Acute Pulmonary Embolism Leading to Cavitation and Large Pulmonary Abscess: A Rare Complication of Pulmonary Infarction

AbstractPerioperative acute pulmonary embolism represents a relatively rare complication; however, it could be very serious and devastating in some cases. Its diagnosis could be particularly challenging, especially in the intraoperative period. Herein, we emphasize some key concepts with the aim to perform an early and appropriate risk stratification, diagnostic and therapeutic approach in a multidisciplinary fashion, a brief overview on thromboprophylaxis, with the main objective to improve outcomes and survival in these challenging patients.

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Pulmonary infarction in acute pulmonary embolism

Thrombosis Research ◽

10.1016/j.thromres.2021.03.022 ◽

2021 ◽

Author(s):

F.H.J. Kaptein ◽

L.J.M. Kroft ◽

G. Hammerschlag ◽

M.K. Ninaber ◽

M.P. Bauer ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Pulmonary Infarction

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Non-surgical management of an abrupt cavitation and large oval-shaped lung abscess secondary to acute thromboembolic pulmonary infarction: a case report

Journal of International Medical Research ◽

10.1177/03000605211031682 ◽

2021 ◽

Vol 49 (8) ◽

pp. 030006052110316

Author(s):

Guofeng Ma ◽

Dan Wang ◽

Chao Yan ◽

Liang Li ◽

Xiaoling Xu ◽

...

Keyword(s):

Pulmonary Embolism ◽

Rare Complication ◽

Pulmonary Arteries ◽

Surgical Excision ◽

Pulmonary Angiography ◽

Lung Abscess ◽

Ct Pulmonary Angiography ◽

Pulmonary Infarction ◽

Once Daily ◽

Non Surgical Treatment

Infected cavitating pulmonary infarction is a rare complication of pulmonary embolism with a high mortality rate. Surgical excision for this complication has been used in past decades. Abrupt cavitation and a large oval-shaped lung abscess caused by acute thromboembolic pulmonary infarction during anticoagulation are rare. We present a 70-year-old man who suffered from pleuritic pain and breathlessness, accompanied by nausea and vomiting for 1 day. A physical examination showed tachycardia and tachypnea with moist rales in the left upper chest. High D-dimer levels, leukocytosis, respiratory failure and left upper lobe consolidation were found on plain computed tomography (CT). CT pulmonary angiography was performed 2 days after the previous CT scan because pulmonary embolism was suspected. This scan showed emboli in the main, right upper, middle, lower and left upper pulmonary arteries with deteriorated left upper lobe consolidation and cavitation. Thromboembolic pulmonary infarction and an abscess were diagnosed. Enoxaparin 60 mg was administered every 12 hours for 10 days, followed by rivaroxaban, antibiotics and drainage of the hydrothorax. The patient improved after the strategy of non-surgical treatment and was discharged approximately 1 month later. The patient had an uneventful course during rivaroxaban 20 mg once daily for 1 year.

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RARE COMPLICATION OF CARDIAC TAMPONADE DURING CATHETER DIRECTED THROMBOLYSIS OF ACUTE PULMONARY EMBOLISM

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)04155-3 ◽

2021 ◽

Vol 77 (18) ◽

pp. 2800

Author(s):

Anila Rao ◽

Lakshmi Rao ◽

Hima Doppalapudi ◽

Surya Rao

Keyword(s):

Pulmonary Embolism ◽

Cardiac Tamponade ◽

Acute Pulmonary Embolism ◽

Rare Complication ◽

Catheter Directed Thrombolysis

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Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

Jornal Brasileiro de Pneumologia ◽

10.1590/1806-3713/e20170438 ◽

2019 ◽

Vol 45 (1) ◽

Cited By ~ 3

Author(s):

Alexandre Dias Mançano ◽

Rosana Souza Rodrigues ◽

Miriam Menna Barreto ◽

Gláucia Zanetti ◽

Thiago Cândido de Moraes ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Computed Tomography Angiography ◽

Acute Pulmonary Embolism ◽

Pulmonary Arteries ◽

Lower Lobe ◽

Pulmonary Infarction ◽

Halo Sign ◽

Reversed Halo Sign ◽

The Right

ABSTRACT Objective: To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. Methods: We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). Results: Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. Conclusions: A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.

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Usefulness of Multidetector Spiral Computed Tomography According to Age and Gender for Diagnosis of Acute Pulmonary Embolism

Yearbook of Pulmonary Disease ◽

10.1016/s8756-3452(08)70661-3 ◽

2008 ◽

Vol 2008 ◽

pp. 214-215

Author(s):

K.L. Lewis

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Spiral Computed Tomography ◽

Spiral Computed ◽

Age And Gender ◽

And Gender ◽

Multidetector Spiral Computed Tomography

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Tissue plasminogen activator as a novel diagnostic aid in acute pulmonary embolism

VASA ◽

10.1024/0301-1526/a000392 ◽

2014 ◽

Vol 43 (6) ◽

pp. 450-458 ◽

Cited By ~ 1

Author(s):

Julio Flores ◽

Ángel García-Avello ◽

Esther Alonso ◽

Antonio Ruíz ◽

Olga Navarrete ◽

...

Keyword(s):

Pulmonary Embolism ◽

Negative Predictive Value ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Predictive Value ◽

Acute Pulmonary Embolism ◽

Enzyme Linked Immunosorbent Assay ◽

Diagnostic Utility ◽

Tissue Plasminogen ◽

D Dimer

Background: We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE). Patients and methods: We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis. Results: PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88–100 %)/95 % (95 % CI, 88–100 %) and 95 % (95 % CI, 88–100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21–37 %) for D-dimer and 24.4 % (95 % CI, 17–33 %) for tPA. Conclusions: The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.

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Pulmonary emboli due to venous aneurysm of extremities

VASA ◽

10.1024/0301-1526/a000124 ◽

2011 ◽

Vol 40 (4) ◽

pp. 327-332 ◽

Cited By ~ 6

Author(s):

Gabrielli ◽

Rosati ◽

Vitale ◽

Millarelli ◽

Siani ◽

...

Keyword(s):

Pulmonary Embolism ◽

Surgical Resection ◽

Potential Risk ◽

Acute Pulmonary Embolism ◽

Prophylactic Surgery ◽

Venous Aneurysm ◽

Pulmonary Emboli ◽

Thromboembolic Events ◽

Thromboembolic Complications ◽

Risk Patients

Venous aneurysms are uncommon but they can have devastating consequences, including pulmonary embolism, other thromboembolic events and death. We report six cases of venous aneurysm of the extremities, in which the first sign of presence was acute pulmonary embolism. Surgical resection is recommended whenever possible. Our experience suggests that prophylactic surgery is cautiously recommended for low-risk patients with venous aneurysms of the abdomen and strongly recommended for extremity deep and superficial venous aneurysms for their potential risk of developing thromboembolic complications despite adequate anticoagulation. Other venous aneurysms should be excised only if they are symptomatic or enlarging.

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