Characteristics of the Wells Score and Associated Factors of Pulmonary Embolisms in Inpatients with Deep Venous Thrombosis

Objective: To evaluate the characteristics of the Wells score and associated factors of acute pulmonary embolisms (PE) in surgical-based inpatients’ with acute deep venous thrombosis (DVT), at Songklanagarind Hospital.Material and Methods: Acute DVT inpatients in the departments of surgery, obstetrics-gynecology and orthopedics; from 2010 to 2016, were extracted from medical records, and retrospectively reviewed. The Wells score was calculated for risk stratification in terms of low, moderate, and high probability. Finally, the associated factors of acute PE were assessed.Results: There were 278 inpatients diagnosed with acute DVT in the surgery (n=142), obstetrics-gynecology (n=101, and orthopedics (n=35) wards. The numbers of low, moderate and high risk probability were 4 (1.0%), 141 (51.0%) and 133 (48.0%), respectively. We identified four factors that were significantly different between the three specialties comprising of: “paralysis, paresis, or recent plaster immobilization of the lower extremities”, “recently bedridden or underwent a major surgical procedure”, “leg edema” and “active cancer”. Regarding the surgery service, patients with acute PE experienced a higher rate of bilateral DVT than those who did not—28.0% and 8.0%, respectively.Conclusion: The low-risk probability determined by Wells score had low incidence of acute DVT in in-patient department settings. Acute bilateral DVT was more significantly associated with acute PE in the surgery service.

SyncoPE: A Rare Presentation of Pulmonary Embolism - A Case Report

Introduction: The S1Q3T3 pattern is neither sensitive nor specific for pulmonary embolisms; however, it can help guide clinical management in a patient with a vague presentation including syncope. Case Presentation: An elderly male presented to the hospital after an unwitnessed syncopal event. His initial EKG on admission revealed an S1Q3T3 pattern which prompted concern for a possible pulmonary embolism as the cause of his syncopal event. Further imaging confirmed the diagnosis.Conclusion: Syncope offers a long list of possible causes, but pulmonary embolism is commonly missed on the differential diagnosis. Our patients’ acute EKG findings ultimately helped guide our management to correctly diagnose our patient with a newfound pulmonary embolism as the cause of his syncopal event.

Clinical importance of the distribution of pulmonary artery embolism in acute pulmonary 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.

Venous thromboembolism in patients with adrenocortical carcinoma after surgery

Background: Adrenocortical carcinoma is a rare malignancy with a poor prognosis. We hypothesized that patients with adrenocortical carcinoma are at high risk for venous thromboembolism, given the numerous risk factors such as malignancy, abdominal surgery, immobility and hormonal excess. The aim of this study was to determine retrospectively the incidence of venous thromboembolisms after surgical treatment in patients with adrenocortical carcinoma. Materials and methods: A retrospective study was performed, collecting data from all patients diagnosed with adrenocortical carcinoma from 2003 to 2018 at the Radboud University Medical Centre, The Netherlands. Results: In 34 patients, eight postoperative venous thromboembolisms, all pulmonary embolisms, were diagnosed in the first 6 months after adrenalectomy (23.5%). In addition, one patient developed pulmonary embolism just prior to surgery and one patient 7 years after surgery. Five of the eight patients with postoperative venous thromboembolisms presented with symptomatic pulmonary embolism whereas the other three pulmonary embolisms were incidentally found on regular follow up CT scans. Seven of the eight venous thromboembolisms occurred within 10 weeks after surgery. Seven of the eight patients had advanced stage adrenocortical carcinoma and four patients already received low-molecular weight heparin during the development of the venous thromboembolism. There was one case of fatal pulmonary embolism in a patient with a cortisol producing tumor with pulmonary metastases, despite the use of a therapeutic dose thromboprophylaxis. Conclusion: Patients with adrenocortical carcinoma are at high risk of developing postoperative venous thromboembolisms. Prolonged postoperative thromboprophylaxis could be considered in these patients.

Clinical characteristics, management, and outcome of incidental pulmonary embolism in cancer patients

Incidental pulmonary embolisms (IPEs) are common in cancer patients. Examining the characteristics and outcomes of IPEs in cancer patients can help to ensure proper management, promoting better outcomes. To determine the clinical characteristics, management, and outcomes of IPEs for cancer patients, we conducted a 1:2 ratio case-control study and identified all consecutive patients with IPE who visited the emergency department at The University of Texas MD Anderson Cancer Center between 1 January 2006 and 1 January 2016. Each IPE case was matched with 2 controls using a propensity score obtained using logistic regression for IPE status with other factors affecting overall survival. A total of 904 confirmed cases were included in the analysis. IPE frequently occurred during the first year after cancer diagnosis (odds ratio [OR], 2.79; 95% confidence interval [95% CI], 2.37-3.29; P < .001). Patients receiving cytotoxic chemotherapy had a nearly threefold greater risk of developing IPE (OR, 2.87; 95% CI, 2.42-3.40; P < .001). In-hospital mortality was 1.9%. The 7- and 30-day mortality rates among the cases were 1.8% and 9.9%, respectively, which was significantly higher than in the control groups: 0.2% and 3.1%, respectively (P < .001). IPE was associated with reduced overall survival (hazard ratio [HR], 1.93; 95% CI, 1.74-2.14; P < .001). Concurrent incidental venous thromboembolism was identified in 189 of the patients (20.9%) and was also associated with reduced overall survival (HR, 1.65; 95% CI, 1.21-2.25; P = .001). Our results show that IPE events are associated with poor outcomes in cancer patients. Proper management plans similar to those of symptomatic pulmonary embolisms are essential.