scholarly journals Atypical bilateral ventilation/perfusion mismatches in an asymptomatic patient suffering from metastatic thyroid cancer

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
David Kersting ◽  
Christoph Rischpler ◽  
Till Plönes ◽  
Clemens Aigner ◽  
Lale Umutlu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thyroid Cancer ◽  
Pulmonary Artery ◽  
Clinical Symptoms ◽  
Pulmonary Ventilation ◽  
Perfusion Scintigraphy ◽  
Thyroid Cancer Patient ◽  
Artery Embolism ◽  
Asymptomatic Patients ◽  
Multiple Metastases

Abstract Background Pulmonary embolism is indicated by ventilation/perfusion (V/P) mismatches in ventilation/perfusion scintigraphy. However, other pathologies may also evoke segmental or lobar mismatches. Thus, diagnosis can be difficult in asymptomatic patients with equivocal clinical presentation. Case presentation We present a case of multiple bilateral pulmonary ventilation/perfusion mismatches in a poorly differentiated thyroid cancer patient. Exact diagnosis was difficult, as the patient was asymptomatic and pulmonary embolism is commonly unilateral in tumour patients and not typical for thyroid cancer. External pulmonary artery compression by aortic aneurysm, multiple metastases or additional bronchopulmonary malignancies were considered as differential diagnosis. After unilateral pulmonary and hilar metastasectomy, perfusion normalised on the operated side. Pulmonary perfusion defects due to pulmonary artery compression by hilar metastases were finally diagnosed. Pulmonary embolism was deemed unlikely due to the left-sided post-operative normalisation, persistence of right-sided V/P mismatches, and the lack of clinical symptoms. Conclusion Pulmonary artery compression may mimic pulmonary artery embolism in lung perfusion scintigraphy and should be considered in bronchopulmonary tumour patients with hilar metastases and unilateral ventilation/perfusion mismatches affecting a complete lobe or even lung. Following the presented case, also bilateral segmental and subsegmental mismatches in patients with hilar metastases from non-bronchopulmonary cancer entities should be carefully evaluated.

scholarly journals On the issue of pulmonary embolism

1898 ◽  
Vol 12 (4) ◽  
pp. 548-549
Author(s):  
A. A. Maksimov
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Pregnant Women ◽  
Artery Embolism ◽  
Physiological Phenomenon ◽  
Pulmonary Artery Embolism

Abstracts. Review of Obstetric and Gynecological literature: Russian.A.A. Maksimov. On the issue of pulmonary embolism . (Journal. Russian. General. Protection. Nar. Health. 1897,. No. 11, p. 647).Schmorl, who discovered pulmonary artery embolism with cells later, identified this phenomenon as the cause of eclampsia in pregnant women. Lubarsch considered embolism as a consequence of all sorts of seizures in pregnant women. Kasyanov, who found embolism in all pregnant women, suggested that this is a physiological phenomenon that occurs during every pregnancy. The author studied the lungs in 40 pregnant rabbits and was convinced that, under normal conditions, the rabbit does not have pulmonary embolism with shorts after.

scholarly journals Pulmonary embolism after thrombolysis of hemodialysis grafts.

1997 ◽  
Vol 8 (9) ◽  
pp. 1458-1461
Author(s):  
H F Smits ◽  
P P Van Rijk ◽  
J W Van Isselt ◽  
W P Mali ◽  
H A Koomans ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Symptoms ◽  
Interventional Procedure ◽  
Pulmonary Perfusion ◽  
Perfusion Scintigraphy ◽  
Substantial Risk ◽  
Pulmonary Embolization ◽  
Hemodialysis Graft

The aim of this study was to determine the incidence of pulmonary embolization occurring after mechanical or pharmacomechanical percutaneous intravascular thrombolysis in 23 patients with occluded hemodialysis grafts. In all patients, pulmonary perfusion scintigraphy was performed before and immediately after thrombolysis. In eight (35%) of the patients, there was evidence of pulmonary embolism resulting from the interventional procedure; however, in only one was there clinical symptoms. It is concluded that there is substantial risk of pulmonary embolism in patients undergoing percutaneous intravascular thrombolysis for an occluded hemodialysis graft.

scholarly journals Diagnosis of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery with Echocardiography and Digital Subtraction Angiography

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Haiyan Yang ◽  
Jinqing Li ◽  
Xiaojuan Ji
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Digital Subtraction Angiography ◽  
Left Coronary Artery ◽  
Clinical Symptoms ◽  
Anomalous Origin ◽  
Digital Subtraction ◽  
Cardiac Murmur ◽  
Asymptomatic Patients ◽  
Convenient Technique

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a common coronary artery anomaly associated with high mortality and may lead to sudden death if left unrecognized and untreated. This report describes an 8-year-old female who had cardiac murmur but with no clinical symptoms. Electrocardiogram (ECG) was normal, but echocardiography made the diagnosis of ALCAPA. Digital subtraction angiography (DSA) with cardiac catheterization angiography (CAG) confirmed the diagnosis, and finally, the patient received surgery. This case demonstrates that echocardiography is a sensitive and convenient technique for establishing the initial diagnosis of ALCAPA in both symptomatic and asymptomatic patients.

scholarly journals Clinical importance of the distribution of pulmonary artery embolism in acute pulmonary embolism

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110047
Author(s):  
Yunqiang Nie ◽  
Li Sun ◽  
Wei Long ◽  
Xin LV ◽  
Cuiyun Li ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Mixed Type ◽  
Acute Pulmonary Embolism ◽  
Disease Duration ◽  
Clinical Importance ◽  
Artery Embolism ◽  
Pulmonary Embolisms ◽  
Pulmonary Artery Embolism

Objective To explore the clinical importance of the distribution of pulmonary artery embolism in acute pulmonary embolism (APE). Methods Sixty-four patients with APE were classified into mixed-type and distal-type pulmonary embolism groups. Their right ventricular systolic pressure (RVSP) and disease duration were recorded, and the diameter of their right ventricles was measured by ultrasound. The computed tomography angiographic clot load was determined as a Mastora score. Results Patients with distal-type pulmonary embolisms had significantly lower RVSPs (44.92 ± 17.04 vs 55.69 ± 17.66 mmHg), and significantly smaller right ventricular diameters (21.08 ± 3.06 vs 23.37 ± 3.48 mm) than those with mixed-type pulmonary embolisms. Additionally, disease duration was significantly longer in patients with distal-type pulmonary embolisms (14.33 ± 11.57 vs 8.10 ± 7.10 days), and they had significantly lower Mastora scores (20.91% ± 18.92% vs 43.96% ± 18.30%) than patients with mixed-type pulmonary embolisms. After treatment, RVSPs decreased significantly in patients with both distal-type and mixed-type pulmonary embolisms. Right ventricle diameters also decreased significantly in patients with mixed-type pulmonary embolisms after treatment. Conclusion Patients with mixed-type pulmonary embolisms are significantly more susceptible to pulmonary hypertension, enlarged right ventricular diameters, and shorter durations of disease than those with distal-type pulmonary embolisms. The distribution of pulmonary artery embolism in APE can provide a clinical reference.

Antithrombin-III Deficiency Causing Deep Vein Thrombosis And Pulmonary Embolism In A Young Male

1981 ◽  
Author(s):  
K Genth ◽  
J Schaefer ◽  
J Frank ◽  
W Krämer ◽  
B Weinei ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Pulmonary Artery ◽  
Antithrombin Iii ◽  
Clinical Symptoms ◽  
Venous Pressure ◽  
Vein Thrombosis ◽  
At Iii ◽  
Antithrombin Iii Deficiency ◽  
Deep Vein

A 34 year old male was admitted to the hospital with typical clinical symptoms of acute pulmonary embolism caused by deep vein thrombosis in the upper leg detected by phlebography. Pulmonary embolism was verified by the lung-perfusion-scintigram. The patient developed an infarct pneumonia with hemoptoe. Episodic thromboembolic phenomena occurred due to antithrombin-III deficiency (AT-III). The method, using homogenic substrates exhibited low AT-III activity of 8.6 IU/ml(25°C) due to a familiar AT-III deficit. Fiberoptic pulmonary catheter was placed into the pulmonary artery to measure pulmonary artery pressure (PAP, PCP), right ventricular pressure (RVP) and to determine cardiac output (CO) using the dye dilution technique. Heart rate (HR), central venous pressure (CVP) and aortic pressure (AOP) were recorded continuously. Patient received immediately fibrinolytic therapy, initiated by an initial dose of streptokinase (SK)(250 000 IU/20 min.), followed by a maintenance dose (100 000 IU/h), lasting 3 days. M-mode echocardiography detected before SK a moderate enlarged right ventricle and a small left ventricle, indicating a low output. After SK these values were improved. In conclusion, this case demonstrated a serious thromboembolic disorder, related to AT-III deficit. SK-therapy improved the hemodynamic situation.

scholarly journals Present aspects of thrombolytic therapy of pulmonary artery thromboembolism

2021 ◽  
Vol 99 (1) ◽  
pp. 6-14
Author(s):  
Y. V. Ovchinnikov ◽  
M. V. Zelenov ◽  
V. S. Polovinka ◽  
E. V. Kryukov
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Pulmonary Artery ◽  
Thrombolytic Therapy ◽  
Pulmonary Blood Flow ◽  
Pulmonary Thromboembolism ◽  
Comparative Efficiency ◽  
Artery Embolism ◽  
Pulmonary Arterial ◽  
Pulmonary Artery Embolism

The concept of high-risk pulmonary artery embolism determines that verification of the occlusion of the pulmonary arterial bed requires urgent restoration of pulmonary blood flow in such patients. Thrombolytic therapy is currently recognized as the main treatment for pulmonary artery thromboembolism. It can save patients’ lives, prevent the development of chronic post embolic pulmonary hypertension and thromboembolism recurrence. The literature review presents thrombolytic medications used in the treatment of pulmonary thromboembolism, describes indications for thrombolytic therapy, comparative efficiency and safety of various thrombolytics. The main complications of thrombolytic therapy are described and the issues of increasing its safety are raised. Criteria for the success of thrombolysis are early diagnosis, accurate risk stratification, and adequate use of reperfusion agents in patients with high-risk or transitionally high-risk of pulmonary embolism.

A case of pulmonary embolism in a fracture of both lower extremities

1903 ◽  
Vol 3 (3-4) ◽  
pp. 155-155
Author(s):  
N. N. Smirnov
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Venous Thrombosis ◽  
Clinical Picture ◽  
Statistical Data ◽  
Lower Extremities ◽  
Lower Leg ◽  
Unexpected Death ◽  
Artery Embolism ◽  
Pulmonary Artery Embolism

In the case observed by the author, the patient had an unexpected death (within 1/2 hour with the onset of cardiac paralysis) in the period of recovery 3 weeks after the fracture of the shin bones (2-sided). Autopsy revealed thrombosis of the vein of the lower leg and embolism of the pulmonary artery, -Embolism on the basis of venous thrombosis, according to statistical data, is rather rare. In total, there are currently 37 cases of proven embolism and 15 cases. 70% of this number should be attributed to after fractures. Depending on the size of the embolus and the place of the drift, it causes a clinical picture of varying severity and outcome.

scholarly journals Prediction of Mortality Associated with Cardiac and Radiological Findings in Patients with Pulmonary Embolism

2020 ◽  
Vol 6 (4) ◽  
pp. 84-90
Author(s):  
Sema Avci ◽  
Gokhan Perincek ◽  
Muammer Karakayali
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Complete Blood Count ◽  
Clinical Signs ◽  
Axis Deviation ◽  
Arterial Blood ◽  
Prediction Of Mortality ◽  
Artery Embolism ◽  
Right Pulmonary Artery ◽  
Pulmonary Artery Embolism

AbstractBackground: In this study, we aimed to compare echocardiography, electrocardiography (ECG) abnormalities, Doppler ultrasonography (USG), and computed tomography pulmonary angiography (CTPA) results in predicting 3-month mortality in patients with acute pulmonary embolism (PE).Methods: This retrospective cohort study included 124 patients (72 females, 52 males) with acute PE. Demographics, symptoms, clinical signs, comorbidities, history of surgery, arterial blood gas, liver-renal functions, complete blood count, echocardiography, ECG, Doppler USG, and CTPA results, as well as 3-month mortality were recorded.Results: pH (z = –2.623; p <0.01), hemoglobin (z = –3.112; p <0.01), and oxygen saturation (z = –2.165; p <0. 01) were significantly higher in survivors. White blood cell (z = –2.703; p <0.01), blood urea nitrogen (z = –3.840; p <0.01), creatinine (z = –3.200; p <0.01), respiratory rate (z = –2.759; p <0.01), and heart rate (z = –2.313; p <0.01) were significantly higher in non-survivors. Nonspecific ST changes (AUC 0.52, 95% CI 0.43–0.61), p pulmonale (AUC 0.52, 95% CI 0.43–0.61), normal axis (AUC 0.61), right axis deviation (AUC 0.56), right ventricle strain pattern (AUC 0.59), and right pulmonary artery embolism (AUC 0.54) on CTPA showed the highest mortality prediction.Conclusions: Nonspecific ST changes, p pulmonale, normal axis and right axis deviation in ECG, RV strain in echocardiography, and right pulmonary artery embolism on CTPA are associated with a higher mortality in patients with PE.

Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?

2011 ◽  
Vol 16 (2) ◽  
pp. 8-9
Author(s):  
Marjorie Eskay-Auerbach
Keyword(s):  
Clinical Symptoms ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Disc Space Narrowing ◽  
Disc Disease ◽  
Disc Space ◽  
Radiographic Findings ◽  
Asymptomatic Patients

Abstract The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.

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