scholarly journals Systemic septic emboli in tricuspid endocarditis due to an atrial communication with a right-to-left shunt

2020 ◽  
Vol 13 (2) ◽  
pp. e233477
Author(s):  
Olivia Farrant ◽  
Gabriella Scozzi ◽  
Rebecca Hughes
Keyword(s):  
Septic Shock ◽  
Tricuspid Valve ◽  
Pulmonary Emboli ◽  
High Dependency Unit ◽  
Septic Embolus ◽  
Septic Emboli ◽  
Previous Episode ◽  
Intravenous Drugs ◽  
High Dependency ◽  
History Of

We present the case of a patient admitted to hospital in septic shock. He had a history of tricuspid valve infective endocarditis (IE) 6 months prior and regularly injected intravenous drugs. A bedside echo on arrival confirmed vegetations on his tricuspid valve, torrential tricuspid regurgitation and signs of significantly raised right-sided pressures. The admission chest radiograph showed consolidative changes in the lungs, suggestive of septic pulmonary emboli. He was commenced on antibiotics and treated in the high-dependency unit. He subsequently developed an acutely ischaemic right foot and nasal tip. Suspicions were raised of a paradoxical septic embolus through a right-to-left shunt, subsequently confirmed on bubble echo which showed passage of agitated saline between the atria. This was not apparent clinically or on echocardiogram during his previous episode of tricuspid valve IE, raising the possibility of the development of an acquired inter-atrial communication since his previous episode.

scholarly journals Use of CytoSorb in the emergency department-high dependency unit: A case report and a mini review

2021 ◽  
Vol 17 (4) ◽  
Author(s):  
Emanuela Biscardi ◽  
Giuseppe Carpinteri ◽  
Pietro Castellino ◽  
Lorenzo Malatino
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Standard Therapy ◽  
Blood Purification ◽  
Blood Levels ◽  
Clinical Parameters ◽  
High Dependency Unit ◽  
High Dependency

Circulating inflammatory mediators and cytokines play a pivotal role in the progression of sepsis, leading in turn to septic shock, organ failure and resistance to standard therapy. Blood purification therapies may be adjuvant treatment for severe sepsis, but results have been shown to be so far controversial. Recently, CytoSorb has achieved promising outcomes on reduction of cytokine blood levels, improvement of clinical parameters and mortality in sepsis, as well as in other acute conditions. It is mostly used in Intensive Care Unit (ICU), in isolated hemoperfusion, or inserted in other circuits in addition to Continuous Renal Replacement Therapy (CRRT), heart-lung machines and extracorporeal membrane oxygenation. We report a case of septic shock occurred in our Emergency Department-High Dependency Unit (ED-HDU), resistant to standard therapy and improved after CytoSorb, so avoiding ICU hospitalization.

scholarly journals Septic pulmonary emboli from mitral valve endocarditis in a patient with repaired tetralogy of fallot

2016 ◽  
Vol 3 (3) ◽  
pp. 7
Author(s):  
Aniket S. Rali ◽  
Arun Iyer ◽  
Claire Sullivan ◽  
James Strainic ◽  
Brian Hoit
Keyword(s):  
Mitral Valve ◽  
Septal Defect ◽  
Pulmonary Emboli ◽  
Transesophageal Echocardiogram ◽  
Bronchial Arteries ◽  
Lower Extremity Weakness ◽  
Septic Emboli ◽  
Multiple Organs ◽  
Computed Tomography Images ◽  
History Of

A 37-year-old woman with a past medical history significant for congenital deafness and surgically repaired Tetralogy ofFallot presented with three day history of nausea, vomiting, fever, chills, dyspnea, and lower extremity weakness and physicalexamination notable for Janeway lesions. Peripheral blood and urine cultures were positive for methicillin sensitive Staphlococcusaureus. Transesophageal echocardiogram was consistent with mitral valve endocarditis. Computed tomography images of thechest, abdomen and pelvis demonstrated septic emboli to multiple organs including lungs, liver, spleen and kidneys. Salinecontrast study was negative for a patent foramen ovale, or residual ventricular septal defect. Thus, effectively ruling out left toright intracardiac shunt as the cause of pulmonary septic emboli from mitral valve endocarditis. Moreover, cardiac MRI did notshow any evidence of right sided endocarditis. Therefore, we believe the source of septic pulmonary emboli from mitral valveendocarditis to be through the bronchial arteries. The extent of septic emboli to various organs and the precise mechanism ofpulmonary emboli from left sided endocarditis in a patient with surgically altered cardiac anatomy make this case unique.

scholarly journals SEPTIC SHOCK AND THE USE OF NOREPINEPHRINE IN A HIGH DEPENDENCY UNIT - MORTALITY AND ADVERSE EVENTS

2015 ◽  
Vol 3 (Suppl 1) ◽  
pp. A877
Author(s):  
M Hallengren ◽  
P Åstrand ◽  
S Eksborg ◽  
H Barle ◽  
C Frostell
Keyword(s):  
Septic Shock ◽  
Adverse Events ◽  
High Dependency Unit ◽  
High Dependency

scholarly journals Pulmonary Septic Emboli due to Azygos Vein Septic Thrombosis

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Ginius Pradhan ◽  
Khaldoon Shaheen ◽  
Mary Muoneke ◽  
Basel Altaqi
Keyword(s):  
Pulmonary Embolism ◽  
Epidural Abscess ◽  
Azygos Vein ◽  
Pulmonary Emboli ◽  
Septic Emboli ◽  
Vein Thrombosis ◽  
History Of ◽  
Septic Pulmonary Embolism ◽  
And Control ◽  
Infectious Source

The triad of extrapulmonary infection, contiguous septic vein thrombosis, and septic pulmonary embolism is a rare complex but associated with significant morbidity and mortality. Septic azygos vein thrombosis is extremely rare and potentially serious since it may also cause pulmonary emboli and sudden death. We report a case of a 32-year-old woman with history of IV drug abuse who presented with epidural abscess and methicillin-resistantS. aureus(MRSA) bacteremia. Later she developed signs of septic pulmonary embolism secondary to septic azygos vein thrombosis. With early diagnosis, appropriate antimicrobial therapy, and control of the infectious source, resolution of the illness can be expected for most patients with avoidance of potential complications.

scholarly journals Case report of subacute presentation of tricuspid valve thrombus complicated by widespread bilateral pulmonary emboli: a multifactorial aetiology

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Libor Myslivecek ◽  
Ying Gue ◽  
Ioannis Vasiliadis
Keyword(s):  
Tricuspid Valve ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Medical Emergency ◽  
Hepatic Veins ◽  
Haemodynamic Instability ◽  
Pulmonary Emboli ◽  
Pulmonary Angiogram ◽  
History Of ◽  
New Onset

Abstract Background  Right heart thrombus (RHTh) complicated by pulmonary embolism (PE) usually presents as a medical emergency with significant haemodynamic instability. However, less is known about subacute presentations. Case summary  We present a 74-year-old haemodynamically stable gentleman with a 3-week history of mild pleuritic chest pain and exertional dyspnoea preceded by lower respiratory tract infection. Early trans-thoracic echocardiogram (TTE) revealed a 3 cm elongated tricuspid valve thrombus with right ventricular dysfunction, new-onset atrial fibrillation, and new-onset severe left ventricular impairment. Subsequent computed tomography pulmonary angiogram showed widespread bilateral pulmonary emboli with retrograde opacification of the hepatic veins. The RHTh successfully resolved with warfarin therapy with no further complications, and the patient was discharged on Day 8 of hospitalization. Discussion  An early TTE is crucial in detecting the RHTh in patients suspected of PE and can significantly change the management compared with uncomplicated PE. The index of suspicion for PE and RHTh should remain high even in subacute cases.

Familial thrombophilia associated with fibrinogen Paris V: Dusart syndrome

Blood ◽  
2000 ◽  
Vol 96 (3) ◽  
pp. 1191-1193 ◽  
Author(s):  
Takashi Tarumi ◽  
Danko Martincic ◽  
Anne Thomas ◽  
Robert Janco ◽  
Mary Hudson ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Early Onset ◽  
Family Members ◽  
Initial Presentation ◽  
Pulmonary Emboli ◽  
Common Cause ◽  
History Of ◽  
Prophylactic Anticoagulation ◽  
Fibrin Clots

Abstract We report on a family with a history of venous thromboembolism associated with fibrinogen Paris V (fibrinogen A-Arg554→Cys). Ten members experienced thrombotic events, including 4 with fatal pulmonary emboli. Pulmonary embolism was the presenting feature in 4. Those with the mutation and a history of thrombosis had somewhat higher fibrinogen concentrations than those with the mutation and no thrombosis (294 ± 70 mg/dL vs 217 ± 37 mg/dL, respectively). The Paris V mutation consistently caused a prolongation of the reptilase time, and fibrin clots containing the abnormal fibrinogen were more translucent than normal clots. Given the early onset of symptoms and the initial presentation with pulmonary embolism in some family members, it was justifiable to offer prophylactic anticoagulation with warfarin to carriers of the mutation. Fibrinogen Paris V has now been reported in 4 apparently unrelated families, indicating that it is a relatively common cause of dysfibrinogenemia-associated thrombosis.

Outcomes of elderly patients with acute kidney injury on a renal high dependency unit

2015 ◽  
Vol 69 (10) ◽  
pp. 1209-1210 ◽  
Author(s):  
J.-H. Wang ◽  
J. Joslin ◽  
R. Jenkins ◽  
C. C. Sharpe ◽  
S. Jayawardene ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Elderly Patients ◽  
Kidney Injury ◽  
High Dependency Unit ◽  
High Dependency

Primary Casualty Reception Ship: the hospital within—Operation Granby

1992 ◽  
Vol 78 (2) ◽  
pp. 55-64
Author(s):  
E. P. Dewa
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Support Services ◽  
Persian Gulf ◽  
Medical Team ◽  
High Dependency Unit ◽  
Full Support ◽  
Hospital Facility ◽  
High Dependency

SummaryAs the build-up of Operation Granby forces developed in the Gulf, casualty estimates indicated the need for a 100-bed hospital facility to care for the possible maritime casualties. RF A Argus, the Air Training Ship, was identified as the potential Primary Casualty Reception Ship (PCRS) and at the end of September 1990 plans were drawn up to convert the forward hangar into a two-storey 100-bed hospital in collective protection (COLPRO).In the three weeks prior to deployment, the hospital was designed, built, equipped and staffed.Argus arrived in the Gulf in mid-November as the PCRS with, all in COLPRO, a 10-bed intensive care unit (ICU), a 14-bed high dependency unit (HDU), a 76-bed low dependency unit (LDU) plus four operating tables in two theatres with full support services.The hospital was staffed by a medical team of 136 personnel and supported by the Air department with four casualty evacuation helicopters, an RN Party and the staff of the RFA.One hundred and five patients were treated of which 78 were returned to duty. Argus as PCRS spent longer in the northern Persian Gulf than any other ship, UK or US.

Patient with systemic emboli in the setting of Klebsiella oxytoca tricuspid valve endocarditis and patent foramen ovale treated with NobleStitch and AngioVac

2021 ◽  
Vol 14 (8) ◽  
pp. e243370
Author(s):  
John Leso ◽  
Majd Al-Ahmad ◽  
Drinnon O Hand
Keyword(s):  
Tricuspid Valve ◽  
Patent Foramen Ovale ◽  
Klebsiella Oxytoca ◽  
Signs And Symptoms ◽  
Foramen Ovale ◽  
Surgical Debulking ◽  
History Of ◽  
Infectious Disease Specialists ◽  
High Index Of Suspicion ◽  
Pfo Closure

A 34-year-old man with a medical history of injection drug use presented with 2 weeks of weakness, nausea, vomiting and septic shock secondary to infective endocarditis of a native tricuspid valve. On admission, CT chest demonstrated multiple cavitary lesions as well as numerous small infarcts seen on MRI brain concerning for systemic septic emboli. Subsequent transthoracic echo with bubble study revealed a large patent foramen ovale (PFO). The patient later received surgical debulking of his tricuspid valve vegetation with AngioVac. Subsequently, PFO closure was performed with a NobleStitch device. The case presented here demonstrates the importance of having a high index of suspicion with right-sided endocarditis and the development of other systemic signs and symptoms. It also underscores the necessity of a multidisciplinary team of cardiologists, surgeons, infectious disease specialists and intensivists in the treatment of these complicated patients.

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