and embolism

    International Nuclear Information System (INIS)

    1,500 pulmonary scans using technetium 99 are reported, and the value of this examination in the diagnosis of pulmonary embolism in patients with complex functional disorders and in their supervision is emphasized. The morphological aspect, especially in lateral films, and the variability of films taken at short intervals are well demonstrated and illustrated by scans which show their practical interest, in difficult cases, in the diagnosis of thrombosis and embolism. But is is above all in the supervision of such cases that radio-isotope scanning is the greatest interest to follow the course of thrombosis and embolism, diagnosed radiologically or clinically or by E.C.G., angiopneumography and radio-isotope scanning. The comparison of repeated lung scans permits to avoid repeated angiography and, alone, permits to follow up the embolic process and its pulmonary vascular consequences

  2. 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.

  3. Value of venous color flow duplex scan as initial screening test for geriatric inpatients with clinically suspected pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Kreidy R

    2011-09-01

    Full Text Available Raghid Kreidy1, Elias Stephan2, Pascale Salameh3, Mirna Waked4 1Department of Vascular Surgery, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon; 2Department of Geriatrics, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon; 3Laboratory of Clinical and Epidemiological Research, Faculty of Pharmacy, Lebanese University, 4Department of Pulmonary Medicine, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon Aim: The contribution of lower extremity venous duplex scan to the diagnostic strategy for pulmonary embolism has been demonstrated by many authors. However, the positive diagnostic value of this noninvasive test in clinically suspected pulmonary embolism is not very high (10%–18%. Since thromboembolic risks increase considerably in hospitalized patients with advanced age, this study aims to determine the importance of lower extremity venous color flow duplex scan in this particular subgroup of patients with clinically suspected pulmonary embolism. The effects of clinical presentation and risk factors on the results of duplex scan have been also studied. Methods: Between July 2007 and January 2010, 95 consecutive Lebanese geriatric ($60 years of age inpatients with clinically suspected pulmonary embolism assessed in an academic tertiary-care center for complete lower extremity venous color flow duplex scan were retrospectively reviewed. Age varied between 60 and 96 years (mean, 79.9 years. Forty patients were males and 55 females. Absence of compressibility was the most important criteria for detecting acute venous thrombosis. Results: Out of 95 patients, 33 patients (34.7% were diagnosed with recent deep venous thrombosis of lower extremities (14 proximal and 19 distal using complete venous ultrasound. Nine of these 33 patients (27.2% had a history of venous thromboembolism and eleven (33.3% presented with edema of lower

  4. Clinically unsuspected pulmonary embolism-an important secondary finding in oncology CT

    International Nuclear Information System (INIS)

    AIM: To determine the rate of finding incidental pulmonary embolisms (PE) at staging or follow-up chest computed tomography (CT) in oncology patients. MATERIALS AND METHODS: Three hundred and eighty-five consecutive chest CT examinations, performed in patients with cancer, were prospectively assessed during a 9-month period between October 2003 and June 2004. These were spiral acquisitions between 5 and 8 mm collimation acquired 25 s after intravenous contrast medium administration. PE was diagnosed if a filling defect was seen in the central pulmonary arteries on two or more consecutive slices. RESULTS: Ten of 385 (2.6%) of these patients had incidentally detected PE. This was not attributable to any specific malignancy or chemotherapeutic regimen. These emboli were all central, between the main pulmonary artery and the lobar level. Although the significance of these findings in patients not clinically suspected of having PE could be contentious, all the patients were started on therapeutic anticoagulation as a result of this observation. CONCLUSION: Over one in 40 oncology patients have incidental central PE visible on the CT images performed to assess their malignancy. Formal review of the pulmonary arteries, using a work station, is advised in patients with malignancy

  5. Correlation between CT features and clinical severity stratification in acute pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To analyze the correlation factors between CT imaging features of pulmonary embolism (PE) and clinical severity stratification, to explore the value of CT pulmonary angiography (CTPA) in acute PE severity stratification. Methods: According to the clinical severity, 48 patients with acute PE proved by CTPA were classified into two groups, including 21 critical and 27 non-critical patients. Embolism index, ratio of central pulmonary involvement, ratio of right ventricle maximum minor axis (RVMMA) to left ventricle maximum minor axis (LVMMA), namely RV: LV, dilation of main pulmonary and/or right pulmonary trunk, and dilation of bronchial arteries in both groups were analyzed comparatively. The correlation factors between CT imaging features and PE clinical severity stratification were explored. The correlation between RV: LV and embolism index of 48 patients was analyzed. Results: Pulmonary embolism index (22.0%-85.0%, median 38.0%), ratio of central pulmonary involvement (42.5%), RV: LV (0.90-1.90, median 1.30), dilation of pulmonary artery (14 eases), and dilation of bronchial artery (8 eases) in critical group (21 eases) were higher than those corresponding factors (5%-48%, median 21.5%, 31.25%, 0.80-1.40, median 1.00, 5 cases, and 3 cases) in non-critical group (27 cases) (Z=4.27, χ2=5.40, Z=2.58, χ2=11.45, χ2=4.87, P<0.05). There was remarkable correlation between RV: LV and embolism index (r=0.61, P<0.05). Conclusion: CTPA is feasible in evaluating PE severity stratification. The higher the embolism index, RV:LV, and the ratio of central pulmonary involvement, the higher probability of serious hemodynamic changes in PE patients. (authors)

  6. Imaging of nonthrombotic pulmonary embolism: biological materials, nonbiological materials, and foreign bodies.

    Science.gov (United States)

    Bach, Andreas Gunter; Restrepo, Carlos Santiago; Abbas, Jasmin; Villanueva, Alberto; Lorenzo Dus, María José; Schöpf, Reinhard; Imanaka, Hideaki; Lehmkuhl, Lukas; Tsang, Flora Hau Fung; Saad, Fathinul Fikri Ahmad; Lau, Eddie; Rubio Alvarez, Jose; Battal, Bilal; Behrmann, Curd; Spielmann, Rolf Peter; Surov, Alexey

    2013-03-01

    Nonthrombotic pulmonary embolism is defined as embolization to the pulmonary circulation caused by a wide range of substances of endogenous and exogenous biological and nonbiological origin and foreign bodies. It is an underestimated cause of acute and chronic embolism. Symptoms cover the entire spectrum from asymptomatic patients to sudden death. In addition to obstruction of the pulmonary vasculature there may be an inflammatory cascade that deteriorates vascular, pulmonary and cardiac function. In most cases the patient history and radiological imaging reveals the true nature of the patient's condition. The purpose of this article is to give the reader a survey on pathophysiology, typical clinical and radiological findings in different forms of nonthrombotic pulmonary embolism. The spectrum of forms presented here includes pulmonary embolism with biological materials (amniotic fluid, trophoblast material, endogenous tissue like bone and brain, fat, Echinococcus granulosus, septic emboli and tumor cells); nonbiological materials (cement, gas, iodinated oil, glue, metallic mercury, radiotracer, silicone, talc, cotton, and hyaluronic acid); and foreign bodies (lost intravascular objects, bullets, catheter fragments, intraoperative material, radioactive seeds, and ventriculoperitoneal shunts). PMID:23102488

  7. Long-term follow-up after embolization of pulmonary arteriovenous malformations with detachable silicone balloons

    DEFF Research Database (Denmark)

    Andersen, Poul Erik; Kjeldsen, Anette D

    2007-01-01

    ) with pulmonary angiography. Fifty-four percent of the balloons were deflated at latest radiographic chest film follow-up, but at pulmonary angiographic follow-up all embolized malformations were without flow irrespective of whether or not the balloons were visible. Detachable silicone balloons are not...

  8. Impact of ventilation/perfusion single-photon emission computed tomography on treatment duration of pulmonary embolism

    OpenAIRE

    Begic, Amela; Opanković, Emina; Cukić, Vesna; Rustempašić, Medzida; Bašić, Amila; Miniati, Massimo; Jögi, Jonas; Bajc, Marika

    2014-01-01

    Purpose The aim of the study was to establish whether the duration of anticoagulant (AC) therapy can be tailored, on an objective basis, by using ventilation/perfusion single-photon emission computed tomography (V/P SPECT) and to assess the extent of residual perfusion defects over time. In particular, we addressed the following: (a) is the extent of perfusion recovery at 3 months of initial pulmonary embolism (PE) diagnosis a satisfactory criterion for deciding the duration of oral AC? (b) I...

  9. Computer processsing of perfusion, ventilation, and V/Q images to highlight pulmonary embolism

    International Nuclear Information System (INIS)

    A method is described for generating regional ventilation/perfusion (V/Q) images of the lung to aid assessment of suspected pulmonary embolism, especially in patients with obstructive airways disease. The radionuclide scans used for this are stored on a computer and comprise: lung perfusion (P) with Tc-99m MAA, lung ventilation at equilibrium (E) with Xe-127, and the sum of the Xe-127 washout images (W). A functional ventilation image is calculated as V = E/W and a functional perfusion image as Q = P/E. Finally a ventilation perfusion ratio image is obtained by taking V/Q. This is normalised by a factor determined from the cumulative frequency distributions of the counts per pixel in the Q and V images so that areas which are well ventilated and perfused are given a V/Q value of 1.0. Areas with normalised V/Q values > 1.5 suggest pulmonary embolism. In 100 studies on patients with abnormal perfusion scans this method proved very helpful by assisting the recognition or exculsion of areas with abnormally high V/Q values. (orig.)

  10. 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.

  11. 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.

  12. Related research between right ventricular dysfunction and pulmonary embolism range of the patients with acute pulmonary thromboembolism

    International Nuclear Information System (INIS)

    Objective: The presence of right ventrieular dysfunction (RVD) increases morbidity and mortality of the patient with pulmonary thromboembolism (PTE). The aims of this study were to evaluate the relation between RVD on echocardiography and pulmonary embolism range on radionuclide palmonary ventilation-perfusion (V/Q) scan of the patients with acute PTE, and to discuss the diagnostic feasibility of RVD by pulmonary embolism range. Methods: All 348 patients with proven PTE were classified as two groups according to the echocardiography diagnosis. Two hundreds and twelve were with RVD and 136 were with normal right ventricular function (N-RVF). All underwent pulmonary V/Q imping.Statistical analysis was performed with SPSS 11.5, and the relation between RVD and pulmonary embolism range was performed with χ2 analysis, correlation analysis, receiver operating characteristic (ROC) curve analysis. Results: Signiticant relations between RVD (right/left ventricular end-diastolic diameter ratio (RVD/LVD)=0.52 ± 0.22. right/left ventricular transverse diameter ratio (RVTD/LVTD) =0.88 ± 0.26, tricuspid regurgitant pressure gradient (TRPG) = (31.93 ± 21.79) nun Hg (1 mm Hg = 0.133 kPa) and right ventricular anterior wall moilon (RVAWM) = (5.77 ± 1.99) mm) and pulmonary embolism range (1 ∼ 36, 11.4 ± 7.1) RVF and RVD and larger embolism range in RVD than in N-RVF (χ2=445.93, P2.58, P<0.01. Conclusion: The pulmonary embolism area waft negatively correlated with the RVD and had potential of being one of the references for the impression of RVD in PTE patients. (authors)

  13. Comparison between scintiscanning and pulmonary angiography in the diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    In the diagnosis of pulmonary embolism, radio-isotope scanning is specific when it reveals complete absence of focal, lobar or segmental perfusion. Diffuse reductions in perfusion cannot be considered significant except in patients with healthy heart and lungs. Radio-isotope scanning shows up well peripheral emboli. Angiography provides definite evidence when it shows up intravascular lacunae or definite vascular obstructions, the diagnosis is probable when localised hypovascularisation or asymmetric vascularisation are found. Angiocardiography and pulmonary scintiscanning are neither contrary nor comparable. Radio-isotope scanning is simpler and less dangerous perhaps and may always be carried out. When it is normal, it eliminates definitely the necessity for angiography the results of which are still morphological

  14. 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.

  15. Risk factors for mortality in patients with septic pulmonary embolism.

    Science.gov (United States)

    Oh, Hong Geun; Cha, Seung-Ick; Shin, Kyung-Min; Lim, Jae-Kwang; Kim, Hyun Jung; Yoo, Seung-Soo; Lee, Jaehee; Lee, Shin-Yup; Kim, Chang-Ho; Park, Jae-Yong

    2016-08-01

    Data regarding prognostic factors for patients with septic pulmonary embolism (SPE) are lacking. The purpose of the present study was to investigate the clinical features of SPE and to ascertain the risk factors for mortality in patients with this condition. Patients with SPE, whose data were retrospectively collected from a tertiary referral center in Korea, were categorized by the presence or absence of in-hospital death into two groups: death and survival groups. The two groups were compared for clinical and radiologic parameters. SPE was community-acquired in most patients (78%). The most common focus of primary infection was that of bone, joint, or soft tissue (33%), followed by liver abscess (17%). The in-hospital mortality was 12%. Multivariate analysis showed that tachypnea (odds ratio [OR] 4.73, 95% confidence interval [CI] 1.09-20.53, p = 0.038) and segmental or lobar consolidation on computed tomography (CT) scan (OR 10.79, 95% CI 2.51-46.43, p = 0.001) were independent predictors of in-hospital death in SPE patients. Taken together, the primary infectious foci of SPE in Korea are different from those reported in Western countries. Tachypnea and segmental or lobar consolidation on CT scan may be independent risk factors for in-hospital death in these patients. PMID:27346380

  16. 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.

  17. Developments in the management and treatment of pulmonary embolism.

    Science.gov (United States)

    Limbrey, Rachel; Howard, Luke

    2015-09-01

    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. PMID:26324810

  18. Chronic pulmonary embolism - radiological imaging and differential diagnosis; Chronische Lungenembolie - Radiologische Bildmorphologie und Differenzialdiagnose

    Energy Technology Data Exchange (ETDEWEB)

    Coppenrath, E.; Herzog, P.; Attenberger, U.; Reiser, M. [Klinikum Innenstadt der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany)

    2007-08-15

    In chronic pulmonary embolism branches of the pulmonary arterial tree remain partially or totally occluded. This may lead to pulmonary hypertension with the development of right ventricular hypertrophy as well as structural changes of pulmonary arteries. Imaging of chronic pulmonary embolism should prove vessel occlusions (pulmonary angiography, MSCT, MRI) and reduction of regional lung perfusion (lung scanning, MSCT, MRI). According to current guidelines ventilation-perfusion lung scanning and pulmonary angiography are still recommended as the methods of choice. MSCT and MRI provide technical alternatives which are helpful in differential diagnosis versus other types of pulmonary hypertension. In spite of medical and surgical measures (in rare cases pulmonary thromboendarterectomy) the prognosis of chronic pulmonary embolism remains unfavourable. (orig.) [German] Bei der chronischen Lungenembolie sind Abschnitte der arteriellen Lungenstrombahn dauerhaft verschlossen. Dies kann zu einer Erhoehung des pulmonal-arteriellen Drucks mit den Folgen einer Rechtsherzbelastung und strukturellen Veraenderungen der Pulmonalarterien fuehren. Bildmorphologisch nachzuweisen sind Gefaessverschluesse (Pulmonalisangiographie, MSCT, MRT) und die Minderperfusion des Lungenparenchyms (Szintigraphie, MSCT, MRT). Nach den bisherigen Empfehlungen gelten fuer die Diagnostik der chronischen Lungenembolie die Lungenszintigraphie (Ventilation/Perfusion) und die Pulmonalisangiographie als Methoden der ersten Wahl. Die MSCT und MRT (Angiographie/Perfusion) stellen technische Alternativen dar. Differenzialdiagnostisch sind andere Formen der pulmonalen Hypertonie abzugrenzen. Trotz medikamentoeser und chirurgischer Therapiemassnahmen (z. B. pulmonale Thrombendarterektomie) bleibt die Prognose der chronischen Lungenembolie unguenstig. (orig.)

  19. 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

  20. Noninvasive diagnosis of pulmonary embolism. Final report 1 Jul 79-30 Jun 81

    International Nuclear Information System (INIS)

    The noninvasive nature of diagnosing pulmonary embolism was investigated along two different lines: labeling of platelets with indium-111-oxine as a tracer to identify pulmonary emboli by gamma camera imaging (hot spot imaging) and by determination of platelet factor-4 release in patients with venous thromboembolism. Primary effort was devoted to the refinement of the process of labeling platelets to achieve maximum efficiency of labeling. Our current technique permits us to label with an efficiency approaching 80%, with minimal free indium. In addition, a closed system for labeling platelets was developed which maintains sterility in the final product. Animals with experimental pulmonary emboli could be imaged consistently to show 'hot' pulmonary emboli by scanning. However, it was shown that the presence of heparin in the blood interferes with the attachment of labeled platelets to thrombi, resulting in a negative scan. Without heparin, the scans become positive. It was also shown that heparin does not interfere with the labeling of platelets with indium-111-oxine. Results from the patient study of platelet factor-4 suggest that when active venous thromboembolism is present, levels of platelet factor-4 are elevated. Sufficient data are not yet available, however, to assess its true value as a marker for venous thromboembolism. Finally, work has almost been completed in the isolation of canine antibodies to platelet factor-4, permitting the development of this test in the experimental animal

  1. Post-traumatic pulmonary embolism in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Mabrouk Bahloul

    2011-01-01

    Full Text Available Objective: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE admitted in the intensive care unit (ICU. Methods: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients admitted to our ICU were classified into two groups. The first group included all patients with confirmed PE; the second group included patients without clinical manifestations 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 its branches. Results: During the study period, 1067 trauma patients were admitted in our ICU. The diagnosis of PE was confirmed in 34 patients (3.2%. The mean delay of development of PE was 11.3 ± 9.3 days. Eight patients (24% developed this complication within five days of ICU admission. On the day of PE diagnosis, the clinical examination showed that 13 patients (38.2% were hypotensive, 23 (67.7% had systemic inflammatory response syndrome (SIRS, three (8.8% had clinical manifestations of deep venous thrombosis (DVT, and 32 (94% had respiratory distress requiring mechanical ventilation. In our study, intravenous unfractionated heparin was used in 32 cases (94% and low molecular weight heparin was used in two cases (4%. The mean ICU stay was 31.6 ± 35.7 days and the mean hospital stay was 32.7 ± 35.3 days. The mortality rate in the ICU was 38.2% and the in-hospital mortality rate was 41%. The multivariate analysis showed that factors associated with poor prognosis in the ICU were the presence of circulatory failure (Shock (Odds ratio (OR = 9.96 and thrombocytopenia (OR = 32

  2. 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

    BACKGROUND: The prothrombotic effect of combined oral contraceptives (COCs) is well-established, with a 3-6-fold increased risk of VTE compared to non-users. When initiation of COCs is considered, it is therefore of paramount importance to carefully evaluate all other potential risk factors for VTE....... Based on a case of life-threatening COC-associated pulmonary embolism in a girl heterozygous for the prothrombin G20210A mutation and with a family history of thrombotic disease, we discuss the importance of assessing not just the genotype but also the phenotype when considering initiation of COCs in...... total occlusion of the right pulmonary artery, and several minor peripheral embolisms bilaterally. She was successfully treated with thrombolysis (alteplase) followed by aPTT-adjusted heparin infusion until adequate anticoagulation with warfarin was achieved. Two years earlier, the patient had been...

  3. Bronchial Artery Embolization in the Management of Pulmonary Parenchymal Endometriosis with Hemoptysis

    International Nuclear Information System (INIS)

    Pulmonary parenchymal endometriosis is extremely rare and usually manifests itself with a recurrent hemoptysis associated with the menstrual cycle. The therapies proposed for women with endometriosis consist of medical treatments and surgery. Bronchial artery embolization has become a well-established and minimally invasive treatment modality for hemoptysis, and to the best of our knowledge, it has not been reported in pulmonary endometriosis. We report a case of pulmonary parenchymal endometriosis treated with embolotheraphy for hemoptysis.

  4. Prognostic value of D-dimer in elderly patients with Pulmonary Embolism.

    Science.gov (United States)

    Polo Friz, Hernan; Buzzini, Chiara; Orenti, Annalisa; Punzi, Veronica; Molteni, Mauro; Primitz, Laura; Cavalieri d'Oro, Luca; Arpaia, Guido; Boracchi, Patrizia; Cimminiello, Claudio

    2016-10-01

    In a general population with acute Pulmonary Embolism (PE) elevated D-dimer concentrations associate with increased mortality. The aim of the study was to assess the ability of D-dimer to predict 30 and 90-days mortality in elderly patients with acute PE. Hemodynamically stable patients aged ≥65 years old with confirmed PE were included in this retrospective cohort study. A pulmonary computerized tomography angiography scan, D-dimer concentrations, simplified Pulmonary Embolism Severity Index (sPESI) variables and vital status were available for all patients. The study included 154 confirmed cases of PE (23.5 % of suspected), median age 79.1 years. D-dimer was higher in patients dead than in those alive at 30 (median 14,547 vs. 8340 ng/mL, p = 0.05) and 90 days (13,604 vs. 7973 ng/mL, p = 0.013). When adding D-dimer to sPESI, the discriminant capacity to predict mortality within 30 and 90 days was increased by 0.080 and 0.089, respectively. The contribution of D-dimer to the discriminating ability was NRI = 0.286 (95 % CI -0.198 to 0.770, p value: 0.247) at 30 days and NRI = 0.605 (95 % CI 0.223-0.988, p-value: 0.002) at 90 days.D-dimer concentration was associated with 30 and 90-days mortality and showed a higher discriminant capacity than sPESI alone to predict 90-days mortality. Adding D-dimer concentrations to sPESI score seems to improve its prognostic ability, supporting multivariable risk models as the best approach to estimate prognosis in elderly patients with PE. PMID:27357135

  5. Studies of ventilation and perfusion in rabbits with experimental pulmonary embolism

    International Nuclear Information System (INIS)

    Ventilation and perfusion studies were performed on 38 experimental rabbits with multiple pulmonary emboli. These embolic materials were human thrombin, lipiodol ultrafluide, gelfoam fragments, ivalon fragments, iron powder and VX-2 cancer. Immediately after the embolization, Xe-133 washout study was begun with the intravenous injection of dissolved xenon. Thereafter, perfusion images were obtained using Tc-99m albumin microspheres (7 to 25μm in diameter). When Xe-133 gas was used, the ventilation study consisting of single-breath, equilibrium after 2.5 minutes and sequential washout images, was carried out in the rabbits. Perfusion scintigrams after embolization showed multiple segmental and subsegmental defects of blood flow to the embolic regions within the both lungs. Xe-133 ventilation images showed homogeneous washout. These thromboemboli had almost disappeared perfusion scintigraphically at 24 hours after embolization. However, in a rabbit after embolization with ivalon fragments mixed with iron powders, a lobar defect in the anterior lobe of the left lung persisted perfusion scintigraphically after 24 hours. Xe- 133 washout from the nonperfused area was considerably prolonged at 20 minutes after embolization. In rabbits after diffuse pulmonary oily microembolization, the washout studies after equilibrium breathing of xenon gas showed remarkable delay in clearing the gas from the whole lung. The perfusion images revealed the fissure sign as a linear area of decreased radioactivity which corresponds to the interlobar fissure. (author)

  6. 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. PMID:24110602

  7. 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.

  8. Ventilation-perfusion lung imaging and selective pulmonary angiography in dogs with experimental pulmonary embolism

    International Nuclear Information System (INIS)

    To determine the accuracy and limitations of Xe-133 ventilation and Tc-99m perfusion lung images (V-P images) in detecting pulmonary emboli (PE), these studies were performed in 23 dogs after experimental production of PE by a modified Wessler technique. Fourteen of the animals also underwent selective pulmonary angiography. Xenon-133 abnormalities were seen immediately after embolization in two of the 23 animals (8.7 percent). Perfusion images revealed the location of 83 percent of emboli that completely obstructed pulmonary vessels, but only 26 percent of those that partially obstructed flow. Defects were seen with 97 percent of emboli that completely occluded vessels larger than 2.0 mm in diameter, but in only 66 percent of those occluding smaller vessels. Oblique perfusion images provided the only evidence of the perfusion defect associated with five of 88 (5.7 percent) angiographically proven emboli. V-P imaging is a sensitive technique for detecting PE unless the emboli lodge in very small vessels or incompletely obstruct a vessel. Xenon-133 abnormalities occur infrequently following PE, and should not be a common cause for a false-negative V-P match in clinical practice

  9. 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

  10. Pulmonary embolism in congenital bleeding disorders: intriguing discrepancies among different clotting factors deficiencies.

    Science.gov (United States)

    Girolami, Antonio; Cosi, Elisabetta; Tasinato, Valentina; Peroni, Edoardo; Girolami, Bruno; Lombardi, Anna Maria

    2016-07-01

    Pulmonary embolism is a complication of deep vein thrombosis. It occurs in the population with a normal clotting mechanism, but it may also occur in patients with congenital bleeding conditions. Here, we report on all cases of pulmonary embolism in congenital hemorrhagic disorders. All reported cases of pulmonary embolism in congenital coagulation disorders have been gathered by a time-unlimited PubMed search. Cross-checking of the references listed at the end of the single papers was carried out to avoid omissions. Seventy-two patients had an objectively demonstrated pulmonary embolism. The event occurred in patients with fibrinogen, factor V, factor VIII (FVII), FVIII, FIX, and FXI deficiency, and in those with von Willebrand's disease. No embolism was reported in FII, factor X, and FXIII deficiency. Thirty were women and 28 were men, whereas in the remaining 14 cases, sex was not reported. Age varied from 6 to 81 years (mean age 34.3 years). The management varied from only supportive to the administration of unfractionated heparin, low-molecular-weight heparin, and anti-vitamin K medications, accompanied by adequate replacement therapy. Evolution was fair or good in the majority of cases, but there were 10 fatalities. Risk factors were present in 61 patients. The most frequent of these were replacement therapy (35 cases), surgery (34), and old age (13). Some patients had more than one risk factor. Eleven patients had no risk factors. There are discrepancies in the prevalence of pulmonary embolism among different clotting disorders. The conditions most frequently affected are FVII deficiency and fibrinogen defects. The significance of the findings is discussed. PMID:26829362

  11. Lung scanning after massive pulmonary embolism in thoracic surgery: reverse flow phenomena

    International Nuclear Information System (INIS)

    After thoracotomy, the pulmonary circulation on the operated side is definitely reduced for several weeks. All lung scans carried out during this post-operative period thus show marked asymmetry between the two lungs. The pulmonary blood flow is then much greater in the healthy lung compared with the operated lung where hypoventilation increases vascular resistance. When pulmonary embolism occurs, two abnormalities are noted: amputation of part of the lung field on the healthy side and, paradoxically, normal activity on operated side. After treatment with Urokinase (3 cases) the previous findings were restored. The embolic area disappeared and the operated lung became less marked. Under heparin therapy (2 cases) the phenomenon was more prolonged in time. This inversion of the vascular distribution for which the term of reverse flow has been proposed, shows the purely functional character of certain changes in pulmonary scans

  12. Computerized detection of pulmonary embolism in computed tomographic pulmonary angiography (CTPA): improvement of vessel segmentation

    Science.gov (United States)

    Zhou, Chuan; Chan, Heang-Ping; Kuriakose, Jean W.; Chughtai, Aamer; Hadjiiski, Lubomir M.; Wei, Jun; Patel, Smita; Kazerooni, Ella A.

    2011-03-01

    Vessel segmentation is a fundamental step in an automated pulmonary embolism (PE) detection system. The purpose of this study is to improve the segmentation scheme for pulmonary vessels affected by PE and other lung diseases. We have developed a multiscale hierarchical vessel enhancement and segmentation (MHES) method for pulmonary vessel tree extraction based on the analysis of eigenvalues of Hessian matrices. However, it is difficult to segment the pulmonary vessels accurately when the vessel is occluded by PEs and/or surrounded by lymphoid tissues or lung diseases. In this study, we developed a method that combines MHES with level set refinement (MHES-LSR) to improve vessel segmentation accuracy. The level set was designed to propagate the initial object contours to the regions with relatively high gray-level, high gradient, and high compactness as measured by the smoothness of the curvature along vessel boundaries. Two and eight CTPA scans were randomly selected as training and test data sets, respectively. Forty volumes of interest (VOI) containing "representative" vessels were manually segmented by a radiologist experienced in CTPA interpretation and used as reference standard. The results show that, for the 32 test VOIs, the average percentage volume error relative to the reference standard was improved from 31.7+/-10.9% using the MHES method to 7.7+/-4.7% using the MHES-LSR method. The correlation between the computer-segmented vessel volume and the reference standard was improved from 0.954 to 0.986. The accuracy of vessel segmentation was improved significantly (p<0.05). The MHES-LSR method may have the potential to improve PE detection.

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

    OpenAIRE

    Bahloul Mabrouk; Chaari Anis; Kallel Hatem; Abid Leila; Hamida Chokri Ben; Dammak Hassen; Rekik Noureddine; Mnif Jameleddine; Chelly Hedi; Bouaziz Mounir

    2010-01-01

    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...

  14. 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.

  15. 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.

  16. Bronchial artery embolization for therapy of pulmonary bleeding in patients with cystic fibrosis

    International Nuclear Information System (INIS)

    Introduction: Acute pulmonary emergencies in patient with cystic fibrosis (CF) can be found in cases of pneumothorax as well as hemoptysis. If the bleeding cannot be stopped by conservative methods, an embolization of the bronchial arteries should be done. Materials and Method: 11 patients were embolized using a combination of PVA particles and microcoils. Results: From January 1996 to June 2001 17 bronchial arteries in 11 patients were embolized. 7 patients suffered from chronical hemoptysis, 4 patients had an acute hemoptysis. In 4 patients both sides were embolized, in 3 patients only one side. The remaining 4 patients needed a second intervention, embolizing the other side. The primary embolizated bronchial artery was still closed in all 4 patients. In 1 patient the selective catheterization of a bronchial artery was not successful, thus the embolization could not be carried out. 1 patient died 5 days after the intervention due to a fulminant pneumonia (Pseudomonas aeruginosa) without recurrent bleeding. In two patients atypical branches from intercostal arteries feeding the bronchial arteries were detected and successfully embolized. All patients profited from the therapy, as bleeding could be stopped or at least be reduced. 3 patients suffered from back pain during or after intervention. There were no severe complications like neurological deficiencies or necroses. (orig.)

  17. Relative accuracy of two diagnostic schemes for detection of pulmonary embolism by ventilation-perfusion scintigraphy

    International Nuclear Information System (INIS)

    Two diagnostic schemes for detection of pulmonary embolism by ventilation-perfusion (V-P) scintigraphy were compared for relative accuracy by two groups of observers interpreting 70 V-P scintiscans. Observers in Group B, who used the criteria recently proposed by Biello et al., had a significantly smaller average number of indeterminate interpretations (41%) than did the observers in Group A (55%), who used a simpler scheme (p less than 0.05). In addition, Group B showed a slight improvement in positive predictive value without a deterioration in the negative predictive value compared with Group A. Along with this improvement in diagnostic performance, Group B achieved a significant reduction in interobserver variability compared with Group A for patients without pulmonary embolism (p less than 0.05). There was no significant difference in interobserver variability between the two groups for patients with pulmonary embolism. The diagnostic scheme introduced by Biello et al. represents a useful improvement for the diagnosis of pulmonary embolism by V-P imaging

  18. Risk profile and clinical outcome of symptomatic isolated subsegmental pulmonary embolism

    NARCIS (Netherlands)

    Den Exter, P. L.; Van Es, J.; Klok, F. A.; Kroft, L. J. M.; Kruip, J. H. A.; Kamphuisen, P. W.; Buller, H. R.; Huisman, M.

    2013-01-01

    Background: Improved imaging techniques have led to an increased detection of subsegmental pulmonary embolism (SSPE). The clinical significance of SSPE is often doubted by clinicians and remains to be determined. Aims: To investigate whether SSPE forms a distinct subset of thromboembolic disease com

  19. 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...

  20. [Treatment standards of the oral anticoagulant in patients with idiopathic pulmonary embolism].

    Science.gov (United States)

    Kowalski, Zbigniew; Kowalski, Piotr; Grzegorek, Damian

    2016-08-01

    The optimal and the most effective treatment of pulmonary embolism is still a matter of concern and each day sees a new set of challenges for the world of medicine. The progress, has been made in recent years, improved quality of life and caused much better treatment results. This is difficult issue in patients, receiving anticoagulant therapy, because they require an individual approach and adjustability to the therapeutic possibilities. The benefits of long-term anticoagulant therapy, which decreases relapses of idiopathic venous thromboembolism and diminishes risk of thromboembolic complications, should be taking under consideration. It is still a matter of dispute the time of carrying out of treatment, especially after the first life idiopathic episode of pulmonary embolism. The purpose of this paper is an overview and a summary of the foregoing achievements concerned the standards of idiopathic pulmonary embolism treatment, expecting benefits flowing with using new oral anticoagulants, as an alternative to known for decades Vitamin K antagonist drugs. A lot of information about new oral anticoagulants speaks in favor of their use, but unknown safety of the drugs caused searching the best strategy of pulmonary embolism treatment all the time. PMID:27591448

  1. Diagnosis of lung embolism by V / Q scintigraphy. Pt. 2. SPECT and SPECT-CT for pulmonary diagnostic in nuclear medicine; V / Q-Szintigrafie zur Diagnostik der Lungenembolie. T. 2. SPECT und SPECT-CT in der nuklearmedizinischen Lungendiagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Krause, T. [Universitaetsklinik fuer Nuklearmedizin, Bern (Switzerland). Inselspital

    2008-12-15

    Imaging of the pulmonary ventilation and perfusion by using SPECT proved to be a useful development of this examination. At first this article gives a brief overview of the technical aspects followed by a discussion of clinical questions regarding pulmonary embolism, preoperative assessment of postoperative lung function as well as radioaerosol deposition and clearance. (orig.)

  2. Krypton 81m ventilation studies in pulmonary embolic disease. Chapter 10

    International Nuclear Information System (INIS)

    Results are presented of 81Krsup(m) ventilation studies carried out on 22 patients suspected of pulmonary embolic disease. All patients showed one or more focal defects of lung perfusion with preserved ventilation, and this was regarded as evidence of pulmonary vascular occlusion. Less than half had a normal distribution of ventilation. Of those with abnormalities, the majority could be accounted for by clinical radiological evidence of abnormalities of lung airways. A small group, however, could have represented bronchial occlusion or narrowing secondary to pulmonary emboli. (author)

  3. Coil Embolization Treatment in Pulmonary Artery Branch Rupture During Swan-Ganz Catheterization

    International Nuclear Information System (INIS)

    Rupture of the pulmonary artery or one of its branches during Swan-Ganz catheterization is a complication that is rare but remains fatal in almost 50% of cases. The risk factors and mechanisms involved in the pathogenesis of this accident have been widely reported. Management is twofold: resuscitation procedures and specific medical or even surgical treatment. We report a case of pulmonary artery rupture occurring during Swan-Ganz catheterization that was treated by coil embolization. This technique, which is quick and simple to use, would appear to be very promising. This is the first case of successful emergency treatment of pulmonary artery rupture using an endovascular technique

  4. [Massive pulmonary embolism due to hydatid vesicles. Report of a case (author's transl)].

    Science.gov (United States)

    Grau Junyent, J M; Vernet Vernet, M; Fernández-Huerta, J M; Ramírez Ruz, J; Urbano-Márquez, A; Rozman, C

    1980-04-25

    A patient with hepatic and peritoneal hydatidosis suffered acute episodes of restrictive bronchial disease for the last 2 years. The patient was admitted during the course of one of this acute episodes with clinical symptoms of pulmonary embolism. Supportive therapeutic measures were prescribed, but the patient died 12 hours latter. Autopsy revealed hepatic, peritoneal and pulmonary hidatidosis as well as multiple pulmonary thromboembolisms due to hydatid vesicles. Literature on this subject is reviewed, and different clinical forms and therapeutic possibilities are discussed. The importance of small therapeutic possibilities are discussed. The importance of small recurrent hydatid embolisms in the pathogenesis of acute or subacute cor pulmonale in patients with liver hydatidosis is stressed. PMID:7374237

  5. Value of multislice CT for the work-up of pulmonary embolism

    International Nuclear Information System (INIS)

    Multislice computed tomography (MSCT) of the pulmonary arteries has overcome the limitations of single-slice CT and is accepted as the sole reference standard for imaging pulmonary embolism (PE) in many institutions. This technique provides the opportunity of efficient risk stratification to enable adequate differential therapy. With a low or intermediate pretest probability and a negative CT angiography (CTA), relevant PE can be ruled out safely. In >30% further diagnoses other than pulmonary embolism, e.g., pneumonia or aortic aneurysm, can be established on the basis of thoracic CTA. This article discusses the present role of MSCT in diagnostic imaging of PE and provides optimized acquisition protocols as well as practical aspects for secondary image reconstruction. Examples of typical imaging features of PE are shown. Diagnostic algorithms for daily emergency practice are discussed with respect to artifacts and pitfalls in image interpretation. (orig.)

  6. 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

  7. Asymptomatic Bone Cement Pulmonary Embolism after Vertebroplasty: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Girolamo Geraci

    2013-01-01

    Full Text Available Introduction. Acrylic cement pulmonary embolism is a potentially serious complication following vertebroplasty. Case Report. A 70-year-old male patient was treated with percutaneous vertebroplasty for osteoporotic nontraumatic vertebral collapse of L5-S1. Asymptomatic pulmonary cement embolism was detected on routine postoperative chest radiogram and the patient was treated with enoxaparin, amoxicillin, and dexamethasone. At the followup CT scan no further migration of any cement material was reported; and the course was uneventful. Discussion. The frequency of local leakage of bone cement is relatively high (about 80–90%, moreover, the rate of cement leakage into the perivertebral veins (seen in up to 24% of vertebral bodies treated with consequent pulmonary cement embolism varies from 4.6 to 6.8% (up to 26% in radiologic studies; the risk of embolism is increased with the liquid consistency of the cement and with the treatment of some malignant lesions. Patients may remain asymptomatic and develop no known long-term sequelae. Conclusions. Our ancedotal case illustrates the need for close monitoring of patients undergoing percutaneous vertebroplasty and emphasizes the importance of prompt and correct diagnosis and treatment, even if actually there is no agreement regarding the therapeutic strategy.

  8. Study on incidence of pulmonary embolism in patients with cardiac pacemakers using lung perfusion mapping and ventilation scanning

    International Nuclear Information System (INIS)

    We investigated pulmonary perfusion mapping and ventilation scanning employing 99mTC-MMA and 81mKr-Gas in patients with DDD and VVI cardiac pacemaker implantation. In 51 cases among 175 patients we observed some defects which matched the results from lung perfusion scanning in the pulmonary segments and sub-segments. These were diagnosed as pulmonary embolism after the possibility of other pulmonary diseases was rejected. The incidence rate of pulmonary embolism in patients with VVI (Ventricular pacing/sensing, inhibited type) pacemakers was 47 out of 138, or 34.1%, especially for those who received a pulmonary scanning examination whithin 6 months after pacemaker implantation. In contrast, those who were examined after 6 months had lower rates as well as chronological factors. The incidence rate of pulmonary embolism in 37 patients with DDD (Double chamber pacing/sensing, double modes of response) pacemakers was 10.8%, considerably lower than that for patients with VVI pacemakers. Therefore, one main factor of pulmonary embolism in patients with pacemakers could be the non-physiological phase of the contractions of both atria and ventricles. Other factors, such as the presence of foreign bodies in the endocardium, aging, and hypertension, could also promote pulmonary embolism. (author)

  9. 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.......6-3.3]). In the GPA cohort, 70% of the vascular events occurred during phases with active vasculitis. CONCLUSION: The present study confirms that GPA patients have a markedly increased risk of venous thromboembolism. We did not observe an increased risk of stroke in our cohort. Thus, our observations demonstrate...

  10. Critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected pulmonary embolism.

    Science.gov (United States)

    Fesmire, Francis M; Brown, Michael D; Espinosa, James A; Shih, Richard D; Silvers, Scott M; Wolf, Stephen J; Decker, Wyatt W

    2011-06-01

    This clinical policy from the American College of Emergency Physicians is the revision of a 2003 clinical policy on the evaluation and management of adult patients presenting with suspected pulmonary embolism (PE).(1) A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) Do objective criteria provide improved risk stratification over gestalt clinical assessment in the evaluation of patients with possible PE? (2) What is the utility of the Pulmonary Embolism Rule-out Criteria (PERC) in the evaluation of patients with suspected PE? (3)What is the role of quantitative D-dimer testing in the exclusion of PE? (4) What is the role of computed tomography pulmonary angiogram of the chest as the sole diagnostic test in the exclusion of PE? (5) What is the role of venous imaging in the evaluation of patients with suspected PE? (6) What are the indications for thrombolytic therapy in patients with PE? Evidence was graded and recommendations were given based on the strength of the available data in the medical literature. PMID:21621092

  11. 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.

  12. 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.

  13. Catheter-related right atrial thrombus and pulmonary embolism: A case report and systematic review of the literature

    OpenAIRE

    Karen EA Burns; Andrew McLaren

    2009-01-01

    Central venous catheters (CVCs) are commonly used in clinical practice. One of the foremost complications associated with their use is the potential for symptomatic or asymptomatic thrombosis. CVC thrombosis, in turn, may not only result in vascular and catheter occlusion but also infection, pulmonary embolism, and formation of right heart thromboemboli. Thrombi within cardiac chambers are associated with an increased risk of mortality due to their potential for embolization to the pulmonary ...

  14. 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.)

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

    International Nuclear Information System (INIS)

    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.)

  16. Diagnostic efficacy of ventilation/perfusion (V/Q) segmental equivalent concept in the diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    One hundred and twenty-nine angiographically proven ventilation/perfusion (V/Q) lung scans in patients with suspected pulmonary embolism (PE) were analyzed. Three V/Q matching and 8 V/Q mismatching patterns were identified. Likelihood ratios and probability estimates of pulmonary embolism based on Bayes' analysis were obtained for each of the 11 V/Q patterns. When the prevalence of pulmonary embolism is 40% (pretest probability), a normal perfusion pattern, a non-segmental V/Q mismatch pattern, 1 segmental equivalent V/Q mismatch without diffuse xenon retention, and single lobar V/Q mismatch pattern without additional mismatching defects had 0% posterior probability for pulmonary embolism. V/Q matching pattern without X-ray opacification had 7% posterior probability for pulmonary embolism. The V/Q mismatch pattern between 1 and 1.5 segment equivalents with single segmental defects had 86% posterior probability for PE. Ventilation/perfusion mismatch defect greater than 1.5 segmental equivalent without lobar defects had 95% posterior probability for PE and lobar V/Q mismatch defect with additional segmental defects had 90% posterior probability for pulmonary embolism

  17. 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.)

  18. Java interface to a computer-aided diagnosis system for acute pulmonary embolism using PIOPED findings

    Science.gov (United States)

    Frederick, Erik D.; Tourassi, Georgia D.; Gauger, Matthew; Floyd, Carey E., Jr.

    1999-05-01

    An interface to a Computer Aided Diagnosis (CAD) system for diagnosis of Acute Pulmonary Embolism (PE) from PIOPED radiographic findings was developed. The interface is based on Internet technology which is user-friendly and available on a broad range of computing platforms. It was designed to be used as a research tool and as a data collection tool, allowing researchers to observe the behavior of a CAD system and to collect radiographic findings on ventilation-perfusion lung scans and chest radiographs. The interface collects findings from physicians in the PIOPED reporting format, processes those findings and presents them as inputs to an artificial neural network (ANN) previously trained on findings from 1,064 patients from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study. The likelihood of PE predicted by the ANN and by the physician using the system is then saved for later analysis.

  19. [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.

  20. The application of multi-slice CT and image post processing techniques in diagnosing of pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To characterize the pulmonary embolism (PE) on multi-slice CT pulmonary angiography, and to evaluate the role of multi-slice CT pulmonary angiography (CTPA) in the diagnosis of PE. Methods: Forty-five patients with PE confirmed by CTPA were retrospective analyzed. Images were reconstructed with maximal intensity projection (MIP), multiple planar reconstruction (MPR) and volume rendering technique (VRT). The display of pulmonary arteries and the ability of detecting embolisms were compared among the three different reconstruction techniques. Results: MPR images showed superiority to MIP and VRT images in displaying embolisms (P<0.05). Conclusion: MPR images were better than those of MIP and VRT, but provided poor three-dimensional information; MIP and VRT were more straightforward than MPR in displaying large branches of pulmonary artery. MPR combined with MIP and VRT could help to accurately establish PE diagnosis. (author)

  1. 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.

  2. Multifactal analysis for the quantification of pulmonary embolism in ventilation-perfusion scans

    International Nuclear Information System (INIS)

    The clinical presentation of pulmonary embolism is highly non-specific. This preliminary study aims at quantifying the difference between normal and abnormal areas in ventilation-perfusion scans and estimating the potential of the fractal dimension to precisely discriminate risk grade of pulmonary embolism. The ventilation and perfusion images were obtained in the ventilation-perfusion scans. We displayed fractal spectrum of all levels of intensity to determine most important threshold for our purposes and then the difference of the ventilation and the perfusion is calculated pixel by pixel. From this difference image the integral of the underperfused areas are used as features. With the aid of these features we disposed of overall slope analysis for all possible values of the length of analyzed data points segment to find linear portion of function. The box-counting method, which the most important dimension is DBBW (arises by summing squares of counting black NB and squares which contains just part of fractal of partially black NBW), was used to establish fractal dimension. The means of the computed fractal (box) dimensions in eleven cases that were obtained on patients suspected with pulmonary embolism for whom reliable examination was essential to establish final diagnosis were 1.21 for normality and 1.42 for abnormality. Depending on the probability of the risk grade, the average fractal dimension were : FDhigh=1.52, FDintermediate=1.40, FDlow=1.26 with coefficient of correlation R=0.999. This study demonstrated that multifractal analysis shows promise for the detection and characterization of pulmonary embolism. The fractal dimension succeeded to quantify meaningful aspects of the possible detective differences among the various potential

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

    OpenAIRE

    Gospodarevskaya, Elena V; Goergen, Stacy K; Harris, Anthony H; Chan, Thomas; de Campo, John F; Wolfe, Rory; Gan, Eng T; Wheeler, Michael B.; McKay, John

    2006-01-01

    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...

  4. Relationship between obstructive sleep apnea and 30-day mortality among patients with pulmonary embolism

    OpenAIRE

    Farzin Ghiasi; Amin Ahmadpoor; Babak Amra

    2015-01-01

    Background: Pulmonary embolism (PE) is the most life-threatening form of venous thrombosis which causes the majority of mortalities in this category. Obstructive sleep apnea (OSA) has been indicated as one of the risk factors for thromboembolism because of hemostatic alterations. The present study was designed to seek for the relationship between OSA and 30-day mortality of patients with PE. Materials and Methods: This prospective cohort study was conducted among 137 consecutive patients refe...

  5. Multifactal analysis for the quantification of pulmonary embolism in ventilation-perfusion scans

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Hoon; Kim, Hee Joung; Yun, Mi Jin; Yoo, Hyung Sik [Yonsei University College of Medicine, Seoul, (Korea, Republic of)

    2002-07-01

    The clinical presentation of pulmonary embolism is highly non-specific. This preliminary study aims at quantifying the difference between normal and abnormal areas in ventilation-perfusion scans and estimating the potential of the fractal dimension to precisely discriminate risk grade of pulmonary embolism. The ventilation and perfusion images were obtained in the ventilation-perfusion scans. We displayed fractal spectrum of all levels of intensity to determine most important threshold for our purposes and then the difference of the ventilation and the perfusion is calculated pixel by pixel. From this difference image the integral of the underperfused areas are used as features. With the aid of these features we disposed of overall slope analysis for all possible values of the length of analyzed data points segment to find linear portion of function. The box-counting method, which the most important dimension is DBBW (arises by summing squares of counting black NB and squares which contains just part of fractal of partially black NBW), was used to establish fractal dimension. The means of the computed fractal (box) dimensions in eleven cases that were obtained on patients suspected with pulmonary embolism for whom reliable examination was essential to establish final diagnosis were 1.21 for normality and 1.42 for abnormality. Depending on the probability of the risk grade, the average fractal dimension were : FDhigh=1.52, FDintermediate=1.40, FDlow=1.26 with coefficient of correlation R=0.999. This study demonstrated that multifractal analysis shows promise for the detection and characterization of pulmonary embolism. The fractal dimension succeeded to quantify meaningful aspects of the possible detective differences among the various potential.

  6. Ventilation/Perfusion SPECT for Diagnosis of Pulmonary Embolism and Other Diseases

    OpenAIRE

    Björn Jonson; Marika Bajc

    2010-01-01

    V / P S P E C T has the potential to become a first hand tool for diagnosis of pulmonary embolism based on standardized technology and new holistic interpretation criteria. Pretest probability helps clinicians choose the most appropriate objective test for diagnosis or exclusion of PE. Interpretation should also take into account all ventilation and perfusion patterns allowing diagnosis of other cardiopulmonary diseases than PE. In such contexts, V / P S P E C T has excellent sensitivity and ...

  7. Capnometry in suspected pulmonary embolism with positive D-dimer in the field

    OpenAIRE

    Rumpf, Tadeja Hernja; Križmarić, Miljenko; Grmec, Štefek

    2009-01-01

    Introduction Pulmonary embolism (PE) is one of the greatest diagnostic challenges in prehospital emergency setting. Most patients with suspected PE have a positive D-dimer and undergo diagnostic testing. Excluding PE with additional non-invasive tests would reduce the need for further imaging tests. We aimed to determine the effectiveness of combination of clinical probability and end-tidal carbon dioxide (PetCO2) for evaluation of suspected PE with abnormal concentrations of D-dimer in preho...

  8. Lung scintigraphy in the diagnosis of pulmonary embolism: current methods and interpretation criteria in clinical practice

    OpenAIRE

    Skarlovnik, Ajda; Hrastnik, Damjana; Fettich, Jure; Grmek, Marko

    2014-01-01

    Background In current clinical practice lung scintigraphy is mainly used to exclude pulmonary embolism (PE). Modified diagnostic criteria for planar lung scintigraphy are considered, as newer scitigraphic methods, especially single photon emission computed tomography (SPECT) are becoming more popular. Patients and methods. Data of 98 outpatients who underwent planar ventilation/perfusion (V/Q) scintigraphy and 49 outpatients who underwent V/Q SPECT from the emergency department (ED) were retr...

  9. Serum microRNA-1233 is a specific biomarker for diagnosing acute pulmonary embolism

    OpenAIRE

    Kessler, Thorsten; Erdmann, Jeanette; Vilne, Baiba; Bruse, Petra; Kurowski, Volkhard; Diemert, Patrick; Schunkert, Heribert; Sager, Hendrik B

    2016-01-01

    Background Circulating microRNAs (miRNAs) emerge as novel biomarkers in cardiovascular diseases. Diagnosing acute pulmonary embolism (PE) remains challenging due to a diverse clinical presentation and the lack of specific biomarkers. Here we evaluate serum miRNAs as potential biomarkers in acute PE. Methods We enrolled 30 patients with acute, CT (computed tomography)-angiographically confirmed central PE and collected serum samples on the day of emergency room admission (1st day) and from 22 ...

  10. Routine clinical utility of aerosol lung scan (ALS) in patients being evaluated for pulmonary embolism (PE)

    International Nuclear Information System (INIS)

    99mTc-DTPA/MDA aerosol lung scan (ALS) (using BARC apparatus), 99mTc-MAA lung perfusion scan and chest radiography are routinely performed during the same visit in patients referred with the clinical suspicion of pulmonary embolism (PE). It is concluded that ALS is an excellent for diagnostic interpretation of PE as compared with chest radiography in significant number of patients

  11. Postoperative pulmonary embolism in a three year old with Klippel–Trenaunay syndrome

    OpenAIRE

    Jana Hudcova; Monica Kleinman; Daniel Talmor

    2009-01-01

    Jana Hudcova1, Monica Kleinman2, Daniel Talmor11Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; 2Department of Anesthesia, Division of Critical Care Medicine, Children’s Hospital Boston and Harvard Medical School, Boston, MA, USAAbstract: Massive pulmonary embolism (PE) in a small child is a rare event and unified guidelines for its treatment are missing. Timely diagnosis and management of m...

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

    OpenAIRE

    Anja Käberich; Simone Wärntges; Stavros Konstantinides

    2014-01-01

    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 populati...

  13. Pericardial tamponade masking associated pulmonary thrombo embolism in a case of adeno carcinoma of lung

    Directory of Open Access Journals (Sweden)

    Srinivasan Kandasamy

    2015-08-01

    Full Text Available This case report describes a patient admitted with shortness of breath of 15 days duration and found to have cardiac tamponade, which masked concomitant pulmonary embolism that was diagnosed by echocardiographic signs of dilate RA/RV with PAH only after successful pericardiocentesis. Subsequently patient was found to have widely metastatic adenocarcinoma of lungs. This case emphasizes the diagnostic challenge when cardiac tamponade is associated with pulmonary thromboembolism and requires high index of clinical suspicion in patients with underlying malignancy. [Int J Res Med Sci 2015; 3(8.000: 2126-2128

  14. 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.

  15. Chronic pulmonary embolism presenting with right ventricular dilatation on thallium myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Cardwell, C.; Keighley, C.; Keady, M.A.; Better, N. [St. F.X. Cabrini Hospital and Alfred Hospital, Melbourne, VIC (Australia). Department of Nuclear Medicine

    1998-06-01

    Full text: A 61 year old male presented to the Nuclear Medicine Department for an exercise thallium study with a three month history of exertional dyspnoea for investigation. Patient history included PTCA to LAD and pulmonary embolism 16 years previously. The patient underwent 5.24 minutes of a standard treadmill Bruce protocol which was terminated due to his usual dyspnoea. The patient was injected with 120 MBq of 201-Thallous Chloride at peak exercise and prone SPECT imaging performed 8 minutes later with a dual head gamma camera. Reconstructed images demonstrated normal myocardial perfusion at a moderate level of haemodynamic stress. However, moderate night ventricular dilatation was noted raising the possibility of respiratory disease as cause for symptoms. Echocardiography confirmed right ventricular dilatation and moderate to severe pulmonary hypertension while subsequent respiratory function tests were unremarkable. The patient was then referred to Nuclear Medicine for a ventilation and perfusion lung scan. A six view ventilation study was performed following inhalation of 99mTc Technegas and corresponding perfusion images were acquired following intravenous administration of 99mTc MAA. The ventilation and perfusion images demonstrated multiple matched segmental defects bilaterally, suggestive of chronic thrombo-embolism. The patient was subsequently anti-coagulated with improvement of symptoms. In conclusion, our study has demonstrated how right ventricular dilatation on myocardial scintigraphy can alert the clinician to alternative causes for dyspnoea, and in our case resulted subsequently in a diagnosis of chronic pulmonary embolism

  16. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Gerard O’Connor

    2015-01-01

    Full Text Available More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI or pulmonary embolism (PE. Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR. We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scenario in which recombinant tissue Plasminogen Activator (rtPA may be beneficial in cardiac arrest. In addition to the strong clinical suspicion of pulmonary embolism as the causative agent of the patient’s cardiac arrest, the extremely low end-tidal CO2 suggested a massive PE. The absence of dilatation of the right heart on subxiphoid ultrasound argued against the diagnosis of PE, but not conclusively so. In the context of the circulatory collapse induced by cardiac arrest, this aspect was relegated in terms of importance. The second dose of rtPA utilised in this case resulted in return of spontaneous circulation (ROSC and did not result in haemorrhage or an adverse effect.

  17. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest.

    Science.gov (United States)

    O'Connor, Gerard; Fitzpatrick, Gareth; El-Gammal, Ayman; Gilligan, Peadar

    2015-01-01

    More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scenario in which recombinant tissue Plasminogen Activator (rtPA) may be beneficial in cardiac arrest. In addition to the strong clinical suspicion of pulmonary embolism as the causative agent of the patient's cardiac arrest, the extremely low end-tidal CO2 suggested a massive PE. The absence of dilatation of the right heart on subxiphoid ultrasound argued against the diagnosis of PE, but not conclusively so. In the context of the circulatory collapse induced by cardiac arrest, this aspect was relegated in terms of importance. The second dose of rtPA utilised in this case resulted in return of spontaneous circulation (ROSC) and did not result in haemorrhage or an adverse effect. PMID:26664765

  18. 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

  19. Ventilation/perfusion lung scan to diagnose pulmonary embolism: new insights (for the year 2000)

    International Nuclear Information System (INIS)

    We present the changes that have taken place since the results of 'Prospective Investigation of Pulmonary Embolism Diagnosis' (PIOPED) in the diagnostic approach of pulmonary embolism (PE). In 1990 PIOPED documented the value of ventilation/perfusion lung scanning, but pulmonary angiography was often unavoidable. PIOPED had some drawbacks. During the last decade, three significant improvements have appeared: new ventilation tracers such as Technegas and 81m krypton yield high quality and dependable images; PIOPED reading criteria have been revised and improved; the diagnostic approach has benefited from lower extremity ultrasonography and D-dimer assay. New strategic approaches have therefore been devised and have become accurate enough to avoid the use of pulmonary angiography in a vast majority of cases. In pulmonary scintigram reading, the presence of an abnormal chest X-ray or of an underlying cardiopulmonary disease deserves special attention. Helical CT is of limited value in presence of PE restricted to sub-segmental arteries. Already published multicenter trials seem to indicate a lesser diagnostic value than initially anticipated with this semi-invasive method. CT cannot yet be recommended as a first line screening test for PE. (authors)

  20. Role of spiral CT in the diagnostic work-up of acute and chronic pulmonary embolism

    International Nuclear Information System (INIS)

    With the more widespread availability of spiral CT scanners during the last five years spiral CT angiography of the pulmonary arteries has been etablished as an accurate test for acute and chronic pulmonary embolism. It is reliable in the direct visualization of thrombotic material down to the segmental level. In several studies, sensitivity and specificity of 80 to 100% as compared with pulmonary angiography were reported. Compared with scintigraphy and echocardiography, spiral CT more often provides a definite and certain diagnosis. In addition to the direct visualization of the emboli spiral CT shows vessel wall thickening as a sign of older emboli, infarction, pneumonia, pleural effusion. Differential diagnoses are depicted significantly more frequent compared with scintigraphy. In chronic thromboembolic disease spiral CT detects vessel wall alterations even more often than angiography. Additionally, spiral CT demonstrates typical changes due to pulmonary hypertension and right heart failure. Depending on the experience of the investigator and the local conditions, spiral CT is equally well suited for further work-up of indeterminate scintigraphic findings or as a primary screening tool for patients in whom pulmonary embolism is suspected. (orig./MG)

  1. Mechanisms underlying gas exchange alterations in an experimental model of pulmonary embolism

    Directory of Open Access Journals (Sweden)

    J.H.T. Ferreira

    2006-09-01

    Full Text Available The aim of the present study was to determine the ventilation/perfusion ratio that contributes to hypoxemia in pulmonary embolism by analyzing blood gases and volumetric capnography in a model of experimental acute pulmonary embolism. Pulmonary embolization with autologous blood clots was induced in seven pigs weighing 24.00 ± 0.6 kg, anesthetized and mechanically ventilated. Significant changes occurred from baseline to 20 min after embolization, such as reduction in oxygen partial pressures in arterial blood (from 87.71 ± 8.64 to 39.14 ± 6.77 mmHg and alveolar air (from 92.97 ± 2.14 to 63.91 ± 8.27 mmHg. The effective alveolar ventilation exhibited a significant reduction (from 199.62 ± 42.01 to 84.34 ± 44.13 consistent with the fall in alveolar gas volume that effectively participated in gas exchange. The relation between the alveolar ventilation that effectively participated in gas exchange and cardiac output (V Aeff/Q ratio also presented a significant reduction after embolization (from 0.96 ± 0.34 to 0.33 ± 0.17 fraction. The carbon dioxide partial pressure increased significantly in arterial blood (from 37.51 ± 1.71 to 60.76 ± 6.62 mmHg, but decreased significantly in exhaled air at the end of the respiratory cycle (from 35.57 ± 1.22 to 23.15 ± 8.24 mmHg. Exhaled air at the end of the respiratory cycle returned to baseline values 40 min after embolism. The arterial to alveolar carbon dioxide gradient increased significantly (from 1.94 ± 1.36 to 37.61 ± 12.79 mmHg, as also did the calculated alveolar (from 56.38 ± 22.47 to 178.09 ± 37.46 mL and physiological (from 0.37 ± 0.05 to 0.75 ± 0.10 fraction dead spaces. Based on our data, we conclude that the severe arterial hypoxemia observed in this experimental model may be attributed to the reduction of the V Aeff/Q ratio. We were also able to demonstrate that V Aeff/Q progressively improves after embolization, a fact attributed to the alveolar ventilation redistribution

  2. 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.

  3. 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.

  4. Risk-adapted management of acute pulmonary embolism: recent evidence, new guidelines.

    Science.gov (United States)

    Käberich, Anja; Wärntges, Simone; Konstantinides, Stavros

    2014-10-01

    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. PMID:25386356

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

    International Nuclear Information System (INIS)

    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.)

  6. 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.)

  7. Diagnosis of Massive Pulmonary Embolism in Man by Radioisotope Scanning

    International Nuclear Information System (INIS)

    Macroaggregated human-serum albumin particles labelled with either I131 or chromium-51 have been utilized to determine regional blood flow to the lungs in dogs and man. Following intravenous injection, the particles accumulated in the lung, permitting clear delineation of the lung fields by scintillation scanning. In patients with lung abscess, pneumonia, atelectasis, tumours and thromboembolic disease of the lung, there was a decreased accumulation of the radioactivity in the regions of the lungs involved. The technique was found to be clinically useful in the diagnosis of massive pulmonary emboli in man and in the demonstration of vascular occlusion in certain patients with cor pulmonale. Studies in dogs made possible the determination of the rate at which revascularization occurred following experimental pulmonary emboli. Scintillation scanning was carried out at various times after the removal of the experimental emboli. The circulation was restored through the lungs within a period of several weeks after the removal of chronic pulmonary emboli in dogs. Although aggregated human-serum albumin retained its antigenicity in rabbits, guinea pigs and dogs, extensive studies failed to reveal any antigenicity of the particles to man. Because of the rapid metabolism of the macroaggregated albumin particles, the radiation to the patient was well within permissible levels. The use of albumin of high specific activity permitted injections of small chemical quantities; consequently no cardiovascular effects, such as increases in pulmonary artery pressure, changes in electrocardiogram or respiratory rate, were noted. (author)

  8. An evaluation of Technegas as a ventilation agent compared with krypton-81m in the scintigraphic diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    A ventilation agent that provides good quality lung images, which is cheap, easy to use and non-toxic, with a low radiation dose, has long been sought. Technegas, an ultrafine aerosol of technetium-99m-labelled carbon, was developed with these qualities in mind. We have studied Technegas in a clinical setting to evaluate some of these qualities. Twenty-five patients referred with a diagnosis of suspected pulmonary embolism were investigated during the same study using both krypton-81 m and Technegas as ventilation agents in conjunction with 99mTc-macroaggregated albumin as a perfusion agent. Technegas provided images which were of satisfactory quality. Images were obtained relatively easily and without discomfort to the patient, and Technegas has the advantge of always being available. A semi-quantitative regional assessment was employed which showed a good correlation (r=0.499, P<0.001) between Technegas and krypton-81 m ventilation. We report on an effect not previously found to be significant, that is lung regions were better ventilated with Technegas than with krypton-81 m. This altered the diagnostic probability rating of pulmonary embolism in a number of patients (n=3, 12%) compared with kryupton-81 m. This effect was also noted in a further 8 patients (32%) without a change in the diagnostic probability. We offer possible explanations for this phenomenon. (orig.)

  9. [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. PMID:26906402

  10. A case of Multiple Unilateral Pulmonary arteriovenous Malformation Relapse: Efficacy of embolization treatment

    Directory of Open Access Journals (Sweden)

    Masiello Rossella

    2015-01-01

    Full Text Available Pulmonary arteriovenous Malformations (PAVMs are a rare vascular alteration characterized by abnormal communications between the pulmonary arteries and veins resulting in an extracardiac right-to-left (R-L shunt. The majority of PAVMs are associated with an autosomal dominant vascular disorder also known as Osler-Weber- Rendu Syndrome. PAVMs appearance can be both single and multiple. Clinical manifestations include hypoxemia, dyspnea cyanosis, hemoptysis and cerebrovascular ischemic events or abscesses. We report a case of an 18 year old female with severe respiratory failure caused by a relapse of multiple unilateral pulmonary arterovenous fistula. Symptoms at admission include dyspnea, cyanosis and clubbing. The patient underwent pulmonary angio-TC scan, brain CT and echocardiography. The thoracic angio-CT scan showed the presence of PAVMs of RUL and RLL; a marked increase of right bronchial artery caliber and its branches with an aneurismatic dilatation was also observed. The patient underwent percutaneous transcatheter embolization using Amplatzer Vascular Plug IV; a relevant clinical and functional improvement was subsequently recorded. Embolization is effective in the treatment of relapsing PAVMS.

  11. Pulmonary thrombo-embolism in pregnancy: diagnosis and management

    OpenAIRE

    Louise E. Simcox; Laura Ormesher; Clare Tower; Greer, Ian A

    2015-01-01

    Key points Venous thromboembolism (VTE) in pregnancy remains a leading cause of direct maternal mortality in the developed world and identifiable risk factors are increasing in incidence.; VTE is approximately 10-times more common in the pregnant population (compared with non-pregnant women) with an incidence of 1 in 1000 and the highest risk in the postnatal period.; If pulmonary imaging is required, ventilation perfusion scanning is usually the preferred initial test to detect pulm...

  12. Combined ventilation-perfusion scintigraphy for demonstration of pulmonary embolism

    International Nuclear Information System (INIS)

    In 34 patients with suggested pulmonary emboli, ventilation scintigraphy with 133Xe and perfusion scintigraphy with 99Tcsup(m)-labelled albumin spheres were carried out. The combined ventilation-perfusion scintigraphy had a significantly higher diagnostic specificity (1.0, confidence limit 0.69-1.0) than perfusion scintigraphy alone (0.48, 0.26-0.70). Both methods had a diagnostic sensitivity of 1.0. (Auth.)

  13. Role of combined perfusion/ventilation scanning in diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    This study was conducted on 200 patients with suspected pulmonary embolism. Their age ranged 9-74 years with a mean age of 41.9+14.6 years.The commonest symptoms were dyspnea; chest pain and haemoptysis in 67.5%,49.5% and 14.5% respectively, whereas the main signs were tachycardia in 64.5% followed by rales and oedema of lower limbs in 28.5% and 14% respectively. Cardiac diseases were presenting the main risk factors in 47% followed by DVT, surgery, COLD in 24%,10% and 9.5% respectively. perfusion lung scan was normal in 27.5%, whereas low, intermediate and high probability scans were seen in 7%,23.5% and 42% respectively. The addition of ventilation scan, change probability of perfusion defects into 18.5%,19% and 31.5% in low, intermediate and high probability scans respectively. In addition 3.5% of patient diagnosed as non- embolic disease. There was significant correlation with increase number of symptoms and signs in relation to scan probability in both whole group and high probability group. Also, the incidence of pulmonary embolism appear to be additive with increase number of risk factors in the group of high probability scans. 3 figs., 3 tabs

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

    International Nuclear Information System (INIS)

    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 ≤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 (ETCO2, 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. (orig.)

  15. 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.)

  16. A comparative study of ventilation/perfusion scintigraphy and MRPA in the diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: The aim of this study was to evaluate the diagnostic value of ventilation/perfusion (V/Q) scintigraphy in pulmonary embolism (PE) in comparison with three-dimensional (3D) magnetic resonance pulmonary angiography (MRPA). Methods: Twenty-eight patients underwent pulmonary V/Q imaging and MRPA within 3 d. There were 11 men and 17 women with mean age of (50.1 ± 14.4) years. Among them, 22 PE were confirmed by pulmonary arteriography or operation, as well as clinical followed-up after successful thrombolytic therapy. These 22 patients were divided into 3 groups: lobe, segment, and subsegment lesions. In the other 6 patients, PE had been ruled out by clinical comprehensive analysis and follow-up survey, including one case confirmed by pulmonary arteriography. Results: In lobe group, both V/Q imaging and MRPA detected all PEs. In segment group, V/Q imaging detected 125 segmental pathological changes and MRPA demonstrated 139 abnormal segmental pulmonary arteries. The latter had partially overestimated, but the statistic difference was not significant (P=0.110). In subsegment group, V/Q imaging detected 84 subsegment pathological changes, whereas MRPA demonstrated 55 subsegment arterial damages, the statistic difference was significant between two groups. (P<0.05). Conclusion: MRPA and V/Q imaging are both sensitive methods for detecting lobar and segmental PE, but V/Q imaging is far better than MRPA in detecting subsegment PE. (authors)

  17. A Case of Cryptogenic Stroke Associated with Patent Foramen Ovale Coexisting with Pulmonary Embolisms, Deep Vein Thromboses, and Renal Artery Infarctions

    OpenAIRE

    Park, Moon-Sik; Park, Jong-Pil; Yun, So-Hee; Lee, Jae-Un; Kim, Joong-Keun; Lee, Na-Eun; Song, Ji-Eun; Lee, Shin-Eun; John, Sung-Hee; Lim, Ji-Hyun; Rhew, Jay-Young

    2012-01-01

    A paradoxical embolism is defined as a systemic arterial embolism requiring the passage of a venous thrombus into the arterial circulatory system through a right-to-left shunt, and is commonly related to patent foramen ovale (PFO). However, coexisting pulmonary embolisms, deep vein thromboses (DVT), and multipe systemic arterial embolisms, associated with PFO, are rare. Here, we report a patient who had a cryptogenic ischemic stroke, associated with PFO, which is complicated with a massive pu...

  18. 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...

  19. Acute pulmonary embolism caused by enlarged uterine leiomyoma: A rare presentation

    Science.gov (United States)

    Khademvatani, Kamal; Rezaei, Yousef; Kerachian, Abdollah; Seyyed-Mohammadzad, Mir Hossein; Eskandari, Ramin; Rostamzadeh, Alireza

    2014-01-01

    Patient: Female, 42 Final Diagnosis: Acute pulmonary embolism Symptoms: Chest pain • dyspnea Medication: Streptokinase • Warfarin Clinical Procedure: — Specialty: Cardiology and Neoplasm Objective: Management of emergency care Background: Deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) caused by pelvic vein compression are rare and life-threatening complications of leiomyoma of the uterus. Case Report: We report a 42-year-old virgin woman with a history of leiomyoma who presented to the emergency department with complaints of dyspnea and pleuritic chest pain with transient spotting. On physical examination, she had a non-tender abdomen with a 20-week size uterus. Imaging investigations revealed an acute DVT in her left leg and a huge uterine-derived mass compressing the common iliac veins. Transesophageal echocardiography (TEE) demonstrated an echogenic mass in her right pulmonary artery consistent with thrombosis. The patient was completely cured using thrombolytic therapy and myomectomy, and was well at 1 year after thrombolysis. Conclusions: PE caused by pelvic vein compression is a rare complication of leiomyoma, which should be considered. Thrombolytic therapy associated with myomectomy can be implemented for treating such cases, and TEE can be used for diagnosing suspected high-risk PE. PMID:25061497

  20. Postoperative pulmonary embolism in a three year old with Klippel–Trenaunay syndrome

    Directory of Open Access Journals (Sweden)

    Jana Hudcova

    2009-01-01

    Full Text Available Jana Hudcova1, Monica Kleinman2, Daniel Talmor11Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; 2Department of Anesthesia, Division of Critical Care Medicine, Children’s Hospital Boston and Harvard Medical School, Boston, MA, USAAbstract: Massive pulmonary embolism (PE in a small child is a rare event and unified guidelines for its treatment are missing. Timely diagnosis and management of massive pulmonary embolism is of crucial importance for a good outcome. We describe a unique management of PE causing oxygenation failure using a combination of catheter extraction technique, and regional thrombolysis on top of systemic heparin administration and inferior vena cava filter placement. Pulmonary hypertension was treated with inhaled nitric oxide. We believe that catheter extraction technique and regional thrombolysis is an option to consider provided that resources and expertise are available. Preoperative placement of an inferior vena cava filter should be contemplated in such high risk situations.Keywords: embolectomy, regional thrombolysis, inferior vena cava filter, inhaled nitric oxide

  1. 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

  2. Experimental evaluation of a new retrievable inferior vena cava filter for protection from acute pulmonary embolism in canine

    International Nuclear Information System (INIS)

    Objective: To evaluate the validity, safety and feasibility of a new retrieval inferior vena cava filter for the prevention of pulmonary embolism in an animal model. Methods: The model of deep iliofemoral venous thrombosis was established in 12 experimental dogs. In control group(6 experimental dogs), the deep venous thrombosis was made to fall off directly. In experimental group (6 experimental dogs), the deep venous thrombosis was made to fall off with an implanted filter in inferior vena cava. The filter's thrombus-trapping efficacy was evaluated by angiography of pulmonary artery, measurement of the mean pressure of pulmonary artery and arterial oxygen saturation before and after the deep venous thrombus falling off. Results: All filters implanted in the experimental dogs could successfully capture clot coming from deep venous thrombosis. There was no case of pulmonary embolism in experimental groups. On the other hand, pulmonary embolism occurred following the fall of deep venous thrombus in all dogs of control group. Conclusion: The retrievable inferior vena cava filter can effectively prevent from the pulmonary embolism due to falling off of the emboli from deep venous thrombosis. The process of implantation and retrieval is relatively simple and easy. (authors)

  3. [Diagnosing pulmonary embolism during pregnancy: how should we do?].

    Science.gov (United States)

    Soulier V; Righini M; Perrier A

    2014-10-22

    No diagnostic strategy for pulmonary embo- lism (PE) during pregnancy is based on strong evidence and unanimously accepted. Clinical scores are not validated. The diagnostic yield of the non radiating tests is low: D-dimer is rarely negative in pregnant women and lower limb venous compression ultrasonography is poorly sensitive. Nevertheless, they are still recommended as first line exams. The radia- ting exams (ventilation-perfusion scintigra- phy and thoracic angio-CT) have an equiva- lent diagnostic yield (more than 90%). But both raise the risk of cancer: any childhood cancer for the fetus (scintigraphy), and breast cancer for the mother (angio-CT). However, the diagnosis of PE in the pregnant woman has a major impact and must be established with certainty, even if this requires performing radiation imaging. PMID:25518203

  4. Diagnosis of pulmonary embolism with spiral CT as a second procedure following scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Strijen, Marco J.L. van; Kieft, Gerard J. [Department of Radiology, Leyenburg Ziekenhuis, Leyweg 275, 2545 CH The Hague (Netherlands); Monye, Wouter de; Bloem, Johan L. [Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden (Netherlands); Pattynama, Peter M.T. [Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden (Netherlands); Department of Radiology, Erasmus University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam (Netherlands); Huisman, Menno V. [Leiden University Medical Center, Dept. of General Internal Medicine, P.O. Box 9600, 2300 RC Leiden (Netherlands); Smith, Sierd J. [Department of Internal Medicine, Leyenburg Hospital, Leyweg 275, 2545 CH The Hague (Netherlands)

    2003-07-01

    Heading Abstract.Our objective was to evaluate, in a routine clinical setting, the role of spiral CT as a second procedure in patients with clinically suspected pulmonary embolism (PE) and abnormal perfusion scan. We prospectively studied the role of spiral CT in 279 patients suspected of PE. All patients started their diagnostic algorithm with chest radiographs and perfusion scintigraphy. Depending on the results of perfusion scintigraphy, patients proceeded to subsequent levels in the algorithm: stop if perfusion scintigraphy was normal; CT and pulmonary angiography if subsegmental perfusion defects were seen; ventilation scintigraphy followed by CT when segmental perfusion defects were seen; and pulmonary angiography in this last group when results of ventilation/perfusion scintigraphy and CT were incongruent. Reference diagnosis was based on normal perfusion scintigraphy, high probability perfusion/ventilation scintigraphy in combination with abnormal CT, or pulmonary angiography. If PE was present, the largest involved branch was noted on pulmonary angiography, or on spiral CT scan in case of a high-probability ventilation/perfusion scan and a positive CT scan. A distinction was made between embolism in a segmental branch or larger, or subsegmental embolism. Two hundred seventy-nine patients had abnormal scintigraphy. In 27 patients spiral CT and/or pulmonary angiography were non-diagnostic and these were excluded for image analysis. Using spiral CT we correctly identified 117 of 135 patients with PE, and 106 of 117 patients without PE. Sensitivity and specificity was therefore 87 and 91%, respectively. Prevalence of PE was 53%. Positive and negative predictive values were, respectively, 91 and 86%. In the high-probability group, sensitivity and specificity increased to 97 and 100%, respectively, with a prevalence of 90%. In the non-high probability-group sensitivity and specificity decreased to 61 and 89%, respectively, with a prevalence of 25%. In a routine

  5. Diagnosis of pulmonary embolism with spiral CT as a second procedure following scintigraphy

    International Nuclear Information System (INIS)

    Heading Abstract.Our objective was to evaluate, in a routine clinical setting, the role of spiral CT as a second procedure in patients with clinically suspected pulmonary embolism (PE) and abnormal perfusion scan. We prospectively studied the role of spiral CT in 279 patients suspected of PE. All patients started their diagnostic algorithm with chest radiographs and perfusion scintigraphy. Depending on the results of perfusion scintigraphy, patients proceeded to subsequent levels in the algorithm: stop if perfusion scintigraphy was normal; CT and pulmonary angiography if subsegmental perfusion defects were seen; ventilation scintigraphy followed by CT when segmental perfusion defects were seen; and pulmonary angiography in this last group when results of ventilation/perfusion scintigraphy and CT were incongruent. Reference diagnosis was based on normal perfusion scintigraphy, high probability perfusion/ventilation scintigraphy in combination with abnormal CT, or pulmonary angiography. If PE was present, the largest involved branch was noted on pulmonary angiography, or on spiral CT scan in case of a high-probability ventilation/perfusion scan and a positive CT scan. A distinction was made between embolism in a segmental branch or larger, or subsegmental embolism. Two hundred seventy-nine patients had abnormal scintigraphy. In 27 patients spiral CT and/or pulmonary angiography were non-diagnostic and these were excluded for image analysis. Using spiral CT we correctly identified 117 of 135 patients with PE, and 106 of 117 patients without PE. Sensitivity and specificity was therefore 87 and 91%, respectively. Prevalence of PE was 53%. Positive and negative predictive values were, respectively, 91 and 86%. In the high-probability group, sensitivity and specificity increased to 97 and 100%, respectively, with a prevalence of 90%. In the non-high probability-group sensitivity and specificity decreased to 61 and 89%, respectively, with a prevalence of 25%. In a routine

  6. Successful pregnancy after pulmonary embolism and heparin-induced thrombocytopenia--case report.

    Science.gov (United States)

    Plesinac, S; Babović, I; Karapandzić, V Plesinac

    2013-01-01

    The authors present the case of a nulliparous 34-year-old patient. At the tenth week of gestation, she developed phlebothrombosis of veins of the right leg and massive pulmonary embolism. After thrombolytic and heparin therapy she developed rethrombosis and heparin-induced thrombocytopenia type II. Lepirudin was introduced in therapy and in the 12th week of gestation acenocumarol was added. After the 34th week, she received danaparoid sodium. After a week, by cesarean section, a healthy and mature female was delivered. PMID:23971268

  7. Venous extravasation and polymethylmethacrylate pulmonary embolism following fluoroscopy-guided percutaneous vertebroplasty

    International Nuclear Information System (INIS)

    Percutaneous vertebroplasty has gained widespread popularity and demonstrated clinical efficacy in the treatment of spinal osteoporotic compression fractures and pathologic osteolytic lesions. Despite its rapid pain relief and safety, this minimally invasive intervention has exhibited some rare complications over the past decade. In this case study, we describe a patient with an uncommon complication of polymethylmethacrylate (PMMA) cement pulmonary embolism following fluoroscopy-guided percutaneous vertebroplasty for treatment of pain associated with an osteoporotic vertebral fracture. We present this case to highlight that vertebroplasty is not risk-free and that knowledge of such potentially severe complication is necessary for prevention and optimal operative outcomes

  8. 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

  9. Ventilation-perfusion scintigraphy for the diagnosis of pulmonary embolism; Pulmonale Perfusions- und Ventilationsszintigraphie in der Diagnostik der Lungenarterienembolie

    Energy Technology Data Exchange (ETDEWEB)

    Poeppel, T.D. [Universitaetsklinikum Essen, Nuklearmedizinische Klinik, Essen (Germany); Krause, B.J. [Universitaetsklinikum rechts der Isar, Technische Universitaet Muenchen, Nuklearmedizinische Klinik und Poliklinik, Muenchen (Germany)

    2007-08-15

    Diagnosis of venous thrombosis and pulmonary embolism is a common clinical problem. Imaging results frequently play a central role in the clinical decision process. This article on nuclear medicine procedures in the diagnosis of suspected pulmonary embolism provides information on pathophysiological basics, commonly used radiopharmaceuticals as well as procedure and interpretation of ventilation-perfusion scintigraphy. (orig.) [German] Die Diagnosestellung einer venoesen Thrombose und Lungenembolie erweist sich klinisch zumeist als schwierig. Die bildgebende Diagnostik stellt dann oftmals die entscheidende Untersuchung im klinischen Entscheidungsprozess dar. Der vorliegende Beitrag zu den nuklearmedizinischen Verfahren in der Diagnostik der Lungenarterienembolie erlaeutert die pathophysiologischen Grundlagen, die verwendeten Radiopharmaka sowie die Durchfuehrung und Interpretation der Perfusions- und Ventilationsszintigraphie. (orig.)

  10. Medical image of the week: saddle pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Jaffer F

    2016-05-01

    Full Text Available No abstract available. Article truncated at 150 words. A 66-year-old woman with recent history of left knee surgery and L2-L5 spinal fusion within the past month presented to the Emergency Department (ED with pleuritic chest pain and shortness of breath for three days. On admission, reported crushing diffuse substernal chest pain worsened to 10/10 on the pain scale on the day of presentation. In the ED, physical examination was remarkable for tachycardia, tachypnea, diaphoresis and hypotension. Initial electrocardiogram was significant for sinus tachycardia with S1Q3T3 pattern. thoracic computed tomography angiogram (CTA showed saddle pulmonary embolus (PE with extension into segmental vasculature, right greater than left (Figure 1. A bedside echocardiogram demonstrated diastolic and systolic bowing of the intraventricular septum into the left ventricle. An emergent trans-thoracic echocardiogram confirmed flattened septum consistent with right ventricle pressure overload with right ventricular systolic pressure of 55 mmHg + central venous pressure (CVP and reduced left ventricular ejection fraction of 38%. Her ...

  11. 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.

  12. 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.

  13. 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.)

  14. Guidance for the treatment of deep vein thrombosis and pulmonary embolism.

    Science.gov (United States)

    Streiff, Michael B; Agnelli, Giancarlo; Connors, Jean M; Crowther, Mark; Eichinger, Sabine; Lopes, Renato; McBane, Robert D; Moll, Stephan; Ansell, Jack

    2016-01-01

    This guidance document focuses on the diagnosis and treatment of venous thromboembolism (VTE). Efficient, cost effective diagnosis of VTE is facilitated by combining medical history and physical examination with pre-test probability models, D dimer testing and selective use of confirmatory imaging. Clinical prediction rules, biomarkers and imaging can be used to tailor therapy to disease severity. Anticoagulation options for acute VTE include unfractionated heparin, low molecular weight heparin, fondaparinux and the direct oral anticoagulants (DOACs). DOACs are as effective as conventional therapy with LMWH and vitamin K antagonists. Thrombolytic therapy is reserved for massive pulmonary embolism (PE) or extensive deep vein thrombosis (DVT). Inferior vena cava filters are reserved for patients with acute VTE and contraindications to anticoagulation. Retrievable filters are strongly preferred. The possibility of thoracic outlet syndrome and May-Thurner syndrome should be considered in patients with subclavian/axillary and left common iliac vein DVT, respectively in absence of identifiable triggers. The optimal duration of therapy is dictated by the presence of modifiable thrombotic risk factors. Long term anticoagulation should be considered in patients with unprovoked VTE as well as persistent prothrombotic risk factors such as cancer. Short-term therapy is sufficient for most patients with VTE associated with transient situational triggers such as major surgery. Biomarkers such as D dimer and risk assessment models such the Vienna risk prediction model offer the potential to customize VTE therapy for the individual patient. Insufficient data exist to support the integration of bleeding risk models into duration of therapy planning. PMID:26780738

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

    International Nuclear Information System (INIS)

    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.)

  16. Detection of pulmonary embolism with gadolinium-enhanced dual energy CT: an experimental study

    International Nuclear Information System (INIS)

    Objective: To evaluate the feasibility of gadolinium-enhanced dual energy CT pulmonary angiography (CTPA) in detecting pulmonary embolism (PE). Methods: In vitro dual energy CT of phantoms of gadolinium and iodinated contrast agents with different diluted ratio was performed, and CT values were measured at different tube voltages. Ten rabbits which were grouped into 3 ml/kg and 5 ml/kg groups underwent dual energy CT scan. CT values of pulmonary artery trunk and the first branch of pulmonary artery were measured. Sponge gelatin were injected into the femoral vein of 6 rabbits to make PE model next day, then lungs were re-imaged with dual energy CT 2 h after embolization. Creatinine was repeatedly measured before and one day after injection of gadolinium via ear marginal vein or femoral vein sampling.One-way ANOVA test and independent student t test were used to analyze the difference of pulmonary artery enhancement between different groups. Results: (1) Compared with iodinated contrast agent, CT value of gadolinium-based contrast agent at 80 kV was higher than those at 140 kV and average-weighted 120 kV. (2) At 140, 80, and average weighted 120 kV, CT values of pulmonary artery trunk [CT values were (463.1 ± 118.0), (664.2 ± 188.0), (522.9 ± 137.7) HU] and of the first branch of pulmonary artery [ CT values were (445.1 ± 82.3), (606.7 ± 207.2), (493.4 ± 117.3) HU] were higher than those at 3 ml/kg [CT value of pulmonary artery trunk was (258.1 ± 55.1), (384.0 ± 92.3), (295.4 ± 73.6) HU, CT value of the first branch of pulmonary artery (245.0 ± 73.2), (309.1 ± 94.2), (263.8 ±78.5) HU; all P<0.05]. CT values of pulmonary artery trunk and the first branch of pulmonary artery at 80 kV were higher than those at 140 kV and average-weighted 120 kV (pulmonary artery trunk: F=6.004, P=0.005; the first branch of pulmonary artery: F=4.374, P=0.018). In 6 rabbits, CTPA showed the enhancement cut-off of bilateral pulmonary arteries, gadolinium mapping showed

  17. 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

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

    International Nuclear Information System (INIS)

    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

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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.)

  5. A study on the relationship between deep vein thrombosis of lower extremities and pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To evaluate the relationship between deep vein thrombosis (DVT) and pulmonary embolism (PE) and the origin of PE. Methods: Fifty normal people and 200 patients with highly suspected PE and DVT of lower extremities underwent pulmonary perfusion/ventilation (P/V) imaging with 99Tcm-macroaggregated albumin (MAA) and 99Tcm-glucose phosphate (GP), 15 patients among them also underwent pulmonary artery angiography. Results: Fifty normal people gave normal images of P/V. Among 200 patients, 175 were with multiple PE, 25 were normal; among PE patients, 128 were with lower extremity venous disorders (73.14%), 25 cases without PE were all with extremity venous disorders; among 153 with lower extremity venous diseases, 128 were with PE (83.66%); 119 of them had DVT, 101 cases' PEs originated from iliofemoral vein thrombosis (84.87%). Conclusion: It is effective to diagnosis PE and its origin with combinative use of pulmonary perfusion/ventilation imaging and lower extremity vein imaging

  6. DIFFICULT WEANING AFTER PULMONARY ENDARTERECTOMY FO R CHRONIC PULMONARY EMBOLISM: A CASE REPORT

    OpenAIRE

    Melchisedec; Sheetal; Bedi; Valsa; Anish G.

    2013-01-01

    SUMMARY: A 33 yrs old male presented with dyspnea on exertion since 6yrs was diagnosed to have chronic thromboembolic pulmonary hypertension (C TEPH) for which he underwent pulmonary endarterectomy (PEA) using deep hypothermic circulatory arrest (DHCA). After the operation the patient developed reperfusion edema and hypoxaemia because of which patient had delayed weaning from mechanical ventilation.

  7. Pulmonary embolism: is scintigraphy useful after initial angio-CT?; Embolie pulmonaire: la scintigraphie pulmonaire est-elle utile en seconde intention?

    Energy Technology Data Exchange (ETDEWEB)

    Paul, J.P.; Fiessinger, J.N.; Hernigou, A.; Sapoval, M.; Emmerich, J.; Gaux, J.C. [Hopital Broussais, Service de Radiologie Vasculaire, 75 - Paris (France)

    2000-08-01

    Purpose. To assess the value of ventilation-perfusion scintigraphy. after an initial helical CT with absence of pulmonary embolism (PE). Material and methods. Twenty eight consecutive patients with clinical suspicion of pulmonary embolism underwent helical CT scan to look for an intra-luminal clot. When the CT-scan was positive for PE, diagnosis was retained. If the result was negative, a ventilation-perfusion scintigraphy was performed. If the result was also negative, diagnosis of PE was excluded. In case of discrepancy, a pulmonary angiography was performed and used as gold-standard. Results. Twenty-one patients showed PE at CT-angio and 7 did not. Two of these 7 had normal or low probability scintigraphy, excluding diagnosis of PE. One had intermediate V/P scan and 4 had high probability V/P scan. For these 5 discrepancies, none of them had PE on angiography. Conclusion. In this population, scintigraphy was not appropriate after a negative CT-angio for PE. In case of persistent doubt after a normal initial helical CT, pulmonary angiography is required. (author)

  8. Comparison of V/Q SPECT and planar V/Q lung scintigraphy in diagnosing acute pulmonary embolism

    DEFF Research Database (Denmark)

    Borgwardt, Henrik Gutte; Mortensen, Jann; Jensen, Claus Verner;

    2010-01-01

    Planar ventilation/perfusion (V/Q) scintigraphy is currently the standard method for the diagnosis of pulmonary embolism (PE) in most nuclear medicine centers. However, recent studies have shown a superior sensitivity and specificity when applying V/Q single photon emission computed tomography...

  9. 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)

  10. Catheter-Related Right Atrial Thrombus and Pulmonary Embolism: A Case Report and Systematic Review of the Literature

    Directory of Open Access Journals (Sweden)

    Karen EA Burns

    2009-01-01

    Full Text Available Central venous catheters (CVCs are commonly used in clinical practice. One of the foremost complications associated with their use is the potential for symptomatic or asymptomatic thrombosis. CVC thrombosis, in turn, may not only result in vascular and catheter occlusion but also infection, pulmonary embolism, and formation of right heart thromboemboli. Thrombi within cardiac chambers are associated with an increased risk of mortality due to their potential for embolization to the pulmonary vasculature. We describe the case of a 77-year-old man, who was successfully thrombolyzed following detection of a right atrial thrombus and hemodynamically significant pulmonary embolism resulting from thrombus formation on the tip of a peripherally inserted central catheter (PICC. The present article is the first report of a PICC-related right atrial thrombus in an adult treated with thrombolysis. A systematic review of the literature suggests that the true incidence of this complication may be underestimated because the diagnosis may not be considered in asymptomatic and symptomatic patients, or may be missed by transthoracic echocardiography. The present case highlights the importance of maintaining a high index of suspicion for thromboembolic complications and heparin-induced thrombocytopenia in patients with CVCs or a PICC. It also underscores the important role of transesophageal echocardiography and thrombolysis in the diagnosis and management, respectively, of right heart thromboemboli with associated pulmonary embolism.

  11. [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.

  12. Is there a place for inhaled nitric oxide in the therapy of acute pulmonary embolism?

    Science.gov (United States)

    Tanus-Santos, Jose E; Theodorakis, Michael J

    2002-01-01

    Acute pulmonary embolism (PE) is a serious complication resulting from the migration of emboli to the lungs. Although deep venous thrombi are the most common source of emboli to the lungs, other important sources include air, amniotic fluid, fat and bone marrow. Regardless of the specific source of the emboli, very little progress has been made in the pharmacological management of this high mortality condition. Because the prognosis is linked to the degree of elevation of pulmonary vascular resistance, any therapeutic intervention to improve the hemodynamics would probably increase the low survival rate of this critical condition. Inhaled nitric oxide (iNO) has been widely tested and used in cases of pulmonary hypertension of different causes. In the last few years some authors have described beneficial effects of iNO in animal models of acute PE and in anecdotal cases of massive PE. The primary cause of death in massive PE that is caused by deep venous thrombi, gas or amniotic fluid, is acute right heart failure and circulatory shock. Increased pulmonary vascular resistance following acute PE is the cumulative result of mechanical obstruction of pulmonary vessels and pulmonary arteriolar constriction (attributable to a neurogenic reflex and to the release of vasoconstrictors). As such, the vasodilator effects of iNO could actively oppose the pulmonary hypertension following PE. This hypothesis is consistently supported by experimental studies in different animal models of PE, which demonstrated that iNO decreased (by 10 to 20%) the pulmonary artery pressure without improving pulmonary gas exchange. Although maximal vasodilatory effects are probably achieved by less than 5 parts per million iNO, which is a relatively low concentration, no dose-response study has been published so far. In addition to the animal studies, a few anecdotal reports in the literature suggest that iNO may improve the hemodynamics during acute PE. However, no prospective, controlled

  13. 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.

  14. 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

  15. 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

  16. Invasive hemodynamic assessment of pulmonary hypertension

    OpenAIRE

    Pagnamenta, Alberto

    2015-01-01

    The diagnosis of pulmonary hypertension requires an invasive confirmation of an elevated mean pulmonary artery pressure during a right heart catheterization. The present thesis reviews the invasive hemodynamic approaches to assess the functional state of the pulmonary circulation and its impact on right ventricular function in pulmonary vascular diseases. Pulmonary vascular resistance is better characterized by multi-point pressure/flow measurements. The occlusion analysis of the pulmonary ar...

  17. 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

  18. 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.

  19. The value of lung ventilation-perfusion scintigraphy in monitoring therapeutic effects in pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: Lung ventilation-perfusion (V/Q) scintigraphy was an effective way in the evaluation of therapeutic effects of anticoagulation and thrombolysis for pulmonary embolism (PE). Methods: Lung 99Tcm-Technegas ventilation and 99Tcm-macro-aggregated albumin (MAA) perfusion scintigraphy was performed before and after treatment and repeated in different observation period in 65 cases with PE. Results: Among 296 abnormal pulmonary segment in 44 cases with PE, 106 segments (35.8%) were found back to normal after anticoagulation treatment for 1.5 years, with 69 (23.3%) improved and 121 (40.9%) no change. Among 165 abnormal pulmonary segments in 21 cases with PE, 85 segments (51.5%) were normal after anticoagulation and thrombolysis treatment, with 29 improved (17.6%) and 51 no change (30.9%). The statistical significant difference was found in patients treated with anticoagulation, anticoagulation and thrombolysis after 7 and 14 d, respectively (χ2=8.79 and 56.31, P<0.05 and <0.01). Conclusion: Lung V/Q scintigraphy has great value in monitoring the therapeutic effects of anticoagulation and thrombolysis. (authors)

  20. 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.

  1. Lung scintigraphy in the diagnosis of pulmonary embolism: current methods and interpretation criteria in clinical practice

    International Nuclear Information System (INIS)

    In current clinical practice lung scintigraphy is mainly used to exclude pulmonary embolism (PE). Modified diagnostic criteria for planar lung scintigraphy are considered, as newer scitigraphic methods, especially single photon emission computed tomography (SPECT) are becoming more popular. Data of 98 outpatients who underwent planar ventilation/perfusion (V/Q) scintigraphy and 49 outpatients who underwent V/Q SPECT from the emergency department (ED) were retrospectively collected. Planar V/Q images were interpreted according to 0.5 segment mismatch criteria and revised PIOPED II criteria and perfusion scans according to PISA-PED criteria. V/Q SPECT images were interpreted according to the criteria suggested in EANM guidelines. Final diagnosis of PE was based on the clinical decision of an attending physician and evaluation of a 12 months follow-up period. Using 0.5 segment mismatch criteria and revised PIOPED II, planar V/Q scans were diagnostic in 93% and 84% of cases, respectively. Among the diagnostic planar scans readings specificity for 0.5 segment mismatch criteria was 98%, and 99% for revised PIOPED II criteria. V/Q SPECT showed a sensitivity of 100% and a specificity of 98%, without any non-diagnostic cases. In patients with low pretest probability for PE, planar V/Q scans assessed by 0.5 segment mismatch criteria were diagnostic in 92%, and in 85% using revised PIOPED II criteria, while perfusion scintigraphy without ventilation scans was diagnostic in 80%. Lung scintigraphy yielded diagnostically definitive results and is reliable in ruling out PE in patients from ED. V/Q SPECT has excellent specificity and sensitivity without any non-diagnostic results. Percentage of non-diagnostic results in planar lung scintigraphy is considerably smaller when 0.5 segment mismatch criteria instead of revised PIOPED II criteria are used. Diagnostic value of perfusion scintigraphy according to PISA-PED criteria is inferior to combined V/Q scintigraphy; the difference is

  2. 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. PMID:26438275

  3. Prevention of deep vein thrombosis and pulmonary embolism in patients with stroke.

    Science.gov (United States)

    Field, Thalia S; Hill, Michael D

    2012-01-01

    Venous thromboembolism (VTE), encompassing deep venous thrombosis and pulmonary embolism, is a potentially fatal but preventable complication of stroke. Reported rates of VTE after stroke have decreased over the last four decades, possibly due to the implementation of stroke units, early mobilization and hydration, and increased early use of antiplatelets. Additional means of thromboprophylaxis in stroke include mechanical methods (ie, compression stockings) to prevent venous stasis and medical therapy including antiplatelets, heparins, and heparinoids. Risk of VTE must be balanced by potential risk of hemorrhagic complications from pharmacotherapy. Unfractionated heparin, low-molecular-weight heparin (LMWH), and danaparoid are acceptable options for chemoprophylaxis though none have shown superior efficacy for VTE prevention without an associated increase in major hemorrhage. The efficacy and timing of pharmacological thromboprophylaxis in hemorrhagic stroke are not well defined. Graduated compression stockings are associated with an increased rate of adverse events and are not recommended and intermittent pneumatic compression stockings require further investigation. PMID:21733942

  4. Ventilation/Perfusion SPECT for Diagnosis of Pulmonary Embolism and Other Diseases

    Directory of Open Access Journals (Sweden)

    Marika Bajc

    2011-01-01

    Full Text Available V/PSPECT has the potential to become a first hand tool for diagnosis of pulmonary embolism based on standardized technology and new holistic interpretation criteria. Pretest probability helps clinicians choose the most appropriate objective test for diagnosis or exclusion of PE. Interpretation should also take into account all ventilation and perfusion patterns allowing diagnosis of other cardiopulmonary diseases than PE. In such contexts, V/PSPECT has excellent sensitivity and specificity. Nondiagnostic reports are ≤3%. V/PSPECT has no contraindication; it is noninvasive and has very low radiation exposure. Moreover, acquisition time for V/PSPECT is only 20 minutes. It allows quantification of PE extension which has an impact on individual treatment. It is uniquely useful for followup and research.

  5. Cardiac thrombus with risk of fulminant pulmonary embolism in paediatric antiphospholipid syndrome.

    Science.gov (United States)

    Albinski, M; Hufnagel, M; Schelling, J; Fleck, T; Siepe, M; Zieger, B; Stiller, B

    2016-07-01

    Antiphospholipid Syndrome (APS) describes a systemic disease caused by autoantibodies to membrane components. Involving coagulation pathways, complement factors and immune cells, it results in thrombosis in any blood vessel. Its clinical presentation varies considerably depending upon the organ affected. Paediatric data on APS remain sparse. Most case reports focus on catastrophic APS with multiple small-vessel occlusions and a life-threatening course. Here, we report on a 15-year-old patient with deep vein thrombosis and a right ventricular tumour posing the risk of a fulminant pulmonary embolism. The tumour was surgically removed. Histology revealed it to be a thrombus. The patient fully recovered and is currently treated with long term anticoagulation. PMID:27138626

  6. 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.

  7. Intravenous Immunoglobulin-Induced Pulmonary Embolism: It Is Time to Act!

    Science.gov (United States)

    Bilal, Jawad; Riaz, Irbaz B; Hill, Jennifer L; Zangeneh, Tirdad T

    2016-01-01

    Pulmonary embolism (PE) is a common clinical problem affecting 600,000 patients per year in the United States. Although the diagnosis can be easily confirmed by imaging techniques, such as computed tomographic angiography of the chest, the identification of underlying mechanism leading to PE is important for appropriate duration of anticoagulation, and prevention of subsequent episodes. The differential diagnosis of underlying mechanism is broad and must include careful review of medication history. Drug-related thromboembolic disease can be easily missed and may have catastrophic consequences. The identification of the culprit drug is important for prevention of subsequent episodes and choosing appropriate duration of anticoagulation. We report a case of a middle-aged man who developed PE after administration of intravenous immunoglobulin. PMID:26164024

  8. 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

  9. 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

  10. 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.

  11. Functional images of regional ventilation perfusion ratios (V/Q) with krypton 81M in the diagnosis of pulmonary embolism (P.E.)

    International Nuclear Information System (INIS)

    A quantitative analysis of perfusion and ventilation scan with 81m Kr by the computation of a physiological parameter V/Q is reported. Such a quantitative analysis provides a simple tool for the diagnosis of pulmonary embolism (P.E.) when the accuracy of visual assessment of combined ventilation and perfusion scan is low. It may be useful to discriminate patients with P.E. from patients with chronic obstructive lung disease (C.O.P.D.) on the basis of V/R distribution and values

  12. The primary experimental study of self-made percutaneous catheterized thrombectomy device for acute massive pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To evaluate efficacy, feasibility and safety of the self-made percutaneous catheterized thrombectomy divice in animal model for thrombus removal. Methods: Seven dogs were selected, with acute massive pulmonary embolism animal models created by injecting thrombi into the pulmonary arterial trunk via percutaneous femoral vein approach. After half an hours the catheter sheath was inserted into the occluded pulmonary artery through right femoral vein in 5 dogs, left femoral vein in 1 dog and right internal jugular vein in another one. The procedure began to remove the thrombi with simultaneous recording the thrombectomy time and the blood volume drainage. Blood gass was tested before and after embolization together with those of thrombi removement, continuously monitored pulmonary arterial pressure and intermittently performed angiography. The mean time form vascular recanalization to euthanasia was 2 hours, and then the lung specimens were resected for histological examination. Results: One animal died of pulmonary arterial penetration during thrombi removal, but others were all alive by the end of the test. Mean time of removing thrombi was 2.4 minutes with mean volume blood drainage of 84 ml. Angiograms showed the approximately complete patency of the pulmonary arterial trunk after reopening of occlusion but still with remnont thrombi within distal branches and arterial pressure with blood gas returned to normal level. Pathology revealed the recanalization of pulmonary arterial trunk but with thromi still staying in the distal branches, and effusion around the arteries. Conclusions: The self-made percutaneous catheterized thrombectomy device is effective, feasible and comparatively safe in the treatment of acute massive pulmonary embolism in this primary test. (authors)

  13. Prognostic stratification of pulmonary embolism: what does it change from 2014 European Society of Cardiology guidelines?

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2014-10-01

    Full Text Available Prognostic stratification is of utmost importance for clinical management of acute pulmonary embolism (PE. Clinical presentation, echocardiography and biomarkers represented the key points on which recommendations of European Society of Cardiology (ESC released in 2008 were based. In fact, in 2008 the ESC prognostic model suggested to divide acute PE in high risk, heamodynamically unstable, based on presentation with shock or hypotension, and non high risk, haemodynamically stable. The non high risk PE was divided in intermediate rand low risk PE based on echocardiographicand biomarkers signs of right heart dysfunction (RHD and myocardial damage. This approach was not an academic speculation but permitted to define the early mortality risk (>15% in high risk, 3-15% in intermediate risk, <1% in low risk and bring the most appropriate treatment. Over the years it became clear that co-morbidity influenced the early mortality risk and may define better the low mortality risk. Practical clinical scores, such as the Pulmonary Embolism Severity Index, PESI, in its original or simplified version, demonstrated to have high prognostic power to identify high (early mortality risk over 10% and low risk (early mortality risk ≤ 1% patients. Furthermore, it has become clear that the combination of ESC prognostic model, based on haemodynamics, and clinical prognostic scores may improve the prognostic stratification of acute PE, especially for patients with intermediate risk in whom the range of early mortality risk is wide The latest version of ESC recommendations on management of acute PE released in August 2014 go toward this direction and suggest to divide the non high risk PE in low or intermediate risk taking in account the PESI score. In this review we describe the prognostic strategy of acute PE suggested from the latest version of ESC recommendations.http://dx.doi.org/10.7175/rhc.v5i4.952

  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. Automated interpretation of ventilation-perfusion lung scintigrams for the diagnosis of pulmonary embolism using artificial neural networks

    International Nuclear Information System (INIS)

    The purpose of this study was to develop a completely automated method for the interpretation of ventilation-perfusion (V-P) lung scintigrams used in the diagnosis of pulmonary embolism. An artificial neural network was trained for the diagnosis of pulmonary embolism using 18 automatically obtained features from each set of V-P scintigrams. The techniques used to process the images included their alignment to templates, the construction of quotient images based on the ventilation and perfusion images, and the calculation of measures describing V-P mismatches in the quotient images. The templates represented lungs of normal size and shape without any pathological changes. Images that could not be properly aligned to the templates were detected and excluded automatically. After exclusion of those V-P scintigrams not properly aligned to the templates, 478 V-P scintigrams remained in a training group of consecutive patients with suspected pulmonary embolism, and a further 87 V-P scintigrams formed a separate test group comprising patients who had undergone pulmonary angiography. The performance of the neural network, measured as the area under the receiver operating characteristic curve, was 0.87 (95% confidence limits 0.82-0.92) in the training group and 0.79 (0.69-0.88) in the test group. It is concluded that a completely automated method can be used for the interpretation of V-P scintigrams. The performance of this method is similar to others previously presented, whereby features were extracted manually. (orig.)

  16. Lung scan accuracy and precision in the diagnosis of pulmonary embolism by transmission, perfusion and ventilation procedures

    International Nuclear Information System (INIS)

    Although there is controversy over the value of radionuclide lung scans in the diagnosis of pulmonary thrombo-embolism, the procedure remains non-invasive, accurate and precise given proper methodological and interpretive criteria. Reviewing 959 procedures from the past decade in 539 patients, including 23 autopsies (correctly diagnosed antemortem), 93 emergencies (67 in 1973; 26 since), 8 pulmonary angiograms, 649 (8 view) perfusion studies with transmission view and 'first pass' flow using 99mTc-Macroparticles (MAA or HAM), 257 ventilation studies using 133-Xenen, 53 'aerosol' studies (either 'wet' or 'dry' radioinhalant), 113 computer analyses and 13 'closing volumes' (as well estimated by imaging as standard techniques (p<0.05)); a sensitivity of 92 percent, a specificity of 96 percent, an efficiency of 96 percent with a probability of disease with a positive study of 90 percent and a likelihood of disease with a negative study of 2 percent were found. Peripheral thrombosis and positive lung scans for pulmonary embolism occurred frequently. Based on these data, the lung scan properly carried out is reliable especially to exclude pulmonary embolism, frequently rendering invasive procedures unnecessary. (Author)

  17. Automated interpretation of ventilation-perfusion lung scintigrams for the diagnosis of pulmonary embolism using artificial neural networks

    Energy Technology Data Exchange (ETDEWEB)

    Holst, H.; Jaerund, A.; Traegil, K.; Evander, E.; Edenbrandt, L. [Department of Clinical Physiology, Lund University, Lund (Sweden); Aastroem, K.; Heyden, A.; Kahl, F.; Sparr, G. [Department of Mathematics, Lund Institute of Technology, Lund (Sweden); Palmer, J. [Department of Radiation Physics, Lund University, Lund (Sweden)

    2000-04-01

    The purpose of this study was to develop a completely automated method for the interpretation of ventilation-perfusion (V-P) lung scintigrams used in the diagnosis of pulmonary embolism. An artificial neural network was trained for the diagnosis of pulmonary embolism using 18 automatically obtained features from each set of V-P scintigrams. The techniques used to process the images included their alignment to templates, the construction of quotient images based on the ventilation and perfusion images, and the calculation of measures describing V-P mismatches in the quotient images. The templates represented lungs of normal size and shape without any pathological changes. Images that could not be properly aligned to the templates were detected and excluded automatically. After exclusion of those V-P scintigrams not properly aligned to the templates, 478 V-P scintigrams remained in a training group of consecutive patients with suspected pulmonary embolism, and a further 87 V-P scintigrams formed a separate test group comprising patients who had undergone pulmonary angiography. The performance of the neural network, measured as the area under the receiver operating characteristic curve, was 0.87 (95% confidence limits 0.82-0.92) in the training group and 0.79 (0.69-0.88) in the test group. It is concluded that a completely automated method can be used for the interpretation of V-P scintigrams. The performance of this method is similar to others previously presented, whereby features were extracted manually. (orig.)

  18. Logistic regression model for identification of right ventricular dysfunction in patients with acute pulmonary embolism by means of computed tomography

    International Nuclear Information System (INIS)

    Purpose: Diagnosis of right ventricular dysfunction in patients with acute pulmonary embolism (PE) is known to be associated with increased risk of mortality. The aim of the study was to calculate a logistic regression model for reliable identification of right ventricular dysfunction (RVD) in patients diagnosed with computed tomography pulmonary angiography. Material and methods: Ninety-seven consecutive patients with acute pulmonary embolism were divided into groups with and without RVD basing upon echocardiographic measurement of pulmonary artery systolic pressure (PASP). PE severity was graded with the pulmonary obstruction score. CT measurements of heart chambers and mediastinal vessels were performed; position of interventricular septum and presence of contrast reflux into the inferior vena cava were also recorded. The logistic regression model was prepared by means of stepwise logistic regression. Results: Among the used parameters, the final model consisted of pulmonary obstruction score, short axis diameter of right ventricle and diameter of inferior vena cava. The calculated model is characterized by 79% sensitivity and 81% specificity, and its performance was significantly better than single CT-based measurements. Conclusion: Logistic regression model identifies RVD significantly better, than single CT-based measurements

  19. Pulmonary Embolism Presenting as Abdominal Pain: An Atypical Presentation of a Common Diagnosis.

    Science.gov (United States)

    Rehman, Hasan; John, Elizabeth; Parikh, Payal

    2016-01-01

    Pulmonary embolism (PE) is a frequent diagnosis made in the emergency department and can present in many different ways. Abdominal pain is an unusual presenting symptom for PE. It is essential to maintain a high degree of suspicion in these patients, as a delay in diagnosis can be devastating for the patient and confers a high risk of mortality if left untreated. Here, we report the case of a 53-year-old male who presented to the emergency department with worsening right upper quadrant abdominal pain with fevers. Initial imaging was benign, although lab work showed worsening leukocytosis and bilirubin. Abdominal pathology seemed most likely, but the team kept PE on the differential. Further imaging revealed acute pulmonary embolus in the segmental branch of the right lower lobe extending distally into subsegmental branches. The patient was started on anticoagulation and improved drastically. This case highlights the necessity of keeping a broad differential and maintaining a systematic approach when dealing with nonspecific complaints. Furthermore, a discussion on the pathophysiology on why PE can present atypically as abdominal pain, as well as fevers, is reviewed. Using this information can hopefully lead to a subtle diagnosis of PE in the future and lead to a life-saving diagnosis. PMID:27642528

  20. Electron beam computed tomography and ventilation perfusion scintigraphy in the diagnosis of pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Kettner, Beatrice I.; Sandrock, Dirk; Reisinger, Ingrid; Munz, Dieter L. [Clinic for Nuclear Medicine, Humboldt University of Berlin (Germany); Enzweiler, Christian N.H. [Department of Radiology, Humboldt University of Berlin (Germany)

    2002-05-01

    The purpose of this study, performed in patients with suspected pulmonary embolism (PE), was to compare V/Q scans and electron beam computed tomography (CT) scans on a patient-by-patient and segment-by-segment basis. Both a segment-based and a lobe-based analysis was performed in those patients positive for PE. The diagnosis of PE was assumed on the basis of a mismatch at V/Q scanning or a filling defect in a pulmonary vessel at contrast-enhanced electron beam CT. In 37/45 patients (24 female, 21 male, 58{+-}16 years) with suspected PE, the diagnosis of PE was confirmed or excluded by both modalities, resulting in a correlation of 82% between electron beam CT and V/Q scanning. In the 28 patients positive for PE according to one or both modalities, 504 segments were evaluated. Of these 504 segments, 248 (nearly 50%) showed perfusion defects on V/Q scans, of which only 90 (36%) displayed emboli at electron beam CT. Overall, a total of only 135 of the 504 segments (27%) were abnormal at electron beam CT. More than 50% of the patients with discrepant results did not show an embolus at electron beam CT. It is concluded that there is a good correlation (82%) between V/Q scanning and electron beam CT on a patient-by-patient basis but a markedly less good correlation (62%) in a segment-based analysis. (orig.)

  1. Equipment availability and diagnostic strategies for suspected pulmonary embolism in Austria

    Energy Technology Data Exchange (ETDEWEB)

    Schibany, N.; Fleischmann, D.; Thallinger, C.; Ba-Ssalamah, A. [Vienna Univ. (Austria). Inst. fuer Radiologie; Schibany, A. [Joanneum Research, Vienna (Austria); Hahne, J. [Ludwig Boltzmann Inst. for Clinical and Experimental Radiology, Vienna (Austria); Herold, C.J. [Vienna Univ. (Austria). Inst. fuer Radiologie; Ludwig Boltzmann Inst. for Clinical and Experimental Radiology, Vienna (Austria)

    2001-11-01

    The aim of this study was to investigate equipment availability and current diagnostic strategies for suspected pulmonary embolism (PE) in Austrian hospitals. A questionnaire was sent to the medical directors of all Austrian hospitals with emergency and/or surgical, orthopedic, and medical departments. The questionnaire contained questions regarding the available equipment suitable for the imaging diagnosis of PE, the first-line and second-line imaging tests for patients with suspected PE, and additional lower extremity venous imaging and laboratory tests that complement the diagnostic armamentarium. The return rate for questionnaires was 81% (127 of 157 hospitals). There were 97% of hospitals that had the equipment to perform sonography, 59% could perform pulmonary angiography, 54% spiral CT, 19% ventilation/perfusion (V/P) scintigraphy, and 4% perfusion scintigraphy alone. Spiral-CT angiography (SCTA) was the first-line imaging study for suspected PE in 56% of hospitals, followed by echocardiography and V/P scintigraphy. Lower extremity venous imaging (47%) and, interestingly, V/P scintigraphy (43%), served as second-line imaging tests. D-dimer tests were included in the diagnostic strategy in 74% of hospitals. Spiral-CT angiography is the most commonly used primary method for suspected PE in Austrian hospitals. The V/P scintigraphy is available only in a minority of hospitals to investigate patients with suspected PE. When V/P scintigraphy is available, however, it is employed in a large number of patients per annum. (orig.)

  2. Relationship between scintigraphic probability and angiographic certainty in acute pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To determine if the angiographic findings correlate with the scintigraphic probability for the diagnosis of pulmonary embolism (PE). Methods: From a total of 160 consecutive patients who underwent both nuclear imaging and invasive selective pulmonary angiography we reviewed the ventilation (Xe-133 in 2 oblique posterior views) and perfusion (Tc-MAA) (VQ) scans and selective angiograms of those 40 patients (15 men; 25 women, average age 57) who were discharged from hospital on anticoagulants with a diagnosis of PE. Results: the VQ scans were read as high (N=18; 45%), intermediate (N=10; 25%) or low (N=12; 30%) probability. The angiograms were interpreted as either positive (filling defect, trailing embolus or branch occlusion) (N=29; 73%), single tiny embolus (single small sub-segmental filling defect) (N=5; 12%), or equivocal (N=6; 15%). The distribution of the angiographic sub-groups among the 3 scintigraphic categories is presented. Conclusion: In patients diagnosed with PE based on selective angiography, a lower probability of PE on VQ scintigraphy correlates with a lesser degree of diagnostic certainty on angiography. (author)

  3. 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.

  4. [Pulmonary embolism and disseminated intravascular coagulation after being bitten by a Bothrops lanceolatus snake. Apropos of a case].

    Science.gov (United States)

    Estrade, G; Garnier, D; Bernasconi, F; Donatien, Y

    1989-11-01

    The authors report the case of a Bothrops lanceolatus snake bite complicated by severe pulmonary embolism a few hours after admission. This thromboembolic complication developed despite heparin therapy and was followed by disseminated intravascular coagulation (DIC). Vascular thrombosis and pulmonary embolism are rare after Bothrops lanceolatus snake bite as patients are usually hypocoagulable due to DIC. In this case, the thromboembolism was probably caused by the procoagulant effect of the thrombin-like enzymes of the snake venom which may have been injected directly into the vein of a young woman taking a contraceptive pill. A specific antivenin which has recently become available fort treatment may decrease the complications of Bothrops lanceolatus snake bite. PMID:2514645

  5. An unusual finding of massive pulmonary embolism in a patient during treatment with high-dose ibuprofen.

    Science.gov (United States)

    Bilora, Franca; Adamo, Angelo; Pomerri, Fabio; Prandoni, Paolo

    2016-02-01

    Non-steroidal anti-inflammatory drugs have been associated with an increased risk of venous thromboembolism. We report for the first time, the case of a patient who developed massive pulmonary embolism after a long period of treatment with high doses of ibuprofen. A 65-year-old woman was admitted with severe dyspnea while on treatment with high doses of ibuprofen for diffuse spine pain due to arthrosis. A spiral computed tomography showed a massive pulmonary embolism. No other explanation for the thromboembolic disorder was found. She was successfully treated with therapeutic doses of low-molecular-weight heparin followed by rivaroxaban. Ibuprofen was discontinued and replaced by tramadol. High-dose ibuprofen is likely to have accounted for the life-threatening thromboembolic disorder.

  6. MOBILE RIGHT HEART THROMBUS WITH PULMONARY EMBOLISM IN A PATIENT WITH POLYCYTHEMIA RUBRA VERA AND SPLANCHNIC VEIN THROMBOSIS

    OpenAIRE

    Panduranga, Prashanth; Mukhaini, Mohammed; Saleem, Muhammad; Al-Delamie, Taha; Zachariah, Sunny; Al-Taie, Saqar

    2010-01-01

    Splanchnic vein thrombosis in patients with polycythemia rubra vera is well-known. Development of mobile right heart thrombus in these patients has not been reported previously. We describe a young patient with Polycythemia rubra vera and splanchnic vein thrombosis with ischemic bowel who underwent small bowel resection. He developed a large mobile right atrial thrombus and bilateral pulmonary embolism. He also had upper gastrointestinal bleed. His management was complicated and challenging d...

  7. 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....

  8. Massive postoperative pulmonary embolism in a young woman using oral contraceptives: the value of a preoperative anesthetic consult.

    Science.gov (United States)

    Amar, S; Van Boven, M; Rooijakkers, H; Momeni, M

    2014-01-01

    We describe the case of a woman with a history of active tabagism and on the oral contraceptive Yasmin, presenting in the Post-Anesthesia Care Unit (PACU) with a cardiac arrest due to massive pulmonary embolism following transforaminal lumbar interbody fusion surgery. The patient had preoperatively several risk factors for deep venous thrombosis. This case-report emphasizes the value of a preoperative anesthetic visit and eventual temporary cessation of certain oral contraceptives in specific cases. PMID:25223166

  9. Comparison of V/Q SPECT and planar V/Q lung scintigraphy in diagnosing acute pulmonary embolism

    DEFF Research Database (Denmark)

    Borgwardt, Henrik Gutte; Mortensen, Jann; Jensen, Claus Verner;

    2010-01-01

    Planar ventilation/perfusion (V/Q) scintigraphy is currently the standard method for the diagnosis of pulmonary embolism (PE) in most nuclear medicine centers. However, recent studies have shown a superior sensitivity and specificity when applying V/Q single photon emission computed tomography...... (SPECT) in diagnosing PE. This study evaluated the diagnostic performance of three-dimensional V/Q SPECT in comparison with planar V/Q scintigraphy....

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

    OpenAIRE

    Hellfritzsch, Maja; Grove, Erik Lerkevang

    2015-01-01

    Patient: Female, 14 Final Diagnosis: Pulmonary embolism Symptoms: Chest pain • dyspnea • syncope Medication: Combined oral contraceptives Clinical Procedure: — Specialty: Internal Medicine Objective: Adverse events of drug therapy Background: The prothrombotic effect of combined oral contraceptives (COCs) is well-established, with a 3–6-fold increased risk of VTE compared to non-users. When initiation of COCs is considered, it is therefore of paramount importance to carefully evaluate all oth...

  11. Computer-assisted detection of pulmonary embolism : evaluation of pulmonary CT angiograms performed in an on-call setting

    NARCIS (Netherlands)

    Wittenberg, Rianne; Peters, Joost F.; Sonnemans, Jeroen J.; Prokop, Mathias; Schaefer-Prokop, Cornelia M.

    2010-01-01

    The purpose of the study was to assess the stand-alone performance of computer-assisted detection (CAD) for evaluation of pulmonary CT angiograms (CTPA) performed in an on-call setting. In this institutional review board-approved study, we retrospectively included 292 consecutive CTPA performed duri

  12. Efficient detection of peripheral pulmonary embolism by ventilation/perfusion SPECT in cases where helical CT was non diagnostic

    International Nuclear Information System (INIS)

    In recent year's Helical CT (HCT) has played a major role in the diagnostics of pulmonary embolism (PE). However it may be non diagnostic in small and peripheral pulmonary embolism. For two years we have been using a new and fast pulmonary ventilation/perfusion SPECT method for precise detection of pulmonary embolism. Purpose: To study the feasibility of the fast SPECT method in detection of small PE at patients with negative HCT. Methods: 43 consecutive patients (17 males, 26 females, age 27 - 91 yr ,mean 64 yr) with clinical suspicion of pulmonary embolism but negative finding in HCT were included. A ventilation / perfusion SPECT was performed. The patient was positioned in the triple head gamma camera (Marconi/Philips Irix, LEHR collimators) and Technegas was inhaled until the count rate increased above 1000 c/s. Ventilation SPECT was acquired in ten minutes and then perfusion SPECT in six minutes after the injection, without moving the patient, of 120 - 150 MBq 99mTc-MAA resulting, at least, four times the ventilation count rate. The acquired data was grouped into 120 128 x 128 projections. It was reconstructed iteratively and filtered using the same parameters in both data sets. Both orthogonal slice sets were displayed simultaneously side by side for evaluation. The extension of affected (mismatch) segments at every patient was counted. The amount of the defect was scores as follows: 0 = no defect, 1 = subsegmental defect, 2= segmental defect. For diagnosis of PE the minimal score number was 2. Results: Pulmonary embolism was stated in 14 of 43 helical CT negative patients (32 %). The score number was 2 in six cases, 3 in four cases and 4 or more in four cases. So, the majority of the patients had relatively small and peripheral PE. Conclusion: Ventilation/perfusion SPECT revealed PE at 32 % of the patients with a negative helical CT finding. Ventilation/perfusion SPECT is a fast (acquired in 16 minutes) and precise method for clinical diagnostics of PE. It

  13. Unusual Development of Pulmonary Tumor Embolism from Controlled Liver Metastases of Transitional Cell Carcinoma: An Autopsy Case.

    Science.gov (United States)

    Kitayama, Hiromitsu; Yokota, Taro; Kondo, Tomohiro; Sugiyama, Junko; Hirayama, Michiaki; Oyamada, Yumiko; Tsuji, Yasushi

    2016-01-01

    Clinicians generally suspect pulmonary tumor embolism (PTE) with uncontrolled carcinomas which often spread to lungs. We, however, experienced an autopsy case of diffuse microscopic PTE despite controlled liver metastases of transitional cell carcinoma (TCC). A 66-year-old man with progressing respiratory symptoms showed almost normal chest findings on computed tomography. Although liver metastases were successfully shrunk by chemotherapy, the patient died from aggressive respiratory failure. An autopsy revealed small pulmonary vessels showing diffuse tumor emboli. TCC can cause PTE even if liver metastases are controlled. We must therefore be aware that PTE can manifest as respiratory symptoms without any computed tomography findings. PMID:27580549

  14. 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.

  15. Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses

    Directory of Open Access Journals (Sweden)

    Deng-Wei Chou

    2015-06-01

    Full Text Available OBJECTIVES: Septic pulmonary embolism caused by a Klebsiella (K. pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment. METHOD: We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years. RESULTS: The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%, nodules with or without cavities (79%, pleural effusions (71%, peripheral wedge-shaped opacities (64%, patchy ground-glass opacities (50%, air bronchograms within a nodule (36%, consolidations (21%, halo signs (14%, and lung abscesses (14%. Nine (64% of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14% patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis. CONCLUSION: The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis.

  16. 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

  17. 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

  18. Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Marcos Mello Moreira

    2008-11-01

    Full Text Available Marcos Mello Moreira1, Renato G G Terzi1, Carlos Heitor N Carvalho2, Antonio Francisco de Oliveira Neto3, Mônica Corso Pereira4, Ilma Aparecida Paschoal41Department of Surgery, State University of Campinas, School of Medical Sciences; 2Department of Cardiology, State University of Campinas, School of Medical Sciences; 3Intensive Care Unit of the State University of Campinas, School of Medical Sciences; 4Department of Pulmonology, State University of Campinas, School of Medical Sciences, Campinas, BrazilAbstract: Pulmonary embolism (PE is a common condition. The central aim of this study was to describe the use of volumetric capnography (VCap before and after fibrinolytic treatment of major PE. Lung scintigraphy was used as a base of comparison for the results of this treatment. We describe the cases of two conscious and spontaneously breathing patients (20- and 24-year-old women with major PE undergoing thrombolysis. Curves of CO2 were obtained by VCap and associated with arterial blood gas analysis and D-dimer. The pattern of VCap was compared with the VCap of health volunteers. Parameters also calculated were: P(a-etCO2 gradient, alveolar dead space fraction (AVDSf , late dead space fraction (f Dlate, and slope phase III (Slp III. The VCap results before and after thrombolysis for patients 1 and 2 were, respectively, P(a-etCO2: 12.6 to 5.8 and 7.9 to 1.6 (mmHg; AVDSf: 0.46 to 0.18 and 0.25 to 0.05; fDlate: 0.46 to 0.21 and 0.24 to 0.04; Slp III: 1.75 to 5.10 and 1.21 to 5.61 (mmHg/L. Lung scintigraphy was used to compare VCap results from the two subjects with VCap results from healthy volunteers and pigs before and after treatment associated with arterial blood gas, D-dimer, and showed satisfactory agreement.Keywords: pulmonary embolism, capnography, respiratory dead space, thrombolysis, fibrin fibrinogen degradation products/fibrin fragment D

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

    International Nuclear Information System (INIS)

    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.)

  20. 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.)

  1. Accuracy of helical CT for acute pulmonary embolism: ROC analysis of observer performance related to clinical experience

    International Nuclear Information System (INIS)

    The aim of this study was to test the influence of observer experience on the accuracy for interpreting helical CT for acute pulmonary embolism (PE) and to identify sources of observer errors. Three observers of different expertise blindly assessed 147 helical CT scans for suspected PE (true status regarding absence or presence of PE known from independent reference studies). These observers were (a) an experienced CT radiologist, (b) a fellow in CT, and (c) a second-year resident without any formal training in CT. None of them had prior experience with CT for PE. Firstly, 70 CT scans were scored without revealing true PE status. Afterwards, feedback was provided and another 77 CT scans were evaluated. The CT scans were scored on a 5-point confidence scale and receiver-operator-characteristic analysis was performed. Different sources of interpretation errors were analyzed. The two observers with CT experience were significantly more accurate than the unexperienced observer. Their performance was not influenced by feedback training. Certain observer errors were identified, but there was no clear difference among the three observers considering the type of errors. There is significant influence of observer experience on accuracy of reading helical CT for PE: A basic working experience with whole-body CT seems to be a prerequisite. These results suggest that with this experience any radiologist should be able to achieve good accuracy; helical CT thus might become a suitable technique for acute PE in routine clinical practice. (orig.)

  2. Pulmonary embolism: Comparison of ventilation-perfusion lung scintigraphy and helical CT angiography

    International Nuclear Information System (INIS)

    Full text: Objective: Retrospective study of the patients undergoing ventilation-perfusion pulmonary scintigraphy and helical CT angiography from March/ 2000 to July/ 2002, due to suspected pulmonary embolism (PE). Methods: Fifty-four patients were evaluated, with those unable to undergo a ventilation study or whose scintigraphy or CT studies were performed after anticoagulant therapy being excluded. The study group included 40 patients (24 male, 16 female) with an average age of 55,8 ± 18,8 years. Ninety per cent of the patients had a measurement of D-dimers levels and only 5% were submitted to angiography. Results: Both studies were concordant in 32 patients (80%), with concordant positive findings in 25 cases and concordant negative results in 7. In concordant positive cases, main risk factors included venous pathology of the lower extremities (40%) and malignant neoplasms (24%); no risk factors were found in 16% of these patients. Clinical findings included thoracic pain (16 patients), dyspnea (15 cases) and cough (7 patients). In these 25 patients PE was bilateral in 52%, right-sided in 28% and left-sided in the remaining 20%. D-dimers were elevated in 19 patients, normal in 3 and not measured in 3 cases. In concordant negative cases, D-dimers were elevated in 6 patients and not measured in one. Studies were discordant in 8 patients: in 5 of them, lung scintigraphy yielded a high-probability study but CT was negative for PE (revealing parenchymatous consolidation in 3 cases and pleural effusion in 2 patients); two patients had an intermediate-probability lung scintigram but CT was also negative (detecting a pericardial cyst around right hilum in one patient); in the remaining discordant case (a patient with chronic pulmonary hypertension), scintigraphy yielded a low-probability result but CT detected a non-occlusive clot in the right pulmonary artery. The angiographic studies performed in only 2 patients, both with concordant positive studies, confirmed the

  3. An evaluation of preoperative and postoperative ventilation and perfusion lung scintigraphy in the screening for pulmonary embolism after elective orthopedic surgery

    International Nuclear Information System (INIS)

    One hundred two patients undergoing elective knee or hip arthroplasty were studied with radionuclide ventilation scans (V) and perfusion scans (Q) preoperatively (preop) and postoperatively (postop) to assess their relative value in the diagnosis of asymptomatic pulmonary embolism (PE) after orthopedic surgery. Postop Q were read in combination with preop V and Q and postop V using prospective investigation of pulmonary embolism diagnosis (PIOPED) criteria. Of 25 postop Q interpreted as either high or intermediate probability for PE, preop Q were judged useful in 96%; the postop V were useful in 78%; and the preop V were not helpful in any of the cases. Of 63 postop Q interpreted as low probability, preop Q were useful in 74%; the postop V were useful in only 33%; and the preop V were useful in only one case. When postop Q were read as normal (14 cases), none of the three auxiliary studies were found to be useful. Overall, postop V were more helpful than preop Q in only 2%, and preop V contributed significantly in only 1%. This experience suggests that preop Q alone is the most useful adjunct to the postop Q in the postoperative evaluation for PE. The authors conclude that to screen for asymptomatic PE after elective orthopedic surgery, preop Q should be performed in all cases, preop V are not necessary, and postop V need be performed only if a baseline preop Q is not available

  4. Improving the diagnostic performance of lung scintigraphy in suspected pulmonary embolic disease

    Energy Technology Data Exchange (ETDEWEB)

    Gleeson, F.V. [Department of Radiology, Churchill Hospital, Oxford Radcliffe NHS Trust, Oxford (United Kingdom)]. E-mail: fergus.gleeson@radiology.oxford.ac.uk; Turner, S. [Department of Radiology, Churchill Hospital, Oxford Radcliffe NHS Trust, Oxford (United Kingdom); Scarsbrook, A.F. [Department of Radiology, Churchill Hospital, Oxford Radcliffe NHS Trust, Oxford (United Kingdom)

    2006-12-15

    Aim: to determine the effectiveness of a new imaging algorithm in the investigation of suspected pulmonary embolism (PE). Materials and methods: A new imaging algorithm for suspected PE was introduced following the installation of a multisection computed tomography (CT) machine at our institution. Before its installation, patients with suspected PE were evaluated with ventilation/perfusion (V/Q) scintigraphy. Subsequently, patients were triaged according to chest radiography (CR) and respiratory history to either lung scintigraphy or CT pulmonary angiography (CTPA). Patients with a normal CR and no history of lung disease were evaluated using perfusion (Q) scintigraphy [ventilation (V) scintigraphy was no longer performed]. Patients with an abnormal CR, asthma or chronic lung disease were evaluated using CTPA. All V/Q images in a continuous 3-year period before the introduction of the new imaging algorithm and all Q images performed in a 3-year period after its introduction were retrospectively reviewed. Imaging reports were categorized into normal, non-diagnostic (low or intermediate probability) or high probability for PE. Patients in the later group who subsequently underwent CTPA, were also reviewed. Results: After the policy change the percentage of normal scintigrams significantly increased (39 to 60%; p < 0.001). There was a non-significant increase in the percentage of high probability scintigrams (15 to 18%; p = 0.716). Overall the diagnostic yield of lung scintigraphy improved significantly (54 to 78%; p < 0.001). Conclusion: the diagnostic performance of lung scintigraphy can be improved by careful triage of patients to either Q scintigraphy or CTPA based on clinical history and CR findings. Q scintigraphy remains a valuable diagnostic test in the investigation of suspected PE in carefully selected patients.

  5. 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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  7. Position of lung scintigraphy in emergency diagnosis and therapeutic indications in cases of severe pulmonary embolism

    International Nuclear Information System (INIS)

    The position of lung scintigraphy in diagnostic strategy is discussed. This technique appears to afford the key examination in severe pulmonary embolism because of its qualities, which are: - speed of execution, - absolute harmlessness, - diagnostic safety. Taking these points in order: - speed of execution is ensured by the very rapid uptake of I 131-labelled albumin macroaggregates (usable immediately) and the existence of the gamma camera; - harmlessness of the examination by the use of non-allergenic radioactive tracers and doses not significantly restricting the vascular bed still perfused; whichever of the two possible techniques is employed (scanner and gamma camera) the examination can always be practised without getting the patient out of bed, which avoids the risk of clot migration due to movement; - certainty of the result by the fact that in the event of a surgical indication the circulation cut-off image is spectacular and obvious in fact a lung amputation image must be equal to or greater than 50% of the pulmonary field before an operation is decided upon all other images remaining within the scope of a hypocoagulant treatment. A study was carried out in a cardio-vascular surgery department on 28 patients hospitalised with a possible view to embolectomy. Lung scintigraphy allows a quick exploration of the minor circulation. In the special clinical situation of the patients, for whom the advisability of an embolectomy is discussed, the scintigraphic examination provides the key: if normal it eliminates the diagnosis absolutely; if not it reveals without extra risk the spectacular obliterations of the vascular bed on which any therapeutic decision, medical or surgical is based

  8. Multi-slice CT for visualization of pulmonary embolism using perfusion weighted color maps

    International Nuclear Information System (INIS)

    Purpose: The purpose of our preliminary study was to evaluate the feasibility of a new technique for the perfusion weighted color display of the density of lung parenchyma derived from multi-slice CT (MSCT) data sets of clinical routine examinations for visualization of pulmonary embolism (PE). Materials and Methods: Imaging of patients with suspected PE was performed on a commercially available MSCT (Somatom Volume Zoom; Siemens, Forchheim, Germany) after intravenous application of 120 cc of contrast-medium using a power injector. Scan parameters were 140 kV and 100 mAs, using a thin collimation of 4x1 mm and a table speed of 7 mm (pitch: 1.75). Derived from thin collimation axial slices (slice thicknesseff. 1.25 mm, reconstruction increment 0.8 mm), a new image processing technique was deployed. Based on these source images, an automated 3D-segmentation of the lungs was performed followed by threshold based extraction of major airways and vascular structures. The filtered volume data were color encordes and finally overlayed onto the original CT images. This color encoded display of parenchymal density distribution of the lungs was shown in axial, coronal and sagittal plans orientation. In four patients with excluded PE as well as in two patients with proven PE this new technique was performed. Results: In the four patients that were considered negative regarding PE on MSCT, lung densitometry showed a homogeneous distribution of color encoded densities without circumscribed decreased or increased areas, beside the usually present gravity-dependent gradient in ventro-dorsal direction. In the two patients with proven PE, low density values on perfusion weighted color maps were found distally to the occluded pulmonary arteries. (orig.)

  9. [PROGNOSTIC VALUE OF SOME HEMOSTASIS-RELATED, HOMOCYSTEINE, HIGH SENSITIVE C R P AND MULTIDETECTOR COMPUTED TOMOGRAPHY PARAMETERS IN PULMONARY EMBOLISM].

    Science.gov (United States)

    Todua, F; Akhvlediani, M; Vorobiova, E; Baramidze, A; Tsivtsivadze, G; Gachechiladze, D

    2016-05-01

    Nowadays, an arsenal of diagnostic methods is used in diagnosis of pulmonary embolism, which includes x-ray, angiography, perfusion-ventilation scintigraphy, CT and magnetic resonance imaging, Doppler and laboratory studies. Purpose of our study was to evaluate the diagnostic significance of determination of some parameters of hemostasis (D-dimer, Soluble fibrinmonomer complexes, fibrinogen), homocysteine, hs-CRP and multidetector computed tomography in suspected pulmonary embolism. We have examined 54 patients -31 men and 23 women, aged 18 to 76 years, with characteristics of pulmonary embolism. According to our data, Multidetector computed tomography angiopulmonography , measuring D-dimer, fibrinogen and related hyperhomocysteinemia with increased level of hs-CRP may serve as binding, diagnostically significant laboratory markers in the diagnosis and treatment efficacy of pulmonary thromboembolism. PMID:27348165

  10. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  12. Ventilation/perfusion tomography versus planar imaging for diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    The aim: Tomography has proven feasible in routine clinical diagnostics of pulmonary embolism, PE, and validated in experimental studies in pigs. of the study is to evaluate clinical value of tomographic technique against planar imaging on larger number patients. Material and method: 53 consecutive patients with suspected or known PE were studied with planar and tomographic technique and clinically followed up for >6 months. Ventilation was studied after inhalation of 30 MBq 99mTc-DTPA first with planar images, then with tomography. Without movement 100 MBq 99mTc-MAA was injected i.v. Then tomography and finally planar imaging were repeated. The tomographic procedures were completed in 20 minutes. The ventilation tomographic data was corrected for decay prior to reconstruction. Tomographic images of ventilation, perfusion, and ventilation/perfusion quotient were reviewed as multiplane slices and as rotating 3D images. Results: Preliminary 15 patients showed a larger number of emboli in tomographic images. Ancillary findings like heart incompensation and obstructive disease was more clearly revealed in tomography. Current analysis of the 53 patients similarly indicates a higher sensitivity for PE in tomographic studies and improved diagnosis of other diseases. In a few cases patient movement between ventilation and perfusion tomography led to artefacts in V/P images. Conclusion: The present study confirms that tomographic V/P scintigraphy is feasible as a clinical routine. Mismatch identification and diagnostics of PE and other lung disease is facilitated. Improved non-alignment analysis and correction is considered

  13. 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.

  14. Analyse of the prevalence rate and risk factors of pulmonary embolism in the patients with dyspnea

    International Nuclear Information System (INIS)

    Objective: To analyse the prevalence rate and risk factors of pulmonary embolism (PE) in patients with dyspnea and to explore the predisposing causes and its early clinical manifestations. Methods: Retrospective analysis was done in 461 patients with dyspnea performed 99Tcm-macroaggregated albumin (MAA) lung perfusion imaging and 99Tcm-DTPA ventilation imaging or 99Tcm-MAA perfusion imaging and chest X-ray examination. Among them, 48 cases without apparent disease were considered as control group, whereas the remaining patients with other underlying illnesses as patients group. PEMS statistics software package was used for estimation of prevalence rate, χ2 test and PE risk factor analysis. Results: There were 251 PE patients among 461 patients, the prevalence rate [ (π)=95% confidence interval (CI) ] was: lower extremity thrombosis and varicosity (80.79-95.47 ), post cesarean section (55.64-87.12), lower extremity bone surgery or fracture (52.76-87.27 ), cancer operation (52.19-78.19), atrial fibrillation or heart failure (53.30-74.88), obesity (23.14-50.20), post abdominal surgery (20.23-59.43), diabetes (19.12-63.95), chronic bronchitis (1.80-23.06), normal control group (3.47-22.66). Except chronic bronchitis, PE prevalence rate between patients group and control group had significant difference (P99Tcm-MAA and DTPA lung imaging should be done as early as possible. (authors)

  15. Computation of ventilation-perfusion ratio with Kr-81m in pulmonary embolism

    International Nuclear Information System (INIS)

    Diagnostic difficulties occur in pulmonary embolism (PE) during visual analysis of ventilation-perfusion images in matched defects or in chronic obstructive lung disease (COPD). In 44 patients with angiographically confirmed PE and in 40 patients with COPD, the regional ventilation-perfusion ratios (V/Q) were therefore computed using krypton-81m for each perfusion defect, and were displayed in a functional image. In patients with PE and mismatched defects, a high V/Q (1.96) was observed. A V/Q > 1.25 was also found in nine of 11 patients having PE and indeterminate studies (studies with perfusion abnormalities matched by radiographic abnormalities). COPD was characterized by matched defects and low V/Q. The percentage of patients correctly classified as having PE or COPD increased from 56% when considering the match or mismatched character to 88% when based on a V/Q of 1.25 in the region of the perfusion defect. This quantitative analysis, therefore, seems useful in classifying patients with scintigraphic suspicion of PE

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

    Science.gov (United States)

    Levin, David; Seo, Joon Beom; Kiely, David G; Hatabu, Hiroto; Gefter, Warren; van Beek, Edwin J R; Schiebler, Mark L

    2015-06-01

    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. PMID:25864020

  17. Additional diagnostic value of low dose CT in ventilation/perfusion hybrid SPECT for pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To evaluate the assistant diagnostic value of low dose CT in patients with pulmonary embolism (PE) based on ventilation/perfusion (V/Q) SPECT imaging. Methods: One hundred and two patients with clinical suspected PE had been enrolled for this retrospective study. The final diagnosis of PE was made according to the 2008 guidelines of European Society of Cardiology (ESC). All patients underwent V/Q SPECT/CT (Hawkeye 4, GE). The imaging findings from low dose CT lung window were used for differential diagnoses of abnormal regions in SPECT imaging. The diagnostic efficiency of V/Q SPECT alone was compared with that of V/Q SPECT combined with low dose CT scan. Crosstabs χ2 test was performed using SPSS 13.0 software. Results: Twenty-nine patients (28.43%, 29/102) were finally diagnosed as PE. V/Q SPECT alone had a sensitivity of 93.10% (27/29), a specificity of 90.41% (66/73), and an accuracy of 91.18% (93/102). With additional diagnostic information from low dose CT, the diagnostic specificity increased to 95.89% (70/73, χ2=1.72, P>0.05), and the accuracy increased to 95.10% (97/102, χ2=1.23, P>0.05) though the sensitivity remained the same. Conclusion: Imaging information from low dose CT in hybrid SPECT/CT may enhance V/Q diagnostic accuracy for PE. (authors)

  18. 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.

  19. Recent advances in the management of pulmonary embolism: focus on the critically ill patients.

    Science.gov (United States)

    Meyer, Guy; Vieillard-Baron, Antoine; Planquette, Benjamin

    2016-12-01

    The aim of this narrative review is to summarize for intensivists or any physicians managing "severe" pulmonary embolism (PE) the main recent advances or recommendations in the care of patients including risk stratification, diagnostic algorithm, hemodynamic management in the intensive care unit (ICU), recent data regarding the use of thrombolytic treatment and retrievable vena cava filters and finally results of direct oral anticoagulants. Thanks to the improvements achieved in the risk stratification of patients with PE, a better therapeutic approach is now recommended from diagnosis algorithm and indication to admission in ICU to indication of thrombolysis and general hemodynamic support in patients with shock. Given at current dosage, thrombolytic therapy is associated with a reduction in the combined end-point of mortality and hemodynamic decompensation in patients with intermediate-risk PE, but this is obtained without a decrease in overall mortality and with a significant increase in major extracranial and intracranial bleeding. In patients with high-intermediate-risk PE, thrombolytic therapy should be given in case of hemodynamic worsening. Vena cava filters are of little help when anticoagulant treatment is not contraindicated, even in patients with PE and features of clinical severity. Finally, direct oral anticoagulants have been shown to be as effective as and safer than the combination of low molecular weight heparin and vitamin K antagonist(s) in patients with venous thromboembolism and low- to intermediate-risk PE. PMID:26934891

  20. Analysis on the Pathogenesis of Symptomatic Pulmonary Embolism with Human Genomics

    Directory of Open Access Journals (Sweden)

    Hao Wang, Qianglin Duan, Lemin Wang, Zhu Gong, Aibin Liang, Qiang Wang, Haoming Song, Fan Yang, Yanli Song

    2012-01-01

    Full Text Available BACKGROUND: In the present study, the whole human genome oligo microarray was employed to investigate the gene expression profile in symptomatic pulmonary embolism (PE.METHODS: Twenty patients with PE and 20 age and gender matched patients without PE as controls were enrolled into the present study in the same period. The diagnosis of PE was based on the clinical manifestations and findings on imaging examinations. Acute arterial and/or venous thrombosis was excluded in controls. The whole human genome oligo microarray was employed for detection. Statistical analysis was performed with t test following analysis of very small samples of repeated measurements and Gene Ontology (GO analysis.RESULTS: Genomic data showed no damage to vascular endothelial cells in PE patients. Genomic data only found increased mRNA expression of a small amount of coagulation factors in PE patients. In the PE group, anticoagulant proteins, Fibrinolytic system and proteins related to platelet functions only played partial roles in the pathogenesis of PE. In addition, the mRNA expressions of a fraction of adhesion molecules were markedly up-regulated. Gene Ontology analysis showed the genes with down-regulated expressions mainly explain the compromised T cell immunity. Symptomatic VTE patients have compromised T cell immunity.CONCLUSION: The damage to vascular endothelial cells is not necessary in the pathogenesis of VTE, and only a fraction of factors involved in the shared coagulation cascade are activated. Genomic results may provide a new clue for clinical diagnosis, treatment and prevention of VTE.

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

    International Nuclear Information System (INIS)

    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

  2. Complementarity of lung scintigraphy and D-dimer test in pulmonary embolism

    International Nuclear Information System (INIS)

    D-dimer assay (DDA), measuring fibrin degradation products, was compared with lung scintigraphy (LS) in a prospective unselected series of 83 consecutive patients referred owing to suspicion of pulmonary embolism (PE). This patient series was also used to compare several methods of performing and interpreting LS images. The final diagnosis was established independently by a separate panel with all available information except for the result of DDA. D-dimer was determined by ELISA (threshold value 500 ng/ml). LS, including perfusion (.Q) and pseudo-ventilation (Technegas) (.V), was classified according to PIOPED, (1) immediately by the physician on duty, and (2) retrospectively by a blinded panel. A positive (19) or negative (61) diagnosis of PE was achieved in 80 patients, the prevalence of PE being 24%. Only one false-negative was noted on DDA (sensitivity=95%) but there were 42 false-positives (specificity=31%), resulting in a positive predictive value of 30% and a negative predictive value of 95%. Emergency and retrospective interpretations of LS were close (kappa=0.4). In a minority of patients, PE may be excluded with reasonable certainty if DDA is normal, resulting in a significant saving in terms of time and money. (orig.). With 3 tabs

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  4. Prognostic value of troponins in acute nonmassive pulmonary embolism: A meta-analysis.

    Science.gov (United States)

    Bajaj, Anurag; Saleeb, Michael; Rathor, Parul; Sehgal, Vishal; Kabak, Besher; Hosur, Srikanth

    2015-01-01

    The objective of our meta-analysis is to update the evidence on the prognostic value of elevated troponin levels in patient with acute normotensive pulmonary embolism (PE). We did a systematic literature review of database, including Pubmed, EMBASE, and Cochrane. Studies were included if those were done on normotensive patients with acute PE and serum troponin assay was done. The primary end point was short term all cause mortality. The secondary end points were short term PE related mortality and serious adverse events. Elevated troponin levels were significantly associated with the increased risk for short term mortality (odds ratio [OR], 4.80; 95% CI, 3.25-7.08, I(2) = 54%), PE related mortality (OR, 3.80; 95% CI, 2.74-5.27, I(2) = 0%) and serious adverse events (OR, 3.65; 95% CI, 2.41-5.53, I(2) = 47%). Our study suggests that elevated levels of troponin identify a subgroup of patients with increased risk for short term mortality and serious adverse events. PMID:25976228

  5. Advances of ventilation/perfusion scintigraphy in diagnosing acute pulmonary embolism

    International Nuclear Information System (INIS)

    PE is a severe and potentially fatal disease. Early and accurate diagnosis of PE is crucial. Lung scintigraphy is a non-invasive imaging technique to diagnose PE. Recently, major research advances have been achieved in V/Q scintigraphy. The prospective investigation of PE diagnosis (PIOPED)Ⅰ criteria was formalized in the 1990s. In the PIOPED study, the majority of patients had either intermediate probability results or low probability results. Accordingly, the PIOPED Ⅰ criteria were fundamentally flawed. Many investigators established new criteria,such as PIOPED Ⅱ, prospective investigative study of acute pulmonary embolism diagnosis (PISAPED) and European Association of Nuclear Medicine (EANM). With the use of SPECT acquisition, the V/Q scan has undergone a transition to three-dimensional volumetric imaging. SPECT has a higher spatial resolution than planar V/Q scintigraphy, so it can detect abnormalities particularly at the subsegmental level and in the lung bases, where the segments are tightly packed. SPECT V/Q has proven to be clearly superior to planar V/Q and multi-detector CT (MDCT). When SPECT and CT images are acquired on the same scanning bed in the same imaging session, great registration accuracy is achieved with such SPECT/CT scanners. For lung imaging, the emergence of SPECT/CT scanners gives reporting specialists two options to combine structural and functional data and potentially to improve the overall diagnostic accuracy of the modality. (authors)

  6. 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

  7. Role of D-Dimer, Fibrinogen and DDimer/Fibrinogen Rate in the Diagnosis of Pulmonary Embolism

    Directory of Open Access Journals (Sweden)

    Sureyya Yilmaz1

    2016-04-01

    Full Text Available Objective: The migration of a blood clot from the systemic circulation to pulmonary veins is called pulmonary embolism (PE. Pulmonary embolism is difficult to diagnose. The aim of the present study is to investigate the utility and diagnostic contribution of d-dimer, fibrinogen level, and Ddimer/Fibrinogen (D/F rate which are quick, non-invasive, affordable and easily obtainable laboratory tests in PE. Methods: We have evaluated the diagnostic value of D/F rate in 118 patients who were suspected to have PE. Diagnosis of PE was made by computerized tomographic pulmonary angiography. D-dimer level was above normal in all patients. Initially, Wells clinical scoring was applied on the patients and their d-dimer and fibrinogen levels were measured. Results: Seventy seven patients were detected as PE positive (+ and 41 were detected as PE negative (-. Forty-eight of the cases (40.7% were male; the average age was 49.77±19.46 (15-86 years. Between PE (+ and PE (- patients, d-dimer, fibrinogen, and D/F rate median values and standard derivations were detected to be different and statistically significant. Conclusion: According to this study approach to the patients with suspected from PE, D/F ratio is valuable than d-dimer, and fibrinogen level is significantly lower in patients with PE (+ than patients with PE (-.

  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. Pulmonary embolization of immature Fascioloides magna causing fatal hemothorax confirmed by molecular technique in a heifer in the United States.

    Science.gov (United States)

    Lee, Jung Keun; Rosser, Thomas Graham; Cooley, Jim

    2016-09-01

    The current report describes the use of a molecular technique to identify immature Fascioloides magna An 18-month-old Brangus heifer was found dead in the field without any prior clinical signs. The cause of death was exsanguination into the thoracic cavity associated with pulmonary embolization and infection by immature Fascioloides magna resulting in 2 large foci of pulmonary necrosis and focal arteriolar and lung rupture. The liver had a few random migratory tracts with typical iron and porphyrin fluke exhaust, but no identified fluke larvae. A single immature fluke was found in the lungs, and species level identification as F. magna was confirmed by DNA sequence analysis of the ribosomal internal transcribed spacer regions (ITS1 region, 5.8S rRNA gene, and ITS2) and of partial 28S rRNA gene sequence. This is one of only a few pulmonary fascioloidiasis cases associated with hemothorax in the veterinary literature. PMID:27423736

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

    Directory of Open Access Journals (Sweden)

    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. Correlation analysis of plasma brain natriuretic peptide and recent prognosis in patients with acute pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    Hui-Zhao Liu

    2016-01-01

    Objective:To study the correlation analysis of plasma brain natriuretic peptide (BNP) and recent prognosis in patients with acute pulmonary embolism (APE).Methods:98 cases of patients with APE were selected as the research subjects from January 2012 to January 2015, all patients were divided into BNP<100 ng/L group (n=41 cases) and a BNP≥100 ng/L group (n=57 cases) according to the plasma BNP level. Collection of two groups of patients with clinical data and related laboratory examination indexes, record the incidence rate of two groups of patients with clinical adverse events, comparing the difference between the two groups.Results:With the BNP<100 ng/L group comparison, BNP acuity 100 ng/L group patients' heart rate (HR) partial fast, systolic blood pressure (SBP) is low, the number of people in the clinical manifestations of shortness of breath and syncope, blood gas analysis in the oxygen partial pressure (PaO2) are low, the plasma D-dimer is on the high side, the proportion of a massive embolism is higher (P<0.05); The BNP 100 ng/L or group of patients with cardiac shock, tracheal intubation and cardiopulmonary resuscitation (CPR) and the recent clinical adverse events such as death is more than the BNP<100 ng/L group (P<0.05); Logistic regression analysis suggest the plasma BNP levels (OR=1.137,P<0.05) were independent risk factors for the development of clinical adverse events in patients with APE. ROC curve analysis showed that plasma BNP in patients with predicted area under the curve of the clinical adverse events was 0.841 (95%CI=0.585–0.937,P<0.05), the sensitivity and specificity were 87.3% and 79.8% respectively.Conclusions:Early serum BNP level and APE patients is closely related to the severity and prognosis of recent, early detection of plasma BNP helps in evaluating the prognosis of patients with early admission, to guide treatment of clinical significance.

  13. Pulmonary Embolization of Fat and Bone Marrow in Cynomolgus Macaques (Macaca fascicularis)

    OpenAIRE

    Fong, Derek L; Murnane, Robert D; Hotchkiss, Charlotte E; Green, Damian J.; Hukkanen, Renee R.

    2011-01-01

    Fat embolization (FE), the introduction of bone marrow elements into circulation, is a known complication of bone fractures. Although FE has been described in other animal models, this study represents the first reported cases of FE and bone marrow embolism in nonhuman primates. Histopathologic findings from cynomolgus macaques (Macaca fascicularis) indicated that in all 5 cases, fat and bone marrow embolization occurred subsequent to multiple bone marrow biopsies. In the most severe case, ex...

  14. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    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.

  17. Deep Vein Thrombosis and Pulmonary Embolism in a Mountain Guide: Awareness, Diagnostic Challenges, and Management Considerations at Altitude.

    Science.gov (United States)

    Hull, Claire M; Rajendran, Dévan; Fernandez Barnes, Arturo

    2016-03-01

    High intensity exercise is associated with several potentially thrombogenic risk factors, including dehydration and hemoconcentration, vascular trauma, musculoskeletal injuries, inflammation, long-distance travel, and contraceptive usage. These are well documented in case reports of venous thrombosis in track and field athletes. For mountaineers and those working at high altitude, additional risks exist. However, despite there being a high degree of vigilance for "classic" conditions encountered at altitude (eg, acute mountain sickness, high altitude pulmonary edema, and high altitude cerebral edema), mainstream awareness regarding thrombotic conditions and their complications in mountain athletes is relatively low. This is significant because thromboembolic events (including deep vein thrombosis, pulmonary embolism, and cerebral vascular thrombosis) are not uncommon at altitude. We describe a case of deep vein thrombosis and pulmonary embolism in a male mountain guide and discuss the diagnostic issues encountered by his medical practitioners. Potential risk factors affecting blood circulation (eg, seated car travel and compression of popliteal vein) and blood hypercoagulability (eg, hypoxia, environmental and psychological stressors [avalanche risk, extreme cold]) relevant to the subject of this report and mountain athletes in general are identified. Considerations for mitigating and managing thrombosis in addition to personalized care planning at altitude are discussed. The prevalence of thrombosis in mountain athletes is uncharted, but lowlanders increasingly go to high altitude to trek, ski, or climb. Blood clots can and do occur in physically active people, and thrombosis prevention and recognition will demand heightened awareness among participants, healthcare practitioners, and the altitude sport/leisure industry at large. PMID:26723546

  18. Post-operative Unexpected Bilateral Massive Pulmonary Embolism in a Thirty-Year-Old Woman: A Case Report

    Directory of Open Access Journals (Sweden)

    Öznur Şen

    2015-12-01

    Full Text Available Pulmonary embolism (PE is a rare, yet serious complication. That, generally follows invasive procedures in adults. The present report details the case of bilateral pulmonary embolism in a thirty-year-old women after ovarian cyst surgery. A thirty-year-old female patient, who had ovarian cystectomy ten days previously, consulted the emergency department with the complaints of sickness and syncope. Her blood pressure, pulse and respiratory rate were 90/40 mmHg, 150/min. and 35/min, respectively. During examination and phlebotomy, she had a cardiac arrest and responded to a 3-minute cardiopulmonary resuscitation (CPR with tracheal intubation. During imaging procedures, she had three further cardiac arrests and was admitted to the intensive care unit. The preliminary diagnoses were acute renal failure (ARF and PE. Fluid replacement, inotropic support, anticoagulant therapies, as well as sedation to prevent brain damage were started immediately. Thrombolytic therapy was not attempted because she had surgery ten days ago and hematoma was observed on abdominal ultrasound. Inhaled nitric oxide and inhaled iloprost with sildenafil were employed to reduce pulmonary hypertension. When discharged 136 days after hospitalization she was a tracheotomized and, spontaneously breathing home care patient with hypoxic brain injury. Early detection and treatment of PE are of great importance for a good prognosis and prevention of life-threatening complications.

  19. A Giant Mesenteric Desmoid Tumor Revealed by Acute Pulmonary Embolism due to Compression of the Inferior Vena Cava

    Science.gov (United States)

    Palladino, Elisa; Nsenda, Joseph; Siboni, Renaud; Lechner, Christian

    2014-01-01

    Patient: Male, 69 Final Diagnosis: Mesenteric desmoid tumor Symptoms: — Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: Intra-abdominal fibromatosis is a benign rare tumor of fibrous origin with a significant potential for local invasion and no ability to metastasize, but it can recur. The etiology of desmoid tumors is unknown. It is often associated with conditions such as familial adenomatous polyposis and Gardner syndrome. Case Report: We report the case of a 69-year-old man who presented to our hospital with an acute pulmonary embolism. The patient had a past history of colic surgery for a polyp with a high-grade dysplasia. Pulmonary angiography showed partial occlusion of the right superior lobe artery and partial occlusion of the middle lobe artery. The patient was given thrombolytic therapy. Abdominal computerized tomography revealed a mesenterial giant mass with compression of the inferior vena cava (IVC). A biopsy of the mass, confirming aggressive fibromatosis. A laparotomy was performed, which revealed a massive growth occupying the abdomen and attached to the previous ileocolic anastomosis. One day after surgery, his condition deteriorated. Conclusions: This report underlines the potential of imaging investigations of abdomen and vena cava if pulmonary embolism is suspected, especially when there is no evidence of peripheral venous thrombosis or other predisposing factors. Unfortunately, data on the surgical management of desmoid tumor is scarce. Therefore, the standard of treatment is a surgical resection for resectable tumors. PMID:25180474

  20. Clinical Analysis of 208 Cases of Pulmonary Embolism%208例肺栓塞的临床分析

    Institute of Scientific and Technical Information of China (English)

    杨玥; 张爱珍; 杜永成

    2015-01-01

    目的:回顾性分析肺栓塞病例的临床特点、诊断和治疗方法,减少漏诊、误诊,提高对肺栓塞患者的诊断率和治愈率。方法对2009年1月至2013年9月入住山西省人民医院的208例肺栓塞患者的相关危险因素、临床表现、辅助检查结果及治疗方法进行回顾性分析。结果①肺栓塞患者临床表现多样,主要有呼吸困难、咳嗽、胸憋、胸痛和下肢肿胀。②肺栓塞的主要相关危险因素依次为深静脉血栓形成、高血压、吸烟和心功能不全。③常规检查项目中D-二聚体测定可作为筛查肺栓塞的敏感但非特异性指标。④溶栓序贯抗凝治疗与单纯抗凝治疗的治愈率比较二者差异有统计学意义,总有效率差异无统计学意义。结论肺栓塞临床表现及常规检查缺乏特异性,对疑诊患者应综合考虑,提高确诊率,积极治疗。%Objective To retrospectively analyze the clinical features ,diagnosis and therapy of pulmonary embolism for reduction of misdiagnosis and missed diagnosis, and for improving the cure rate.Methods The data of related risk factors, clinical manifestation, auxiliary examination results and treatment of 208 patients with pulmonary embolism in Shanxi Province people’s hospital were summarized.Results①Pulmonary embolism in patients with clinical manifestations of diversity, malnly include dyspnea, cough, chest suppress, chest paln and swelling of lower limbs.②The maln risk factors related to pulmonary embolism are deep vein thrombosis, high blood pressure, smoking and cardiac insufifciency.③Routine inspection project D-dimer determination can be used as screening sensitive but not speciifc indicator of pulmonary embolism.④Thrombolysis sequential anticoagulation compared with pure anticoagulant therapy cure rate was statistically signiifcant difference in, there was no statistically signiifcant difference in total effective rate.Conclusions clinical

  1. 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

  2. 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.

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

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    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.

  4. 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.

  5. Fatal pulmonary embolism following ultrasound-guided foam sclerotherapy combined with multiple microphlebectomies.

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    Bruijninckx, Cornelis Ma

    2016-08-01

    Ambulatory ultrasound-guided foam sclerotherapy (UGFS) for refluxing saphenous veins is considered a safe therapy. Venous thromboembolic complications after UGFS as well as after all other ambulatory ablative venous interventions are rarely reported. This paper reports a fatal pulmonary embolism (PE) following UGFS in combination with an extended phlebectomy, and questions what measures should be taken to minimize the risk for thromboembolic complications after these procedures. In the reported case (unsuspected), extensive non-occluding atherosclerosis as well as obesity in combination with use of an oral contraceptive might have contributed to the development of the PE while the use of a β-blocker might have increased its fatal course considerably. Routine measurement of the ankle-brachial pressure index reduces the risk for undetected atherosclerosis. It appears that 'in the real world' of ambulatory phlebological treatments thromboembolic complications are more common (2.4-4.7%) and appear accompanied by post-procedural mortality. It is concluded therefore that pharmacological thromboprophylaxis appears warranted in selected cases, perhaps even routine application could be considered. Attention is drawn to the highly thrombogenic but not uncommon combination of overweight and use of oral contraceptive. Apart from applying some form of pharmacological thromboprophylaxis, technical adaptations that might prevent or reduce spill over of foam into the deep venous system should be considered. Firstly, next to adherence to the generally accepted maximum of 10 mL of foam per session, it seems prudent to maximize the injected volume of foam per site. Secondly, it seems best to inject the foam in an elevated leg without groin compression. The concentration of the sclerosant does not appear decisive in this respect, although higher concentrations appear more effective and therefore might be injected in lower volumes without compromising efficacy. PMID:26338843

  6. 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.

  7. Prognostic role of alveolar-arterial oxygen pressure difference in acute pulmonary embolism

    International Nuclear Information System (INIS)

    This study investigated the utility of the alveolar-arterial oxygen pressure difference (AaDO2) in predicting the short-term prognosis of acute pulmonary embolism (PE). This study retrospectively enrolled 114 consecutive patients with acute PE, diagnosed by either spiral computed tomography or high probability ventilation-perfusion lung scans. During the first 24 h of admission, all patients had initial artery blood gas collected under room air. Patient exclusion criteria were chronic lung disease, septic emboli, and moderate and low probability lung scans. Patients were assigned to 2 groups based on either 30-day death or a 30-day composite event. Receiver operating characteristic analyses was used to determine the AaDO2 cut-off value for predicting primary and composite endpoints. Statistical analysis demonstrated significant differences in AaDO2 between the 30-day composite endpoint group and the 30-day composite event-free survival group (p=0.012). The AaDO2 had a strong trend between the 30-day death group and the survival group (p=0.062). The best cut-off value for AaDO2 was 53 mmHg and using this, the positive predictive value for 30-day death was 25% and the negative predictive value was 92%. For the 30-day composite endpoint, the positive predictive value for AaDO2 was 35%, and the negative predictive value was 84%. In this study, thrombocytopenia was also an indicator of poor prognosis for patients with acute PE. The AaDO2 measurement is a highly useful and simple measurement for predicting short-term prognosis in patients with acute PE. It has high negative predictive value and moderate positive predictive value for 30-day death and 30-day composite event. Aggressive thrombolytic treatment strategies should be considered for patients with an initial poor prognostic parameter (ie, AaDO2≥53 mmHg). (author)

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

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    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.

  9. Diagnosing Pulmonary Embolism in Pregnancy: Are Biomarkers and Clinical Predictive Models Useful?

    Science.gov (United States)

    Parilla, Barbara V.; Fournogerakis, Rachel; Archer, Amy; Sulo, Suela; Laurent, Lisa; Lee, Patricia; Chhotani, Benazir; Hesse, Kathleen; Kulstad, Erik

    2016-01-01

    Objective The objective of this study was to evaluate whether trimester-specific D-dimer levels or the modified Wells score (MWS) is a useful risk stratification tool to exclude pregnant women at low risk of pulmonary embolism (PE) from diagnostic imaging. Study Design This is a prospective and retrospective cohort study. Pregnant women who underwent diagnostic imaging for suspected PE were prospectively enrolled. D-dimer serum levels were drawn, and a MWS was assigned. Pregnant women diagnosed with a PE before study launch who underwent diagnostic imaging and had a D-dimer level drawn were also evaluated. Results In this study, 17 patients were diagnosed with a PE and 42 patients had no PE on diagnostic imaging. Sixteen out of 17 patients with a PE versus 11 out of 42 without PE had an abnormal D-dimer level (p = 0.001). Four patients with a PE versus zero without a PE had an abnormal MWS (p = 0.005). The combination of a trimester-specific D-dimer level along with the MWS was abnormal in all 17 patients with a documented PE versus 11/42 (26.2%) patients without a documented PE (p = 0.001). Conclusion A combination of trimester-specific D-dimer levels along with a MWS can be used in pregnancy to triage women into a low-risk category for PE and thereby avoid radiation exposure in a majority of pregnant patients. PMID:27119048

  10. Successful Management of Intraoperative Acute Bilateral Pulmonary Embolism in a High Grade Astrocytoma Patient.

    Science.gov (United States)

    Khraise, Wail N; Allouh, Mohammed Z; Hiasat, Mohammad Y; Said, Raed S

    2016-01-01

    BACKGROUND Intraoperative pulmonary embolism (PE) is a rare life-threatening complication in patients undergoing surgical intervention. Generally, cancer patients have a higher risk for developing this complication. Unfortunately, there is no standard procedure for its management. CASE REPORT We report the case of a 39-year-old woman with high-grade glioma in the right frontal lobe who was admitted to the surgical theater for craniotomy and excision of the tumor. During the general anesthesia procedure and just before inserting the central venous line, her end-tidal CO2 and O2 saturation dropped sharply. The anesthesiologist quickly responded with an aggressive resuscitation procedure that included aspiration through the central venous line, 100% O2, and IV administration of ephedrine 6 mg, colloid 500 mL, normal saline 500 mL, and heparin 5000 IU. The patient was extubated and remained in the supine position until she regained consciousness and her vital signs returned to normal. Subsequent radiological examination revealed a massive bilateral PE. A retrievable inferior vena cava (IVC) filter was inserted, and enoxaparin anticoagulant therapy was prescribed to stabilize the patient's condition. After 3 weeks, she underwent an uneventful craniotomy procedure and was discharged a week later under the enoxaparin therapy. CONCLUSIONS The successful management of intraoperative PE requires a quick, accurate diagnosis accompanied with an aggressive, fast response. Anesthesiologists are usually the ones who are held accountable for the diagnosis and early management of this complication. They must be aware of the possibility of such a complication and be ready to react properly and decisively in the operation theater. PMID:27578311

  11. Normal blood D-dimer concentrations: do they exclude pulmonary embolism?

    Institute of Scientific and Technical Information of China (English)

    Guo Zhiguo; Ma Qingbian; Zheng Yaan; Zhang Yumei; Ge Hongxia

    2014-01-01

    Background Although pulmonary embolism (PE) with normal blood D-dimer (DD) concentrations is considered rare,in practice the incidence may be greater than is generally believed.Overlooking PE is potentially dangerous.The aim of this study was to explore the incidence and clinical features of PE with normal DD concentrations.Methods We retrospectively analyzed the records of 29 patients with PE and normal DD concentrations from the past seven years.We here compare relevant clinical characteristics of these patients with those of patients with PE and abnormal DD concentrations.We evaluated the probabilities of differences by computing pretest probability scores (Wells score and revised Geneva score).Results The frequency of normal DD concentrations in patients with PE was 4%.Previous episode(s) of PE were more common in patients with normal DD concentrations than in those with abnormal DD concentrations (P=0.001).Fever,tachycardia,and tachypnea occurred less frequently in the former group (P<0.05) and time between onset of symptoms and DD testing was longer (P=0.001).The diagnosis of PE was delayed in 22 of the 29 cases.Nineteen and seven cases with normal DD concentrations were classified according to pretest scores as intermediate and low risk,respectively.Conclusions PE with normal DD concentrations is uncommon.Although most diagnoses of PE are ruled out by normal DD values,a small number of cases with PE are missed.A combination of pretest probability score and normal DD concentration increases the probability of making the correct diagnosis,but cannot completely exclude patients with suspected PE.When the clinical manifestations cannot be otherwise explained,clinicians should be alert to the possibility of PE with normal DD concentrations in patients with previous episode(s) of PE or a long interval between onset of symptoms and DD testing.

  12. [Radiographic assessment of pulmonary hypertension: Methodical aspects].

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    Korobkova, I Z; Lazutkina, V K; Nizovtsova, L A; Riden, T V

    2015-01-01

    Pulmonary hypertension is a menacing complication of a number of diseases, which is responsible for high mortality rates and considerably poorer quality of life in a patient. The timely detection for pulmonary hypertension allows timely initiation of treatment, thus improvement in prognosis in the patient. Chest X-ray is the most commonly used radiographic technique for various causes. Physicians' awareness about the radiographic manifestations of pulmonary hypertension may contribute to the earlier detection of this severe disease. Owing to the natural contrast of reflected structures, a chest X-ray film gives a unique opportunity to assess pulmonary circulation vessels, to reveal the signs of pulmonary hypertension, and to estimate trends in the course of the disease. The paper details a procedure for analysis and the normal radiographic anatomy of pulmonary circulation vessels, gives the present classification of pulmonary hypertension, and sets forth its X-ray semiotics. PMID:26552229

  13. Analyses of Paradoxical Embolism Originated from Pulmonary Embolism: Chinese Literature Review and A Case Report%肺栓塞合并矛盾性栓塞国内文献分析:附一例报告

    Institute of Scientific and Technical Information of China (English)

    蒋德雄; 王廷杰; 王红军; 冉梅

    2012-01-01

    Objective To improve the knowledge of paradoxical embolism originated from pulmonary embolism. Methods The medical literature about pulmonary embolism complicated with paradoxical embolism from 1998 to 2011 was searched from " Wanfang medical literature database". Meanwhile 1 case diagnosed in Central Hospital of Dazhou City was reported. Then the clinical characteristics were summarized. Results 51 cases of pulmonary embolism complicated with paradoxical embolism were diagnosed,aged from 23 to 76 years old. There were 27 males and 23 females, and sex was unknown in 1 case. In all cases, the cerebral embolism occurred in 30 cases(58. 8% ) ,lower limb artery embolism in 14 cases(27. 4% ) ,kidney artery embolism in 6 cases(ll. 8% ) ,patent foramen ovale with straddling thrombus in 4 cases(8% ),multiple embolism in 8 cases( 15. 7% ) ,heart ventricle with straddling thrombus in 1 case (1. 96% ) ,coronary artery embolism in 1 case( 1. 96% ) ,aorta embolism in 1 case( 1. 96% ) , and spleen embolism in 1 case (1.96%). There were 35 patients ( 68. 8% ) with patent foramen ovale and 7 cases (13.7%) died. Conclusions Paradoxical embolism waranted more awareness in the cases of pulmonary embolism and/or venous thromboembolism and aggressive screening might avoid misdiagnosis.%目的 综合分析国内肺栓塞合并矛盾栓塞的临床情况,提高对矛盾性栓塞的认识.方法 通过检索“万方医学文献数据库”有关肺栓塞合并矛盾性栓塞或反常栓塞的国内文献,结合达州市中心医院收治的1例病例,汇总分析相关临床资料.结果 国内文献报道肺栓塞合并矛盾性栓塞患者共51例,男27例,女23例,1例性别不详;年龄23 ~ 76岁.发生脑栓塞30例(58.8%),肢体动脉栓塞14例(27.4%),肾动脉栓塞6例(11.8%),卵圆孔血栓骑跨4例(8%),多部位栓塞8例(15.7%),心室骑跨、冠状动脉栓塞、主动脉栓塞及脾栓塞各1例(各1.96%);其中记录卵圆孔开放35例(68.8%),死亡7

  14. 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.

  15. 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.

  16. 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

  17. Generalized Malperfusion Due to Systemic Embolization From a Large Thrombosed Pulmonary Vein Aneurysm.

    Science.gov (United States)

    Kreibich, Maximilian; Rylski, Bartosz; Morlock, Julia; Beyersdorf, Friedhelm; Czerny, Martin

    2016-08-01

    We report the case of a 61-year-old patient who presented with generalized malperfusion due to systemic embolization from a large, partially thrombosed aneurysm of the left upper pulmonary vein. When the patient arrived at our center, large thrombus formations were detected in the left atrium and the abdominal aorta, as well as the renal, iliac, and femoral arteries. Renal, splenic, and mesenteric ischemia was diagnosed with computed tomography. The patient was in shock, acute kidney failure, and in high vasopressor need. The case highlights the risk of intraluminal thrombus formation in pulmonary vein aneurysms and underlines the need for systemic anticoagulation therapy and surgical therapy, if diagnosed in time. PMID:27449445

  18. 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.

  19. 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

    International Nuclear Information System (INIS)

    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/LVaxial, RV/LV4-CH, and RV/LVvolume). 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/LVvolume ratio > 1.43 showed the highest area under the curve (AUC) (0.65) for the prediction of adverse clinical events when compared to RV/LVaxial, RV/LV4Ch and troponin I. The AUC for the detection of RVD of RV/LVaxial, RV/LV4Ch, RV/LVvolume, and troponin I were 0.86, 0.86, 0.92, and 0.69, respectively. Combination of RV/LVaxial, RV/LV4Ch, RV/LVvolume 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.

  20. Pulmonary embolism incidence and fatality trends in chinese hospitals from 1997 to 2008: a multicenter registration study.

    Directory of Open Access Journals (Sweden)

    Yuanhua Yang

    Full Text Available BACKGROUND: There has not been sufficient evidence to support the Asians being less susceptible to pulmonary embolism (PE than other ethnicities, because the prevalence of PE/deep venous thrombosis (DVT in different racial and ethnic groups has not been carefully studied until recently except in Caucasians. To test the hypothesis that the Chinese population has a lower risk for PE, this study comprehensively assessed the hospital-based incidence and case fatality rates for PE during the 1997-2008 in China. METHODS: A registration study of patients with suspected PE syndromes admitted to 60 level-3 hospitals involved in the National Cooperative Project for the Prevention and Treatment of Venous Thromboembolism (NCPPT was conducted from January 1997 to December 2008. The only exclusion criterion was an age of less than 18 years. Helical computed tomography scan, ventilation-perfusion lung scintigraphy or pulmonary angiography was carried out before or after hospitalization. All images were reviewed and evaluated independently by two specialists. RESULTS: A total of 18,206 patients were confirmed with PE from 16,972,182 hospital admissions. The annual incidence was 0.1% (95% CI: 0.1% to 0.2%. The overall incidence of PE in male patients (0.2%, 95% CI: 0.1% to 0.3% was higher than that in female patients (0.1% and 95% CI: 0.0% to 0.1%. An increasing incidence gradient for PE was noticed from Southern to Northern China. In addition, the case fatality rate was apparently decreasing: 25.1% (95% CI: 16.2% to 36.9% in 1997 to 8.7% (95% CI: 3.5% to 15.8% in 2008. CONCLUSIONS: Our findings suggest the relatively stable PE incidence and decreasing fatality trends in Chinese hospitals may be partially attributable to the implementation of the NCCPT and suggest the government should reevaluate the severity of PE so that health resources for the prevention, diagnosis and treatment of PE could be used to their fullest.

  1. Worsening Hypoxemia in the Face of Increasing PEEP: A Case of Large Pulmonary Embolism in the Setting of Intracardiac Shunt.

    Science.gov (United States)

    Granati, Glen T; Teressa, Getu

    2016-01-01

    BACKGROUND Patent foramen ovale (PFO) are common, normally resulting in a left-to-right shunt or no net shunting. Pulmonary embolism (PE) can cause sustained increased pulmonary vascular resistance (PVR) and right atrial pressure. Increasing positive end-expiratory pressure (PEEP) improves oxygenation at the expense of increasing intrathoracic pressures (ITP). Airway pressure release ventilation (APRV) decreases shunt fraction, improves ventilation/perfusion (V/Q) matching, increases cardiac output, and decreases right atrial pressure by facilitating low airway pressure. CASE REPORT A 40-year-old man presented with dyspnea and hemoptysis. Oxygen saturation (SaO2) 80% on room air with A-a gradient of 633 mmHg. Post-intubation SaO2 dropped to 71% on assist control, FiO2 100%, and PEEP of 5 cmH20. Successive PEEP dropped SaO2 to 60-70% and blood pressure plummeted. APRV was initaiated with improvement in SaO2 to 95% and improvement in blood pressure. Hemiparesis developed and CT head showed infarction. CT pulmonary angiogram found a large pulmonary embolism. Transthoracic echocardiogram detected right-to left intracardiac shunt, with large PFO. CONCLUSIONS There should be suspicion for a PFO when severe hypoxemia paradoxically worsens in response to increasing airway pressures. Concomitant venous and arterial thromboemboli should prompt evaluation for intra-cardiac shunt. Patients with PFO and hypoxemia should be evaluated for causes of sustained right-to-left pressure gradient, such as PE. Management should aim to decrease PVR and optimize V/Q matching by treating the inciting incident (e.g., thrombolytics in PE) and by minimizing ITP. APRV can minimize PVR and maximize V/Q ratios and should be considered in treating patients similar to the one whose case is presented here. PMID:27377010

  2. 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.

  3. 133Xe three-phase ventilation scans characterize airways disease and aid diagnosis of pulmonary embolism on lung scintigraphy

    International Nuclear Information System (INIS)

    Full text: 133Xe has largely been replaced by 99Tcm aerosols for the ventilation component of lung scans performed for diagnosis of pulmonary embolism. However, aerosols such as Technegas are deposited in the small airways and alveoli and constitute only a snapshot of a single inhalation, which may also be compromised by deposition of activity in central airways. All three phases of ventilatory function - inhalation, equilibration and expiration - are characterized on 133Xe studies, which allows definition of focal ventilatory dysfunction, particularly in obstructive or bullous airways disease. A series of 15 patients with normal inspiratory studies but focal abnormalities in equilibrium and/or washout phases of the 133Xe ventilation scan were reviewed with the concomitant lung perfusion study. The normal inspiratory phase of the 133Xe ventilation scan in these patients reflects the expected deposition pattern of radiolabelled aerosols. However, focal retention of radioxenon activity in the washout phase matched perfusion deficits and allowed scintigraphic differentiation of airways disease from pulmonary embolism in these patients with a normal inspiratory study

  4. 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

  5. Treatment of patients with chronic thrombo­embolic pulmonary hypertension: focus on riociguat

    OpenAIRE

    Smith, Zachary

    2016-01-01

    Zachary R Smith,1 Charles T Makowski,1 Rana L Awdish2 1Department of Pharmacy Services, 2Pulmonary and Critical Care Medicine Division, Henry Ford Hospital, Detroit, MI, USA Abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease of the pulmonary vascular bed that is characterized by elevations in the mean pulmonary artery pressure in the setting of perfusion defects on ventilation–perfusion scan, and subsequently confirmed by pulmonary angiography. CTEPH, or ...

  6. Treatment of patients with chronic thrombo­embolic pulmonary hypertension: focus on riociguat

    OpenAIRE

    Smith ZR; Makowski CT; Awdish RL

    2016-01-01

    Zachary R Smith,1 Charles T Makowski,1 Rana L Awdish2 1Department of Pharmacy Services, 2Pulmonary and Critical Care Medicine Division, Henry Ford Hospital, Detroit, MI, USA Abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease of the pulmonary vascular bed that is characterized by elevations in the mean pulmonary artery pressure in the setting of perfusion defects on ventilation–perfusion scan, and subsequently confirmed by pulmonary angiography. CTEPH, or Worl...

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

    OpenAIRE

    Marion Delcroix

    2013-01-01

    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 saf...

  8. Dead Space Ventilation Parallels Changes in Scintigraphic Vascular Obstruction at Recurrence of Pulmonary Embolism and after Thrombolytic Therapy: A Case Report

    OpenAIRE

    Marc A Rodger; Gwynne Jones; Francois Raymond; Daniel Lalonde; Mike Proulx; Lothar Huebsch; Christopher Bredeson

    1998-01-01

    Physiological and alveolar dead space ventilation both increase in pulmonary embolism (PE) in proportion to the severity of vascular obstruction. The case of a patient with recurrent PE while on heparin therapy is presented. The recurrence was characterized clinically by severe pulmonary vascular obstruction and right heart dysfunction. The patient was treated with thrombolytic therapy, with excellent clinical and scintigraphic resolution. Dead space ventilation measurements at baseline, at t...

  9. The age-adjusted D-dimer safely excludes a high number of pulmonary embolisms in combination with four different clinical decision rules

    NARCIS (Netherlands)

    van Es, J.; Mos, I.C.M.; Douma, R.A.; Nizet, T.A.C.; Durian, M.; van Houten, A.A.; Hofstee, H.M.A.; ten Cate, H.; Ullmann, E.F.; Buller, H.R.; Huisman, M.V.; Kamphuisen, P.W.

    2011-01-01

    Background: Four different clinical decision rules (CDRs) (Wells score, Revised Geneva score (RGS), simplified Wells score and simplified RGS) safely exclude pulmonary embolism (PE), when combined with a normal D-dimer test. Recently, an age adjusted cut-off of the D-dimer (patient's age x 10 ig/L)

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

    International Nuclear Information System (INIS)

    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.)

  11. 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.)

  12. Diagnosis of pulmonary embolism and the underlying venous thrombosis by multi-slice CT; Diagnostik der Lungenembolie und zugrundeliegender Venenthrombosen in der Mehrzeilen-Spiral-CT

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, C.; Kopka, L.; Funke, M.; Funke, C.; Grabbe, E. [Abt. Roentgendiagnostik I, Georg-August-Univ. Goettingen (Germany)

    2001-06-01

    To determine the value of multi-slice CT for the diagnosis of acute pulmonary embolism and an underlying venous thrombosis. Methods: 70 patients with clinically suspected acute pulmonary embolism were examined. Using multi-slice CT a combined examination of the pulmonary arteries and the veins of the lower limb, pelvis and abdomen was performed. Only one single bolus of 150 ml iopromid 300 was injected into a cubital vein with a flow of 4 ml/s. First, the pulmonary arteries were scanned with a slice thickness of 2.5 mm and a pitch of 1.5. On arrival of the contrast medium at the popliteal veins, indicated by bolus trakking, the veins of the lower limbs up to the end of the inferior vena cava were imaged using a slice thickness of 3.75 mm and a pitch of 1.5. The results could be compared with a ventilation-perfusion scan in 48 cases, with a Doppler ultrasound examination in 46 cases, and with a venography in 10 cases. Furthermore, the image quality of all arterial and venous regions was subjectively assessed. Results: In all patients who underwent multi-slice CT the pulmonary arteries as well as the veins of the lower half of the body could be recorded completely. Regarding the pulmonary arteries the image quality showed excellent results for the central and segmental arteries. The region up to the 3rd division in subsegmental branches could be sufficiently judged. More peripherally, a diagnostic assessment was not possible. The image quality of the veins was excellent in all sections, except the calf, where a reliable diagnosis could not be made. The comparison with the other techniques confirmed the superiority of multi-slice CT concerning the central and segmental pulmonary arteries and the veins from the popliteal vein to the inferior vena cava. In contrast, peripheral pulmonary emboli can be detected more certainly in ventilation/perfusion scans. The veins of the calf can be evaluated more reliably with venography. (orig.) [German] Evaluation der Moeglichkeiten

  13. 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

  14. 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.

  15. 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

  16. Clinical evaluation of acute pulmonary embolism after cerebral angiography(report of 11 cases)%脑血管造影术后并发急性肺栓塞临床分析(附11例报道)

    Institute of Scientific and Technical Information of China (English)

    凌天金; 刘娟; 姚国恩; 周华东; 蒋晓江; 许志强

    2013-01-01

    Objective To retrospective analyze the cause of pulmonary embolism after cerebral angiography. Methods Eleven patients with ischemic cerebralvascular disease who showed loss of consciousness, epilepsy, chest pain and palpitation after cerebral angiography. Pulmonary vascular computed tomography were taken to diagnose pulmonary embolism. Results Two patients were given cardiopulmonary recovery, one given intravenous thrombolysis, eight given anticoagulant therapy. Eight patients were getting better, three patients died. Conclusion Pulmonary embolism is a rare complication after cerebral angiography which is apt to misdi -agnosis and missed diagnosis, It's very important to make assessment and prevention before operation.%目的 回顾性报道脑血管造影术后并发急性肺栓塞的临床诊治过程,探讨肺栓塞发生原因及防治措施.方法 11例缺血性脑血管病老年患者,脑血管造影术后活动中出现突发意识丧失、癫痫、胸痛、呼吸困难、心悸等症状,肺动脉CTA确诊为肺栓塞.结果 2例患者行心肺复苏,1例经静脉溶栓,8例进行抗凝治疗,其中死亡3例,8例经治疗后好转.结论 肺栓塞是经股动脉脑血管造影术后少有的并发症,临床易误诊、漏诊,术前评估及预防性治疗极为重要.

  17. The role of ventilation-perfusion lung scintigraphy in the diagnosis of pulmonary embolism in nephrotic syndrome patients

    International Nuclear Information System (INIS)

    Purpose: Patients with nephrotic syndrome (NS) have a high risk to develop thrombosis and even to progress to pulmonary embolism (PE). This study was performed to investigate the possible role of ventilafion-perfusion (V/Q) lung scans to evaluate PE in NS patients. Methods: 194 patients with NS (8 cases of minimal change NS (MCNS), 33 of mesangial proliferative (MsPGN), 19 of Mesangiocapillary glomerulonephritis (MCGN), 69 of membranous nephropathy, 56 of focal and segmental glomerular sclerosis (FSGS), and 9 of NS induced from purpura, SLE, diabetes mellitus or amyloidosis) were studied. In all patients, the development probability of PE was assessed based on the results of V/Q lung scans (Technegas for ventilation and Tc-99m MAA for perfusion imaging). The findings of V/Q lung scans were interrupted into high, intermediate, low or no probability of PE. The patients' clinical symptoms and signs were observed. Additional examinations included chest radiography, and serum biochemical tests such as albumin, blood urea nitrogen (BUN), creatinine (Cr), plasma fibrinogen (Fg), antithrombin III (AT III), prothrombin time (PT), and activated partial thromboplastin time (APTT). Results: Based on the findings of V/Q lung scans, 39 (20%) of the patients were categorized as having a high probability of PE and 56 (29%) as intermediate or low probability of PE. The occurrence of PE in patients with membranous nephropathy (23 cases, 33%) was significantly higher than that in those other pathological types. In the 86 patients with severe hypoalbuminemia (serum albumin concentration = 20g/L. The Fg and AT III levels were found to be correlated with the occurrence of PE. The clinical symptoms and signs, chest radiograph results and values of BUN, Cr, PT and APTT were not consistent with the occurrence of PE. Conclusion: Though usually clinically silent, PE is not a rare complication in patients with NS, especially in those with membranous nephropathy. In this study, the occurrence

  18. Assessment of pulmonary emphysema on CT teleradiology

    International Nuclear Information System (INIS)

    The present study assessed the current wave of using CT for the diagnosis of pulmonary emphysema using teleradiology. Thirty patients were examined. CT images were transmitted by Digital Imaging and Communications in Medicine (DICOM) to an image viewer and displayed in 4-image and 1-image arrays for reading. Pulmonary emphysema was found in 7 of the 30 patients. On both displays, the same diagnosis was obtained in 5 cases. In the remaining 2 cases, the low attenuation areas (LAAs) of mild centrilobular emphysema could be recognized only on the 1-image display. The diagnosis of pulmonary emphysema can be made by CT examination using teleradiology even in cases with mild lesions. (author)

  19. 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.

  20. 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.

  1. Bronchial artery embolization for the treatment of hemoptysis due to pulmonary tuberculosis: its clinical effect with an analysis of the causes of recurrence

    International Nuclear Information System (INIS)

    Objective: To investigate clinical effect of bronchial artery embolization (BAE) in treating massive hemoptysis due to pulmonary tuberculosis and to analyze the causes of recurrence in order to improve the therapeutic results. Methods: A total of 39 cases of patients with recurrent massive hemoptysis due to pulmonary tuberculosis, who were encountered during the period from Oct. 2007 to Sep. 2010, were enrolled in this study. The lesions included infiltrative pulmonary tuberculosis (n= 28) and chronic fibrocavitary pulmonary tuberculosis (n= 11). BAE with polyvinyl alcohol (PVA) particles only was performed in 14 cases (group A), while BAE with both PVA particles and coils was carried out in 25 cases (group B). All the patients were followed up for 12 - 48 months. The results were compared between the two groups. Results: Immediate hemostasis was obtained in 36 cases (92.3%), the clinical result was excellent in 3 cases. The complete cure or excellent result with single embolization procedure was achieved in 30 cases (76.9%). Recurrence was seen in 9 cases (23.1%). The difference in the recurrence rate between group A (42.9%) and group B (12.0%) was statistically significant (P < 0.05). The relapsing rate of patients with chronic fibrocavitary pulmonary tuberculosis was significantly higher than that of patients with infiltrative pulmonary tuberculosis (45.5% vs. 14.3%, P < 0.05). Conclusion: BAE has an instant effect of hemostasis and satisfactory clinical result. Nowadays BAE has already become the treatment of first choice for hemoptysis caused by pulmonary tuberculosis. The dual embolization technique with the combination use of PVA particles and coils can effectively reduce the recurrence of' pulmonary tuberculosis hemoptysis. (authors)

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

    Science.gov (United States)

    Zhou, Yin; Tsauo, Jiaywei; Li, Yuan; Li, Xiao

    2015-10-01

    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.

  3. 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.

  4. 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

  5. Worsening Hypoxemia in the Face of Increasing PEEP: A Case of Large Pulmonary Embolism in the Setting of Intracardiac Shunt

    Science.gov (United States)

    Granati, Glen T.; Teressa, Getu

    2016-01-01

    Patient: Male, 40 Final Diagnosis: Patent foramen ovale Symptoms: Dyspnea exertional • hemoptysis • shortness of breath Medication: — Clinical Procedure: Airway pressure release ventilation Specialty: Critical Care Medicine Objective: Rare co-existance of disease or pathology Background: Patent foramen ovale (PFO) are common, normally resulting in a left to right shunt or no net shunting. Pulmonary embolism (PE) can cause sustained increased pulmonary vascular resistance (PVR) and right atrial pressure. Increasing positive end-expiratory pressure (PEEP) improves oxygenation at the expense of increasing intrathoracic pressures (ITP). Airway pressure release ventilation (APRV) decreases shunt fraction, improves ventilation/perfusion (V/Q) matching, increases cardiac output, and decreases right atrial pressure by facilitating low airway pressure. Case Report: A 40-year-old man presented with dyspnea and hemoptysis. Oxygen saturation (SaO2) 80% on room air with A a gradient of 633 mmHg. Post-intubation SaO2 dropped to 71% on assist control, FiO2 100%, and PEEP of 5 cmH20. Successive PEEP dropped SaO2 to 60–70% and blood pressure plummeted. APRV was initaiated with improvement in SaO2 to 95% and improvement in blood pressure. Hemiparesis developed and CT head showed infarction. CT pulmonary angiogram found a large pulmonary embolism. Transthoracic echocardiogram detected right-to left intracardiac shunt, with large PFO. Conclusions: There should be suspicion for a PFO when severe hypoxemia paradoxically worsens in response to increasing airway pressures. Concomitant venous and arterial thromboemboli should prompt evaluation for intra cardiac shunt. Patients with PFO and hypoxemia should be evaluated for causes of sustained right-to left pressure gradient, such as PE. Management should aim to decrease PVR and optimize V/Q matching by treating the inciting incident (e.g., thrombolytics in PE) and by minimizing ITP. APRV can minimize PVR and maximize V/Q ratios and

  6. MR assessment of fetal pulmonary hypoplasia

    Energy Technology Data Exchange (ETDEWEB)

    Kuwashima, Shigeko; Kohno, Atsushi; Saiki, Natoru; Iimura, Fumitoshi; Kohno, Tatsuo; Hashimoto, Teisuke; Fujioka, Mutsuhisa [Dokkyo Univ. School of Medicine, Mibu, Tochigi (Japan)

    2000-08-01

    The purpose of this study is to evaluate pulmonary hypoplasia of the fetus using MRI. The subjects consisted of 36 fetuses (18 to 40 weeks' gestation). All fetuses or mothers had major anomalies diagnosed on fetal ultrasonography. MR imaging was performed with a 1.5-T magnet and HASTE (half-Fourier acquisition single-shot turbo spin-echo) sequence. MR images were evaluated with special attention to the intensity of the lung. A diagnosis of pulmonary hypoplasia was based on the clinical, surgical, and autopsy findings. All fetuses with normal pulmonary development showed high intensity in the lung, while all fetuses with pulmonary hypoplasia showed a low intensity in the lung, obscured pulmonary vessels and a small thorax. There was a close correlation between the lung intensity and pulmonary growth. MR assessment of lung intensity may facilitate the diagnosis of pulmonary hypoplasia, particularly after 26 weeks' gestation. Some of the normally developing lung showed a low intensity from 20 to 24 weeks of gestational age. The change to normal lung intensity may occur during this period. (author)

  7. 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.

  8. 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.

  9. 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.

  10. Radiographic parenchymal opacity, matching perfusion defect, and normal ventilation: a sign of pulmonary embolism? Work in progress

    International Nuclear Information System (INIS)

    By conventional criteria, perfusion defects that correspond to radiographic parenchymal opacities of similar size have less diagnostic significance for pulmonary embolism (PE) than perfusion defects in areas that are radiographically clear, regardless of the findings on ventilation scan. It was proposed that the demonstration of normal ventilation in areas with matched radiographic opacity and perfusion defects does support the diagnosis of PE. To test this hypothesis, a retrospective review was done of selected cases from a consecutive series of 85 pulmonary angiography studies. Cases were reviewed if the following criteria were met: chest radiography, ventilation-perfusion scintigraphy, and angiography of the relevant regions had all been performed within 24 hours of one another, and there was a radiographic opacity corresponding to the perfusion defect. Sixteen cases fulfilled these criteria. Six patients had normal ventilation in the regions of the radiographic infiltrate and perfusion defect, and all had PE. No patient had an area of opacity and perfusion defect and normal ventilation without PE

  11. The diagnostic value of ventilation-perfusion scintigraphy combined with plasma D-dimer assay in diagnosis of pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical diagnostic value of ventilation-perfusion scintigraphy combined with plasma D-dimer assay in diagnosis of pulmonary embolism (PE). Methods: One hundred and four patients with clinically suspected PE underwent both pulmonary ventilation-perfusion scintigraphy and plasma D-dimer assay. According to the criteria of prospective investigation of the pulmonary embolism diagnosis (PIOPED), ventilation-perfusion scintigraphy was interpreted as normal, very low or low probability of PE, intermediate probability of PE and high probability of PE. High probability was considered as positive; normal and very low or low probability as negative and intermediate probability as non-diagnostic. Plasma D-dimer levels were measured using a quantitative immunoturbidimetric method, and a cut-off value of 500 mg/L was used in the diagnosis of PE. Clinical diagnostic value of ventilation-perfusion scintigraphy, D-dimer assay and combined use of ventilation-perfusion scintigraphy and D-dimer assay for diagnosing PE was evaluated, respectively, comparing with the final clinical diagnosis that was based on the clinical findings. Results: Among the 104 patients, 44 were diagnosed with PE and 60 were excluded. Ventilation-perfusion scintigraphy provided diagnostic interpretations for 86 (82.7%) patients, and non-diagnostic interpretations for 18 (17.3%) patients. For diagnosing PE, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ventilation-perfusion scintigraphy was 84.1%, 75.0%, 78.8%, 71.2% and 86.5%, respectively, and with D-dimer assay was 93.2%, 60.0%, 74.0%, 63.1% and 92.3%, respectively. If a plasma D-dimer level of < 500 mg/L was taken as a criterion to exclude PE for those intermediate probability of ventilation-perfusion scintigraphy, the diagnostic specificity and accuracy would be raised to 85.0% and 84.6%, respectively. Conclusions: When a non-diagnostic interpretation was occurred on

  12. 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

  13. Case report: Subjective loss of performance after pulmonary embolism in an athlete– beyond normal values

    OpenAIRE

    Daniel DUMITRESCU; Gerhardt, Felix; Viethen, Thomas; Schmidt, Matthias; Mayer, Eckhard; Rosenkranz, Stephan

    2016-01-01

    Background Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease. For patients with operable CTEPH, there is a clear recommendation for surgical removal of persistent thrombi by pulmonary endarterectomy (PEA). However, without the presence of PH, therapeutic management of chronic thromboembolic disease (CTED) is challenging - especially in highly trained subjects exceeding predicted values of maximal exercise capacity. Case presentation A 43-year-old male athlete repo...

  14. A case of Multiple Unilateral Pulmonary arteriovenous Malformation Relapse: Efficacy of embolization treatment

    OpenAIRE

    Masiello Rossella; Iadevaia Carlo; Grella Edoardo; Tranfa Carmelindo; Cerqua Francesco; Rossi Giovanni; Santoro Giuseppe; Amato Bruno; Rocca Aldo; De Dona Roberta; Lavoretano Sabrina; Perrotta Fabio

    2015-01-01

    Pulmonary arteriovenous Malformations (PAVMs) are a rare vascular alteration characterized by abnormal communications between the pulmonary arteries and veins resulting in an extracardiac right-to-left (R-L) shunt. The majority of PAVMs are associated with an autosomal dominant vascular disorder also known as Osler-Weber- Rendu Syndrome. PAVMs appearance can be both single and multiple. Clinical manifestations include hypoxemia, dyspnea cyanosis, hemoptysis and cerebrovascular ischemic events...

  15. Scintigraphic evaluation of pulmonary embolism after total hip replacement, using a dry sup(99m)Tc-microaerosol for regional ventilation

    International Nuclear Information System (INIS)

    A new sup(99m)Tc-microaerosol was used for ventilation scintigraphy in combination with prefusion scintigraphy for studying the incidence of pulmonary embolism (PE) from 189 consecutive investigations in patients undergoing total hip replacement. Diagnostic criteria are presented. Perfusion defects of triangular shape were significantly more frequent in combination with ventilation mismatch (PE) than with ventilation match (not PE) (P133Xe for ventilation studies. (orig.)

  16. 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.

  17. Global Emergency Medicine Journal Club: A Social Media Discussion About the Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism Trial

    OpenAIRE

    Rezaie, SR; Swaminathan, AK; Chan, T.; Shaikh, S; Lin, M.

    2015-01-01

    © 2015 American College of Emergency Physicians. Study objective: Annals of Emergency Medicine collaborated with an educational Web site, Academic Life in Emergency Medicine (ALiEM), to host an online discussion session featuring the 2014 Journal of the American Medical Association publication on the Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism (ADJUST-PE) trial by Righini et al. The objective is to describe a 14-day (August 25 to September 7, 2014) worldwide academic dia...

  18. 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.

  19. Pulmonary imaging

    International Nuclear Information System (INIS)

    Studies in pulmonary imaging predominantly depict the distribution of pulmonary perfusion or the ventilation-perfusion balance for the detection of pulmonary embolism, obstructive airway disease, and lung carcinoma. Much work has been done using 133Xe to study both regional ventilation and blood flow. This work has led to a greater understanding of regional blood flow and ventilation, of lung anatomy and morphometry, of the mechanical factors that influence lung function, and of the biochemical and other nonrespiratory functions of the lung. The recent development of emission tomography and the potential for receptor- and function-oriented radiopharmaceuticals have allowed several important regional physiologic processes to be measured. The physical parameters measured in radionuclide emission studies are the temporal and spatial relations of the distribution of tracer in the lungs. Tracers that are diffusible will wash into and out of the lungs at a rate proportional not only to flow but also to membrane permeability. If the radionuclide label is attached to microspheres or macro-aggregates, the amount lodging in any portion of the lung can be related to relative flow in the lung. Metabolism of the lung is reflected by the rate of extraction and disappearance of various labeled radiopharmaceuticals. The problems encountered in assessing the value of ventilation-perfusion scans for the diagnosis of pulmonary embolism are concerned not only with improving specificity, but also with better estimation of the prior probability of pulmonary embolism in the patient being evaluated

  20. Methodology of lung scintigraphy in thrombo-embolic disease. Physiopathological basis; Methodologie des explorations pulmonaires isotopiques dans le cadre de la pathologie thrombo-embolique (T.E.). Rappels physiopathologiques

    Energy Technology Data Exchange (ETDEWEB)

    Munsch, R.C. [Centre Hospitalier de Valence, Service de Medecine Nucleaire, 26 - Valence (France)

    2001-08-01

    Following a review of physiopathology in pulmonary embolism, the author analyses the basis of pulmonary functional assessment at the membrane, ventilation and perfusion levels. The practical consequences are presented for the choice of the most appropriate methods as a function of the objectives and of the evolution of the thrombo-embolic disease. (authors)

  1. sup(99m)Tc particle perfusion/sup(99m)Tc aerosol ventilation imaging using a subtraction technique in suspected pulmonary embolism

    International Nuclear Information System (INIS)

    It is generally acknowledged that ventilation-perfusion mismatch is diagnostic of pulmonary embolism. Lung ventilation imaging with radioactive gases is a good method for the detection of pulmonary embolism, but it is not in widespread use because of the limited availability of sup(81m)Kr gas and the poor physical properties of 133Xe. Aerosols have been proposed, instead of gases for use in lung ventilation imaging. As perfusion and ventilation distributions may change very rapidly, the two imaging procedures should be done in rapid succession. The cheapest way to perform the combined perfusion-ventilation (Q/V) imaging is to use sup(99m)Tc-labelled macroaggregates and aerosols. In our method the perfusion imaging was done first, immediately followed by the ventilation imaging with sup(99m)Tc-labelled aerosols. A computer program was used to subtract the contribution of the perfusion from the combined Q/V image so that the pure ventilation image alone was obtained. The method was tested in 41 patients with suspected pulmonary embolism. (orig.)

  2. 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.

  3. 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.

  4. 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.

  5. The Identification of Dyspnea in the Diagnosis of Pulmonary Embolism:Based on a Rare Case of Pulmonary Embol-ism with Pneumothorax%呼吸困难在肺栓塞鉴别诊断中的作用(附气胸并肺栓塞1例)

    Institute of Scientific and Technical Information of China (English)

    李润生; 蔡礼鸣; 张芳

    2016-01-01

    目的 探讨呼吸困难症状在肺栓塞鉴别诊断中的价值.方法 对临床少见气胸并肺栓塞1例的临床资料进行回顾性分析并复习相关文献.结果 本例因活动后胸闷、气短3d入院,曾在当地镇医院就诊,按右侧气胸治疗症状未见好转,入我院.因气胸诊断明确予胸腔闭式引流,肺复张后仍有胸闷、气短.行相关检查排除心力衰竭、支气管哮喘等可引起呼吸困难的疾病,查D-二聚体增高,CT肺动脉造影检查示两下肺片状不张,下肢彩色多普勒超声检查示下肢肌间静脉血栓,依据临床表现及以上医技检查结果 诊断肺栓塞并下肢深静脉血栓形成,予抗凝治疗后病情好转,出院.结论 呼吸困难是肺栓塞最常见的症状,特异性差.对低危人群通过鉴别呼吸困难病因并保持高度警惕性有助于肺栓塞的及早诊断.%Objective To discuss the value of dyspnea in the diagnosis of pulmonary embolism. Methods Clinical data of one rare case of pneumothorax with pulmonary embolism was retrospectively analyzed in our hospital, and the relevant literature was reviewed. Results The patient, who had been previously diagnosed as right-sided pneumothorax by the local town clinic for chest tightness and shortness of breath for 3 days, was admitted to our hospital and given a treatment of chest drain. But following a full re-expansion, he still had tachypnoea. Further examinations produced a negative result for diseases leading to dyspnea, such as heart failure and bronchial asthma. Meanwhile, the D-dimer test report showed elevated values, computed tomographic pulmonary angiography demonstrated bilateral patchy atelectasis in the lower lobes and color Doppler disclosed thrombi in medial gastrocnemius veins. Therefore, the patient was confirmed as having pulmonary embolism with deep vein thrombosis of the lower limbs according to his clinical features. After anticoagulant therapy, the patient's condition was improved and

  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. Clinical Analysis of 36 Cases of Misdiagnosed Pulmonary Embolism in Emergency Department%肺栓塞36例急诊误诊临床分析

    Institute of Scientific and Technical Information of China (English)

    尹红军; 蒋志锋; 李树; 金爱春; 刘福军

    2012-01-01

    Objective To improve the diagnostic recognition and the rate of early definite diagnosis of pulmonary embolism (PE), and explore diagnostic program of PE in emergency department. Methods Clinical data of 36 cases with misdiagnosed PE in emergency department were reviewed and the revised Geneva score was compared. Results 25 cases were misdiagnosis as cardiovascular disease (69.4% ) , 9 cases regarded as other respiratory disease (25% ) and 2 cases as cerebrum disease (5.6% ). There were 30 patients (83.3% ) with risk factors. The revised Geneva scores were obtained, 26 cases with intermediate probability clinical assessment and 10 cases with low probability. There were high D-dimer concentration in 36 cases. 32 cases were diagnosed as pulmonary embolism by spiral CT pulmonary angiography (CTPA) and 4 cases by Lung ventilation/perfusion scan. Conclusion Misdiagnosis and underdiagnosis are usually due to PE, It is nessesary to improve the knowledge of PE for doctors in Emergency department. To improve the rate of early definite diagnosis of PE and the risk factors of PE is necessary, the revised Geneva scores are used to assess clinical probability and the D-dimer concentration should be taken into account for patients with suspected PE. CTPA is optional.%目的 提高急诊科医生对肺血栓栓塞( pulmonary thromboembolism,PTE)的认识,探索急诊可行的PTE诊断程序,以提高本病早期确诊率.方法 回顾性分析近5年来我院急诊误诊的36例PTE的临床资料,并进行改良Geneva评分评估临床诊断可能性.结果 本组36例误诊为心血管疾病25例(69.4%),误诊为其他呼吸系统疾病9例(25%),误诊为脑血管疾病2例(5.6%),其中30例(83.3%)有易患因素.进行改良Geneva评分显示PTE中度可能性26例,低度可能性10例.查D-二聚体36例均升高,后经螺旋CT肺动脉造影(CTPA)确诊32例、肺通气灌注扫描确诊4例,均予抗凝治疗好转出院.结论 PTE临床易误漏诊,急诊科医生

  8. Hemogram parameters for predicting pulmonary embolism in patients with deep venous thrombosis

    Directory of Open Access Journals (Sweden)

    Kaya H

    2015-11-01

    Full Text Available Hakki Kaya, Recep KurtDepartment of Cardiology, Cumhuriyet University Medical School, Sivas, TurkeyWe read the article of Sevuk et al,1 published in the August 2015 issue of your journal, with great interest. The authors concluded that percentage change in serial measurements of mean platelet volume (MPV and platelet-distribution width (PDW is valuable in predicting the development of pulmonary thromboembolism in patients with a previous history of deep venous thrombosis (DVT. In a similar study conducted by Braekkan et al2 (Tromsø Study, MPV on admission was shown to predict pulmonary thromboembolism.  Read the original paper here

  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. 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.

  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. Clinical application of radioaerosol studies - pulmonary embolism, inhalation burns and glue-sniffers and COPD

    International Nuclear Information System (INIS)

    The alveolar epithelium and the capillary endothelium together form the alveolar capillary membrane. Fluid exchange occurs across this membrane, and is dependent on intravascular and interstitial hydrostatic and oncotic pressures, and on permeability of this membrane. Damage to either the alveolar or capillary component can result in a high permeability pulmonary oedema, even though the alveolar epithelium forms an extremely tight membrane which is ten times less permeable than the capillary endothelium. Nuclear medicine methods can be used to observe changes in integrity of pulmonary capillary endothelium (with first pass dual-indicator dilution technique using successive injections of radiotracer), and of alveolar epithelium, and it is important that the damage should be detected before patients develop clinical pulmonary oedema so that intensive therapy can be instituted early. We have used 99mTc DTPA radioaerosol to measure alteration in pulmonary epithelial permeability and to image the distribution of ventilation in normal and some pathological states. In some clinical studies Tc-99m (tin) colloid radioaerosol has been used to obtain the ventilation images

  13. Comparison of isoflurane and α-chloralose in an anesthetized swine model of acute pulmonary embolism producing right ventricular dysfunction.

    Science.gov (United States)

    Beam, Daren M; Neto-Neves, Evandro M; Stubblefield, William B; Alves, Nathan J; Tune, Johnathan D; Kline, Jeffrey A

    2015-02-01

    Pulmonary embolism (PE) is a leading cause of sudden cardiac death, and a model is needed for testing potential treatments. In developing a model, we compared the hemodynamic effects of isoflurane and α-chloralose in an acute swine model of PE because the choice of anesthesia will likely affect the cardiovascular responses of an animal to PE. At baseline, swine that received α-chloralose (n = 6) had a lower heart rate and cardiac output and higher SpO2, end-tidal CO2, and mean arterial pressure than did those given isoflurane (n = 9). After PE induction, swine given α-chloralose compared with isoflurane exhibited a lower heart rate (63 ± 10 compared with 116 ± 15 bpm) and peripheral arterial pressure (52 ± 12 compared with 61 ± 12 mm Hg); higher SpO2 (98% ± 3% compared with 95% ± 1%), end-tidal CO2 (35 ± 4 compared with 32 ± 5), and systolic blood pressure (121 ± 8 compared with 104 ± 20 mm Hg); and equivalent right ventricular:left ventricular ratios (1.32 ± 0.50 compared with 1.23 ± 0.19) and troponin I mean values (0.09 ± 0.07 ng/mL compared with 0.09 ± 0.06 ng/mL). Isoflurane was associated with widely variable fibrinogen and activated partial thromboplastin time. Intraexperiment mortality was 0 of 6 animals for α-chloralose and 2 of 9 swine for isoflurane. All swine anesthetized with α-chloralose survived with sustained pulmonary hypertension, RV-dilation-associated cardiac injury without the confounding vasodilatory or coagulatory effects of isoflurane. These data demonstrate the physiologic advantages of α-chloralose over isoflurane for anesthesia in a swine model of severe submassive PE. PMID:25730758

  14. 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.

  15. The Evaluation of Serum Copeptin Levels and Some Commonly Seen Thrombophilic Mutation Prevalence in Acute Pulmonary Embolism.

    Science.gov (United States)

    Ozturk, Nurinnisa; Baygutalp, Nurcan Kilic; Bayramoglu, Atif; Polat, Harun; Gul, Mehmet Ali; Bakan, Ebubekir; Aslan, Sahin; Gunes, Ozge Nur

    2016-06-01

    Acute pulmonary embolism (PE) is a common, emergent condition and may affect a large number of patients. Copeptin has been indicated to be a sensitive biomarker of arginine vasopressin release, and has diagnostic and prognostic value in various clinical conditions. Genetic mutations are considerable components of thrombophilic diseases, and factor II gene G20210A, (FII20210A), factor V Leiden (FVL, G1691A) and methylenetetrahydrofolate reductase gene C677T (MTHFR677T) single nucleotide polymorphisms are the most common mutations of thrombophilic diseases. In this study, serum copeptin levels were determined in patients with PE and healthy controls, and the results were discussed. The prevalence of some commonly seen thrombophilic mutations was also evaluated in patients with PE. The study included 32 patients (18 male, 14 female) with PE and 24 (13 male, 11 female) age- and gender-matched healthy controls. A significant difference in serum copeptin levels was determined between the patient and control groups (8.58 ± 4.42 and 4.07 ± 1.02 pmol/L, respectively). Heterozygous mutant genotype for FII20210A and heterozygous mutant genotype for FVL were observed in 3.1 and 9.4% of patients, respectively. Mutant genotype of 49% was determined for MTHFR677T mutations. It was concluded that copeptin may have diagnostic value for PE. PMID:26886096

  16. 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 purp