scholarly journals Surgical Treatment in a High-Risk Pulmonary Embolism: Case Report

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 725
Author(s):  
Horatiu Moldovan ◽  
Andra-Madalina Sibisan ◽  
Robert Tiganasu ◽  
Elena Nechifor ◽  
Daniela Gheorghita ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Ct Scan ◽  
Preoperative Evaluation ◽  
Hemodynamic Instability ◽  
Pulmonary Embolectomy ◽  
Vein Thrombosis ◽  
Severe Hypotension ◽  
Lower Limb Pain ◽  
The Right

We present the case of a 35-year-old woman who had a high-risk pulmonary embolism (according to ESC risk stratification for pulmonary embolism) after she had undergone a Caesarion section. Postoperatively, she presented with acute left lower limb pain, swelling and erythema. A diagnosis was made of deep vein thrombosis (DVT) of the ilio-femoral and popliteal veins. She was started on anticoagulant therapy, which proved to be inefficient, the patient developing a left calf and thigh oedema and shortness of breath. A CT scan revealed high-risk embolus located in the right atrium and through the tricuspid valve. The decision was made to refer her to a cardiovascular surgeon. During her preoperative evaluation, the patient became hemodynamically unstable and was rushed into the operating room, severely desaturated, bradycardic, without consciousness, with severe hypotension. On the basis of the severe state of the patient and the CT scan findings we performed an emergency pulmonary embolectomy, with the patient on cardio-pulmonary by-pass, without cross-clamping the aorta, using a modified Trendelenburg procedure. This case supports using open pulmonary embolectomy for patients with hemodynamic instability on the basis of clinical diagnosis.

Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review

2020 ◽  
Vol 46 (08) ◽  
pp. 895-907
Author(s):  
Nina D. Anfinogenova ◽  
Oksana Y. Vasiltseva ◽  
Alexander V. Vrublevsky ◽  
Irina N. Vorozhtsova ◽  
Sergey V. Popov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Transesophageal Echocardiography ◽  
Three Dimensional ◽  
Right Atrial ◽  
Treatment Protocols ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Right

AbstractPrompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

scholarly journals Features of in-hospital clinical course of pulmonary embolism in patients of different age groups

2020 ◽  
Vol 19 (5) ◽  
pp. 2423
Author(s):  
E. A. Shmidt ◽  
S. A. Berns ◽  
A. G. Neeshpapa ◽  
P. A. Talyzin ◽  
I. I. Zhidkova ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Clinical Course ◽  
Diastolic Pressure ◽  
Age Groups ◽  
Statistical Processing ◽  
Severity Index ◽  
Cardiovascular Comorbidity ◽  
Vein Thrombosis ◽  
Comorbidity Status

Aim. To study the clinical course and management of patients with pulmonary embolism (PE) of various age groups hospitalized in a cardiology hospital.Material and methods. This prospective single-center study in the period from 2016 to 2018 included 154 patients with PE verified by computed tomography. Statistical processing was conducted using the MedCalcVersion 16.2.1 software package (Softwa, Belgium).Results. In all groups, female patients dominated, but the highest number of women (70,7%) belonged to the group of senile patients, while in the group <60 years, only half of patients with PE were women. Comorbid cardiovascular disease and deep vein thrombosis was diagnosed in eldest patients significantly more often than in those <60 years of age. The highest prevalence of cancer and recurrent PE were identified in the group of elderly patients. Thrombolytic therapy was performed most often in patients 60-75 years old, since these patients had a high risk of 30-day mortality according to Pulmonary Embolism Severity Index, but did not have severe comorbidities, as patients older than 75 years. An increase of right atrium size was found in the group of elderly and senile patients in comparison with patients <60 years. The highest pulmonary artery systolic and diastolic pressure was observed in the patients older than 75 years.Conclusion. In the Kemerovo Oblast, PE most often develops in patients aged 60-75 years and is characterized by a more severe clinical course compared with patients younger than 60 years. Patients over the 60 years of age have severe cardiovascular comorbidity status, atrial fibrillation/flutter and recurrent PE. Surgical treatment for senile patients is limited due to the high risk of postoperative complications, which specifies high mortality. Patients <60 years of age are a third of all patients hospitalized with PE. They have a low risk of mortality, but have an unfavorable course of the hospital period.

Saddle pulmonary embolism with fluorouracil: A case report

2020 ◽  
Vol 26 (7) ◽  
pp. 1769-1773
Author(s):  
Kylee E White ◽  
Christopher T Elder
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Case Report ◽  
Single Agent ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Additive Risk ◽  
The Right ◽  
Deep Vein ◽  
To Receive

Introduction As a single agent, fluorouracil has been documented to have a small but present chance of causing extravasation of the port when not properly administered. It has also been shown that cancer patients receiving chemotherapy are at increased risk of deep vein thrombosis, symptomatic or silent. Case report A 43-year-old male patient with stage III colon cancer receiving FOLFOX developed a saddle pulmonary embolism involving possible extravasation that was discovered following cycle 3 of chemotherapy. CT scan and lower extremity Doppler confirmed non-occlusive deep vein thrombosis along with saddle pulmonary embolism. Management and outcome: For acute management, patient underwent bilateral pulmonary artery thrombolysis. Following this, the patient was initiated on rivaroxaban indefinitely. The right subclavian port was removed, and a new port was placed in the left subclavian. Patient went on to receive three more cycles of chemotherapy. Discussion Fluorouracil, an inflammitant, has been shown to have damaging potential, especially in terms of the integrity of the endothelium. Over time, this can lead to serious complications such as cardiotoxicity, including deep vein thrombosis formation. Based on how and when the thrombi were discovered, it is not possible to deduce whether the port, the 5-FU, extravasation or other factors were the precipitators of the formation of the thrombi. The combination of chemotherapy treatment along with CVC placement appears to have an additive risk to the formation of a thrombus. Practitioners should take caution when evaluating for extravasation and CVC integrity and note other potential differentials for causes, including deep vein thrombosis/saddle pulmonary embolism formation.

Prevention of Deep Vein Thrombosis and Pulmonary Embolism in High-Risk Medical Patients

2018 ◽  
Vol 39 (3) ◽  
pp. 483-492 ◽  
Author(s):  
Megan McCullough ◽  
Cyrus Kholdani ◽  
Roham T. Zamanian
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
High Risk ◽  
Medical Patients ◽  
Vein Thrombosis ◽  
Deep Vein

scholarly journals Large diverticulum of the urinary bladder: A rare cause of deep vein thrombosis with consecutive pulmonary embolism

2015 ◽  
Vol 9 (5-6) ◽  
pp. 321
Author(s):  
Oliver Zimmermann ◽  
Jan Torzewski ◽  
Ekkehard Reichenbach-Klinke ◽  
Christine Zenk
Keyword(s):  
Pulmonary Embolism ◽  
Urinary Bladder ◽  
Left Kidney ◽  
Pulmonary Arteries ◽  
Vein Thrombosis ◽  
Progressive Dyspnea ◽  
Vena Femoralis ◽  
The Right ◽  
Deep Vein ◽  
Vena Femoralis Superficialis

A 73-year-old man was admitted with progressive dyspnea; he also had benign prostatic hyperplasia (BPH). An angio computed tomography scan showed pulmonary embolism with thrombi in both main pulmonary arteries. By duplex ultrasonography, we detected a thrombus in the right vena femoralis superficialis and vena femoralis communis. Simultaneously, we also noticed a large diverticulum on the right side of the urinary bladder and urinary stasis II of the left kidney. We consider the BPH as the trigger for a secondary diverticulum of the urinary bladder. As a result of its large dimensions, mechanical compression of the deep right pelvic veins resulted in thrombosis which finally caused the pulmonary embolism. With respect to the urinary stasis II, surgical excavation of the diverticulum with infravesical desobstruction was planned. The potentially lethal course of large diverticula may require surgery.

scholarly journals Recurrent pulmonary embolism related with Paget–Schroetter syndrome: a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Yuki Sahashi ◽  
Junko Naito ◽  
Masanori Kawasaki
Keyword(s):  
Pulmonary Embolism ◽  
Lifestyle Modification ◽  
Axillary Vein ◽  
Vein Thrombosis ◽  
Cardiology Department ◽  
Recurrent Pulmonary Embolism ◽  
The Right ◽  
Contrast Ct ◽  
First Rib Resection ◽  
Deep Vein

Abstract Background Paget–Schroetter syndrome (PSS) is an unusual cause of venous thromboembolism, which is frequently misdiagnosed and undiagnosed in clinical settings. Although axillary-subclavian vein thrombosis is related with PSS typically presents in healthy young athletes, it is possible for this phenomenon to occur in various age settings. Case summary We present a case of recurrent pulmonary embolism caused by a thrombus in dilated axillary vein related with PSS. A 74-year-old man was referred to our cardiology department for chest discomfort and hypoxaemia. The contrast computed tomography (CT) revealed that he suffered from bilateral pulmonary embolism. However, we could not find the source of embolism despite other examinations such as ultrasonography of the inferior limb deep vein. Three months later, the patient complained of dyspnoea for a second time, and a contrast CT scan was subsequently performed revealing a new pulmonary embolism. Surgical resection of the giant thrombus was performed, resulting in a good clinical course without recurrence. Discussion We experienced a case of recurring pulmonary embolism in a patient with undiagnosed PSS, which was related to the active and vigorous movement of the right arm during his working. Although there are various treatments for PSS including anticoagulation, first rib resection, and lifestyle modification, we need to consider what is the best treatment individually.

scholarly journals MORTALITY OUTCOMES FOR SURGICAL PULMONARY EMBOLECTOMY FOR HIGH-RISK PULMONARY EMBOLISM: A COMPREHENSIVE META-ANALYSIS

2016 ◽  
Vol 67 (13) ◽  
pp. 2249 ◽  
Author(s):  
Rajat Kalra ◽  
Navkaranbir Bajaj ◽  
Sameer Ather ◽  
Jason Guichard ◽  
William Lancaster ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Meta Analysis ◽  
Pulmonary Embolectomy

scholarly journals Acute Massive Pulmonary Embolism with Direct Visualization of a Free-floating Right Heart Thrombus Successfully Treated with Fibrinolysis: A Case Report

2020 ◽  
Vol 121 (1) ◽  
pp. 42-48
Author(s):  
Elisavet Kaitalidou ◽  
Dimitrios Karapiperis ◽  
Vasileios Makrakis ◽  
Maria Kipourou ◽  
Dimitrios Petroglou
Keyword(s):  
Pulmonary Embolism ◽  
Hemodynamic Instability ◽  
Massive Pulmonary Embolism ◽  
Right Atrial ◽  
Direct Visualization ◽  
Atrial Thrombus ◽  
Right Heart ◽  
Motor Weakness ◽  
History Of ◽  
The Right

A male patient with a history of immobilization due to motor weakness, was transferred to our emergency department after syncope during physiotherapy, with recorded hypotension. Transthoracic echocardiography showed severe dilatation of the right ventricle (RV), with apex hypercontractility and almost akinetic RV free wall. The above findings, in addition to the unexpected visualization of a large, free-floating, right atrial thrombus, a rare finding associated with high mortality, readily confirmed the clinical suspicion of acute pulmonary embolism (PE) causing circulatory collapse. Intravenous fibrinolysis and vasopressor therapy were successfully administered, and hemodynamic instability was soon alleviated.

scholarly journals Deciding on thrombolytic therapy in pulmonary embolism - is there room for lactate?

2018 ◽  
Vol 146 (7-8) ◽  
pp. 436-439
Author(s):  
Dusanka Obradovic ◽  
Biljana Joves ◽  
Svetislava Milic ◽  
Jovan Matijasevic ◽  
Stanislava Sovilj-Gmizic
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Thrombolytic Therapy ◽  
Hemodynamic Instability ◽  
Positive Outcome ◽  
Pulmonary Angiography ◽  
Clinical Probability ◽  
Tissue Hypoperfusion ◽  
Therapeutic Algorithms ◽  
Wells Score

Introduction. Diagnostic and therapeutic algorithms for pulmonary embolism (PE) have been frequently modified; however, determining clinical probability, which dictates further procedures, has remained the first step. The objective was to illustrate therapeutic dilemma in a patient with intermediate high risk for 30-day mortality. Case outline. The patient was a 56-years-old woman who was referred to our institution for suspected PE. According to the Wells score, the patient was deemed as low-probability for venous thromboembolism, and after further stratification she was placed in a group with intermediate high risk for 30-day mortality. PE was confirmed by computerised tomography pulmonary angiography and she initially received heparin. During the further clinical course, she developed hemodynamic instability, and she received thrombolytic therapy, with a positive outcome. The patient also had increased lactate at admission ? marker of tissue hypoperfusion which is not a part of the routine laboratory work-up in PE patients. Conclusion. Current guidelines state that patients with intermediate high risk for 30-day mortality should be treated with heparin, and then continuously monitored in order to timely recognize potential hemodynamic instability and consequently apply thrombolytics. In the outlined case, thrombolytic therapy was applied only after the patient developed hemodynamic instability, although previously she had early signs of tissue hypoperfusion.

scholarly journals THE DISTRIBUTION OF THE MAIN RISK FACTORS IN PATIENTS WITH INTERMEDIATE-HIGH RISK PULMONARY EMBOLISM

2021 ◽  
Vol 68 (2) ◽  
pp. 262-267
Author(s):  
Alexandru Cristian Ion ◽  
◽  
Irina Dimitriu Cuciureanu ◽  
Catalina Liliana Andrei ◽  
Crina Julieta Sinescu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Age Distribution ◽  
Hemodynamic Instability ◽  
Control Group ◽  
Study Group ◽  
Gender Distribution ◽  
Chi Squared ◽  
Instability Rate

The pulmonary embolism (PE) represents a medical condition with increasing incidence. The various clinical forms of PE have different prognosis, related to the presence of markers of right ventricle (RV) dysfunction (biochemical or imagistic). Material and method. In this study we included 82 consecutive patients with intermediate-high risk PE, assessing the main risk factors distribution. We divided the patients in two groups, study group - receiving thrombolytic therapy (ateplase (t-Pa)) associated to anticoagulation (unfractionated heparin (UFH)) – and control group – receiving anticoagulation alone -. The inclusion in study group was indicated by the high bleeding risk, in this group being included patients without contraindications for thrombolysis, patients without severe renal dysfunction and patients with body mass index (BMI) 18.5-29.9 kg/m2. We assessed the gender distribution in the two groups, the medium age distribution and the main PE risk factors in the two groups. Also, we assessed the effect of the both therapies on the hemodynamic instability rate on 7 day from admission (defined by systolic blood pressure (SBP) < 100 mmHg or a SBP drop >40 mmHg from inclusion value). The statistical analysis was made using SPSS program, by comparing the association between risk factors and the two groups, by Chi-squared test, while the gender and age distribution was made using the Shapiro Wilk test for the evenly data distribution and Wilk test (as the data were unevenly distributed). Results. We found no correlation between the risk factors and the study groups. There was no statistical significance regarding the gender distribution, but the medium age was higher in control group (61.82 y.o vs. 71.28 y.o, p < 0.001. Regarding the hemodynamic instability rate the Chi-squared test proved a statistical significant higher incidence in the control group (p = 0.03).

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