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echo pulmonary embolism

Ajay U Mahajan, Deepak S Laddhad, Deepak Bohara, Sangeeta D Laddhad, Yogita T Dinde, Sachin S Bhabad
A 32 yrs old man presented with shortness of breath and syncopal episode with preceding history of DVT 15days above. Patient has tachycardia hypoxia and hypotension, on evaluation ECG Showed S1 Q3 T3 Pattern, bedside Echo Showed visible thrombus of 3cm in pulmonary artery, successfully thrombolysed with tenecteplase and streptokinase. This case study is presented to stress importance of urgent bedside echo in all sudden onset dysponea and hypoxia to rule out pulmonary Embolism which can be successfully thrombolysed without delay...
June 2016: Journal of the Association of Physicians of India
Dong Jia, Xiao-Ming Zhou, Gang Hou
To evaluate the feasibility and the efficacy of computed tomography pulmonary angiography (CTPA) in differentiating acute pulmonary embolism (PE) patients with or without right ventricular dysfunction and to evaluate the severity of right ventricular dysfunction in acute PE patients with CPTA. We retrospectively collected and measured the following parameters: right ventricular diameter by short axis in the axial plane (RVDaxial), left ventricular diameter by short axis in the axial plane (LVDaxial), right ventricular diameter by level on the reconstructed four-chamber views (RVD4-CH), left ventricular diameter by level on the reconstructed four-chamber views (LVD4-CH), main pulmonary artery diameter (MPAD), ascending aorta diameter (AOD), coronary sinus diameter (CSD), superior vena cava diameter (SVCD), inferior vena cava (IVC) reflux and interventricular septum deviation by CTPA, and we calculated the RVDaxial/LVDaxial, RVD4-CH/LVD4-CH and MPAD/AOD ratios in acute PE patients...
October 12, 2016: Journal of Thrombosis and Thrombolysis
Marzanna Paczyńska, Piotr Sobieraj, Łukasz Burzyński, Maciej Kostrubiec, Małgorzata Wiśniewska, Piotr Bienias, Katarzyna Kurnicka, Barbara Lichodziejewska, Piotr Pruszczyk, Michał Ciurzyński
INTRODUCTION: Right ventricular dysfunction (RVD) is an indicator of poor prognosis in normotensive patients with acute pulmonary embolism (APE). The aim of this study was to compare right ventricular (RV)/left ventricular (LV) ratio measured by echocardiography and multidetector computed tomography (MDCT) with tricuspid annulus plane systolic excursion (TAPSE) as a prognostic factor of APE-related 30-day mortality. MATERIAL AND METHODS: We examined 76 patients with confirmed APE, hemodynamically stable at admission...
October 1, 2016: Archives of Medical Science: AMS
Bhaskar Bhardwaj, Ata Bajwa, Amit Sharma, Arooge Towheed, Bakul V Sanghani, A Iain McGhie
A 71-year-old male presented after sudden onset of confusion and expressive aphasia. MRI head revealed multiple ischemic lesions consistent with cardio-embolic pathophysiology. A computed tomography angiography of lung showed peripheral pulmonary emboli. He underwent a transesophageal echocardiogram as a part of the stroke workup and was found to have vegetations on both aortic and tricuspid valves. The blood cultures did not show any growth, and the patient remained afebrile during the course of hospitalization...
September 30, 2016: Echocardiography
Dawn S Hui, Fernando Fleischman, P Michael McFadden
BACKGROUND: Thromboembolism-in-transit straddling a patent foramen ovale (PFO) is a rare condition that requires urgent surgical intervention to prevent arterial emboli. CASE REPORT: We present the case of a 42-year-old female who presented with a symptomatic pulmonary embolism. Echocardiography identified a PFO, with a bridging thrombus-in-transit and evidence of right ventricular strain. Urgent surgery was performed because of the risk of systemic embolism. A large thrombus was identified during biatrial exploration...
2016: Ochsner Journal
Jeffrey Forris Beecham Chick, Shilpa N Reddy, Ruchika D Bhatt, Benjamin J Shin, James N Kirkpatrick, Scott O Trerotola
PURPOSE: To explore significance, management, and outcomes of central venous catheter (CVC) tip-associated thrombi incidentally detected on echocardiography. MATERIALS AND METHODS: Echocardiogram data from all patients with CVCs from October 2009 to June 2011 were reviewed (N = 170). Patients with CVC tip-associated thrombi were selected (n = 49). Echocardiograms were reviewed for ejection fraction, presence of patent foramen ovale (PFO), presence of other intracardiac shunts, and mean thrombus size...
September 19, 2016: Journal of Vascular and Interventional Radiology: JVIR
Varun Miriyala, Muhammad Umer Awan, Kirmanj Faraj, Bipinpreet Nagra
A 72-year-old male is diagnosed with paradoxical embolus after he presented with concurrent deep vein thrombosis, stroke, and multiple arterial emboli in the presence of a patent foramen ovale (PFO). Paradoxical embolus requires the passage of a thrombus from the venous into the arterial circulation through a right-to-left shunt leading to systemic embolism. But, despite the high incidence of PFO (27.3% across all age groups by autopsy), paradoxical embolism (PDE) is uncommon, representing <2% of all arterial emboli...
2016: Journal of Community Hospital Internal Medicine Perspectives
Walter Serra, Ernesto Crisafulli, Nicola Sverzellati, P Tito Ugolotti, Panajota Tzani, Emilio Marangio, Diego Ardissino, Tiziano Gherli, Alfredo Chetta
BACKGROUND: Pulmonary hypertension (PH) is frequently found at the time of diagnosis of pulmonary embolism (PE). An incomplete resolution of PE can lead to chronic thromboembolic pulmonary hypertension (CTPH). Transthoracic echocardiogram (TTE) is the first step to diagnose an abnormality of the pulmonary vasculature. Based on computed tomography (CT), the Qanadli vascular obstruction index has been extensively used to assess acute PE. OBJECTIVES: Our aim was to ascertain whether at the time of diagnosis of an acute PE episode TTE variables and a Qanadli CT index score may be associated with CTPH 2 years later...
2016: Respiration; International Review of Thoracic Diseases
Chaim Yosefy, Yulia Azhibekov, Boris Brodkin, Vladimir Khalameizer, Amos Katz, Avishag Laish-Farkash
BACKGROUND: Not all echo laboratories have the capability of measuring direct online 3D images, but do have the capability of turning 3D images into 2D ones "online" for bedside measurements. Thus, we hypothesized that a simple and rapid rotation of the sagittal view (green box, x-plane) that shows all needed left atrial appendage (LAA) number of lobes, orifice area, maximal and minimal diameters and depth parameters on the 3D transesophageal echocardiography (3DTEE) image and LAA measurements after turning the images into 2D (Rotational 3DTEE/"Yosefy Rotation") is as accurate as the direct measurement on real-time-3D image (RT3DTEE)...
2016: Cardiovascular Ultrasound
Catherine Hatzantonis, Marcin Czyz, Renata Pyzik, Bronek M Boszczyk
BACKGROUND: Vertebroplasty carries multiple complications due to the leakage of polymethylmethacrylate (PMMA) into the venous system through the iliolumbar or epidural veins. The rate of venous cement complications may vary from 1 to 10 %, with cement extravasation into the venous system in 24 % of patients. Emboli may further migrate into the right heart chambers and pulmonary arteries. Patients may vary in presentation from asymptomatic or symptoms such as syncope to life-threatening complications...
August 17, 2016: European Spine Journal
Hiromitsu Tabata, Hiroshi Kitaguchi, Yuki Terajima, Katsuro Shindo
Cerebral air embolism (CAE) is a rare cause of stroke. Most cerebral air emboli are caused by iatrogenic factors, such as invasive cardiac and pulmonary procedures. Here, we report an unusual case of CAE not related to any medical intervention. An 87-year-old woman became unresponsive after vomiting. A computed tomography (CT) scan of the head 6 hours after the onset of the vomiting revealed multiple air emboli, mainly in the watershed area between the right anterior and middle cerebral arteries. Magnetic resonance imaging with T2* gradient echo showed the air emboli as granular hypointensities...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Qaiser Shafiq, George V Moukarbel, Rajesh Gupta, Dawn-Alita Hernandez, Samer J Khouri
Acute pulmonary embolism remains a common cause of mortality. Early diagnosis and appropriate risk stratification is necessary to individualize treatment strategy. Computed tomography scan of the pulmonary arteries is routinely used to diagnose acute pulmonary embolism and in some cases is useful to assess right ventricular dilation. In patients with acute pulmonary embolism, right ventricular dilation and dysfunction indicates a high-risk situation where immediate administration of thrombolytic agent, catheter-directed thrombolysis, or surgical embolectomy could be considered...
August 10, 2016: Journal of Echocardiography
Peter S Y Yu, Calvin S H Ng, Micky W T Kwok, Malcolm J Underwood, Randolph H L Wong
A 66-year-old man presented with acute type I respiratory failure, and was diagnosed to have a huge mass occupying the right atrium (RA) of the heart, with no evidence of pulmonary embolism. Intra-operative transesophageal echocardiogram identified a patent foramen ovale (PFO) with right-to-left shunt apart from a huge right atrial tumor arising from the atrioventricular groove. The tumor was debulked, and the patent foramen was closed. Patient had an uneventful recovery and WAS discharged on post-operative day 7...
July 2016: Journal of Thoracic Disease
Sahela Nasrin, Fathima Aaysha Cader, Md Salahuddin, Tahera Nazrin, Masuma Jannat Shafi
BACKGROUND: Massive pulmonary embolism (PE) is associated with significant mortality, especially if compounded by haemodynamic instability, right ventricular (RV) dysfunction and right atrial (RA) thrombus. Thrombolysis can be lifesaving in patients with major embolism and cardiogenic shock, and accelerates the resolution of thrombus. Only three fibrinolytic agents-namely streptokinase, urokinase, and recombinant tissue plasminogen activator (alteplase) have been approved in the treatment of PE, with studies demonstrating similar safety profiles...
2016: BMC Research Notes
Drew A Palmer, John E Humphrey, Ariel Fredrick, Thomas C Piemonte, John A Libertino
We report a case of a 54-year-old patient with a T3c renal mass with intracardiac extension of the thrombus to the level of the pulmonary valve. The patient was not a candidate for cardiopulmonary bypass due to recent pulmonary embolism. Under transesophageal echocardiogram guidance, the intracardiac thrombus was removed percutaneously via transvenous mechanical thrombectomy. The patient was effectively downstaged to T3b and underwent successful radical nephrectomy and inferior vena cava thrombectomy without the use of cardiopulmonary bypass...
October 2016: Urology
Nuno Carvalho Guerra, Mathieu Pernot, Georgios Nesseris, Mohammed Al-Yamani, Xavier Roques, Jean-Benoît Thambo, Bernard Kreitmann, François Roubertie
BACKGROUND: Scimitar syndrome may be corrected using different techniques. Repair using an extracardiac conduit has rarely been performed. This study assessed the intermediate-term outcomes of this technique in adults. METHODS: From January 2000 to June 2011, 7 adult patients underwent correction with a ringed polytetrafluoroethylene conduit used to connect the scimitar vein (SV) to the left atrium, posterior to the inferior vena cava (IVC). Preoperative and perioperative data were reviewed retrospectively...
July 14, 2016: Annals of Thoracic Surgery
Manish Bhartiya, Puneet Saxena, Dharmender Singh, V K Sashindran
We report a 42 year old non-smoker male who presented with progressive exertional dyspnoea, productive cough with streaky hemoptysis and progressive pedal edema. His physical examination, ECG, chest X-ray and 2D-ECHO revealed features suggestive of right heart failure and pulmonary hypertension. On further evaluation for the cause of pulmonary hypertension, his CT pulmonary angiography revealed features of chronic pulmonary thromboembolism with calcified thrombus in the main pulmonary artery along with pulmonary hypertension...
June 2016: Indian Journal of Hematology & Blood Transfusion
Glen T Granati, Getu Teressa
BACKGROUND Patent foramen ovale (PFO) are common, normally resulting in a left-to-right shunt or no net shunting. Pulmonary embolism (PE) can cause sustained increased pulmonary vascular resistance (PVR) and right atrial pressure. Increasing positive end-expiratory pressure (PEEP) improves oxygenation at the expense of increasing intrathoracic pressures (ITP). Airway pressure release ventilation (APRV) decreases shunt fraction, improves ventilation/perfusion (V/Q) matching, increases cardiac output, and decreases right atrial pressure by facilitating low airway pressure...
2016: American Journal of Case Reports
Efthymios D Avgerinos, Nathan L Liang, Omar M El-Shazly, Catalyn Toma, Michael J Singh, Michel S Makaroun, Rabih A Chaer
OBJECTIVE: The purpose of this study was to determine the short-term and midterm outcomes of catheter-directed intervention (CDI) compared with anticoagulation (AC) alone in patients with submassive pulmonary embolism (sPE). METHODS: This was a retrospective review of all patients treated for sPE between January 2009 and October 2014. Two groups were identified on the basis of the therapy: AC and CDI. End points included complications, mortality, and change in echocardiographic parameters...
July 2016: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Alexander Levitov, Heidi L Frankel, Michael Blaivas, Andrew W Kirkpatrick, Erik Su, David Evans, Douglas T Summerfield, Anthony Slonim, Raoul Breitkreutz, Susanna Price, Matthew McLaughlin, Paul E Marik, Mahmoud Elbarbary
OBJECTIVE: To establish evidence-based guidelines for the use of bedside cardiac ultrasound, echocardiography, in the ICU and equivalent care sites. METHODS: Grading of Recommendations, Assessment, Development and Evaluation system was used to rank the "levels" of quality of evidence into high (A), moderate (B), or low (C) and to determine the "strength" of recommendations as either strong (strength class 1) or conditional/weak (strength class 2), thus generating six "grades" of recommendations (1A-1B-1C-2A-2B-2C)...
June 2016: Critical Care Medicine
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