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Pulmonary embolism diagnosis

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https://www.readbyqxmd.com/read/29340276/clinical-value-of-ultrasonography-in-diagnosis-of-pulmonary-embolism-in-critically-ill-patients
#1
Ran Zhu, Xiao-Chun Ma
Pulmonary embolism (PE) is a clinical emergency that will increase the mortality if complicated with unstable hemodynamics. Because of its nonspecific clinical symptoms, it's a great challenge to make a PE diagnosis. The golden standard to diagnose PE is computed tomography of pulmonary artery (CTPA), but a diagnosis of PE also composed of evaluation of PE risk factors, possibilities, and risk stratification. Ultrasonography may detect right ventricle strain related to hemodynamic change, intravascular thrombosis, thrombosis in right heart or pulmonary arteries, pulmonary infarction, and local pleural effusion...
December 2017: Journal of Translational Internal Medicine
https://www.readbyqxmd.com/read/29338966/family-history-of-venous-thromboembolism-predicts-the-diagnosis-of-acute-pulmonary-embolism-in-the-emergency-department
#2
Christopher Kelly, Chad Agy, Margaret Carlson, Jacob Steenblik, Joseph Bledsoe, Stephen Hartsell, Troy Madsen
BACKGROUND: Pulmonary embolism (PE) clinical decision rules do not consider a patient's family history of venous thromboembolism (VTE). We evaluated whether a family history of VTE predicts acute PE in the emergency department (ED). METHODS: Over a 5.5-year study period, we enrolled a prospective convenience sample of patients presenting to an academic emergency department with chest pain and/or shortness of breath. We defined a family history of VTE as a first-degree relative with previous PE or deep vein thrombosis (DVT)...
January 6, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29337091/a-clinically-meaningful-interpretation-of-the-prospective-investigation-of-pulmonary-embolism-diagnosis-pioped-ii-and-iii-data
#3
Paul Cronin, Ben A Dwamena
RATIONALE AND OBJECTIVES: This study aimed to calculate the multiple-level likelihood ratios (LRs) and posttest probabilities for a positive, indeterminate, or negative test result for multidetector computed tomography pulmonary angiography (MDCTPA) ± computed tomography venography (CTV) and magnetic resonance pulmonary angiography (MRPA) ± magnetic resonance venography (MRV) for each clinical probability level (two-, three-, and four-level) for the nine most commonly used clinical prediction rules (CPRs) (Wells, Geneva, Miniati, and Charlotte)...
January 11, 2018: Academic Radiology
https://www.readbyqxmd.com/read/29334815/impact-of-medication-adherence-on-risk-of-ischemic-stroke-major-bleeding-and-deep-vein-thrombosis-in-atrial-fibrillation-patients-using-novel-oral-anticoagulants
#4
Chinmay G Deshpande, Stephen Kogut, Robert Laforge, Cynthia Willey
OBJECTIVES: Our study examined the impact of adherence to Novel Oral Anticoagulants (dabigatran and rivaroxaban) [NOACs] on ischemic-stroke (IS), major-bleeding (MB), deep-vein-thrombosis and pulmonary-embolism (DVTPE) risk in a large, nationwide, propensity-matched sample. METHODS: A retrospective cohort study utilized data from a US commercial insurance database (2010-2012). Adults patients with ≥1 diagnosis of atrial fibrillation/flutter (ICD-9 427.31/32), >1 prescription of NOACs and CHA2DS2-VASc score ≥1 were included...
January 16, 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29332925/pulmonary-artery-pseudoaneurysm-secondary-to-lung-inf-lammation
#5
Shinichirou Ishimoto, Hiroyuki Sakurai, Ryouta Higure, Riken Kawachi, Mie Shimamura
Pulmonary artery aneurysms (PAA) and pseudoaneurysms (PAP) are caused by infections, vasculitis, trauma, pulmonary hypertension, congenital heart disease, and connective tissue disease. Most cases of such aneurysm occur in the trunk or major branches of the pulmonary artery, while the peripheral type is less common. The treatment modalities are medical therapy, surgery, and percutaneous catheter embolization. The mortality rate associated with rupture is approximately 50%. We encountered a case of a 53-year-old man with a pulmonary artery pseudoaneurysm secondary to pneumonia and cavity formation during chemotherapy for acute myeloid leukemia (AML)...
January 15, 2018: Annals of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29324936/the-impact-of-lung-perfusion-scintigraphy-in-the-emergency-management-of-patients-with-suspected-pulmonary-embolism
#6
Cristina Ferrari, Alessandra Cimino, Giacomo Bianco, Francesca Iuele, Alessandra Di Palo, Margherita Fanelli, Artor Niccoli-Asabella, Giuseppe Rubini
OBJECTIVE: Pulmonary Embolism (PE) is an emergency condition that requires immediate treatment. As the symptoms and the risk factors are nonspecific, PE differential diagnosis is often required. Even if angio-CT is considered the gold standard for PE diagnosis, the frequent allergic condition and/or chronic renal failure of patients make, in most cases, not possible the use of contrast enhancement in emergency with even more increasing use of Lung Perfusion Scintigraphy (LPS), as a simple and fast examination with no preparation/contraindication...
September 2017: Hellenic Journal of Nuclear Medicine
https://www.readbyqxmd.com/read/29318931/lessons-learned-from-a-critical-analysis-of-the-fontan-operation-over-three-decades-in-a-single-institution
#7
Luiz Fernando Caneo, Aida L R Turquetto, Rodolfo A Neirotti, Maria A Binotto, Leonardo A Miana, Carla Tanamati, Juliano G Penha, João B D Silveira, Thais M Alexandre E Silva, Fabio B Jatene, Marcelo B Jatene
BACKGROUND: The Fontan operation (FO) has evolved and many centers have demonstrated improved results relative to those from earlier eras. We report a single-institution experience over three decades, describing the outcomes and evaluating risk factors. METHODS: Successive patients undergoing primary FO were divided into era I (1984-1994), era II (1995-2004), and era III (2005-2014). Clinical and operative notes were reviewed for demographic, anatomic, and procedure details...
May 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/29315054/ambulatory-management-of-pulmonary-embolism
#8
Houssam Abusibah, Muntasir M Abdelaziz, Peter Standen, Praveen Bhatia, Mahir Ma Hamad
The diagnosis of pulmonary embolism can be very difficult and elusive. It depends greatly on the use of diagnostic tests, which are in turn interpreted according to a pre-test clinical probability. These include non-specific tests such as the chest X-ray and electrocardiograph, which help exclude other conditions such as pneumonia or myocardial infarction. On the other hand, more specific tests such as computed tomography or ventilation/perfusion scanning are used to confirm or exclude the diagnosis of pulmonary embolism...
January 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29312721/retrospective-review-of-the-diagnosis-and-treatment-of-pulmonary-sequestration-in-28-patients-surgery-or-endovascular-techniques
#9
Shi-Xin Zhang, Hai-Dong Wang, Kang Yang, Wei Cheng, Wei Wu
Background: Pulmonary sequestration (PS) is a rare congenital pulmonary malformation. In this study, we aimed to retrospect and evaluate the diagnosis, treatment, and outcomes of PS in 28 patients at our institute. Methods: The files of 28 patients with PS who were treated with surgery (21 cases) or endovascular intervention (7 cases) between May 2005 and June 2016 from a single institute were retrospectively reviewed. The following data of all patients were analyzed: age, sex, clinical symptoms, diagnostic methods, operative techniques, and treatment outcomes...
December 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29310357/risk-profile-management-and-outcomes-of-patients-with-venous-thromboembolism-attended-in-spanish-emergency-departments-the-espheria-registry
#10
Sonia Jimenez, Pedro Ruiz-Artacho, Marta Merlo, Coral Suero, Albert Antolin, José Ramón Casal, Marta Sanchez, Alejandra Ortega-Duarte, Mar Genis, Pascual Piñera
The objective of this study was to determine the clinical profile of and diagnostic and therapeutic approach to patients with venous thromboembolism (VTE) in Spanish Emergency Departments (EDs). Risk factors, adherence to clinical practice guidelines, and outcomes were also evaluated.Patients with VTE diagnosed in 53 Spanish EDs were prospectively and consecutively included. Demographic data, comorbidities, risk factors for VTE, index event characteristics, hemorrhagic risk, and mortality were evaluated. Adherence to clinical practice guidelines was assessed based on clinical probability scales, requests for determination of D-dimer, use of anticoagulant treatment before confirmation of diagnosis, and assessment of bleeding and prognostic risk...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29304488/factors-associated-with-elevated-cardiac-troponin-levels-in-patients-with-acute-pulmonary-thromboembolism
#11
Samad Ghaffari, Nariman Sepehrvand, Leili Pourafkari, Reza Hajizadeh, Elnaz Javanshir, Mehdi Nadiri, Nader D Nader
PURPOSE: We aimed to investigate the factors that are associated with increased cardiac troponin I (cTnI) leakage in the acute pulmonary embolism (PTE) setting and their alignment with patient outcome. METHODS: Adult patients with a diagnosis of PTE were enrolled in this prospective cohort study. The primary endpoint of interest was major adverse cardio-pulmonary events (MACPE), defined as the composite of in-hospital all-cause mortality, need for thrombolysis and mechanical ventilation and surgical embolectomy during index hospitalization...
December 29, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29301920/risk-factors-for-recurrent-venous-thromboembolism-after-unprovoked-pulmonary-embolism-the-padis-pe-randomised-trial
#12
Cécile Tromeur, Olivier Sanchez, Emilie Presles, Gilles Pernod, Laurent Bertoletti, Patrick Jego, Elisabeth Duhamel, Karine Provost, Florence Parent, Philippe Robin, Lucile Deloire, Florent Leven, Fanny Mingant, Luc Bressollette, Pierre-Yves Le Roux, Pierre-Yves Salaun, Michel Nonent, Brigitte Pan-Petesch, Benjamin Planquette, Philippe Girard, Karine Lacut, Solen Melac, Patrick Mismetti, Silvy Laporte, Guy Meyer, Dominique Mottier, Christophe Leroyer, Francis Couturaud
We aimed to identify risk factors for recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism.Analyses were based on the double-blind randomised PADIS-PE trial, which included 371 patients with a first unprovoked pulmonary embolism initially treated during 6 months who were randomised to receive an additional 18 months of warfarin or placebo and followed up for 2 years after study treatment discontinuation. All patients had ventilation/perfusion lung scan at inclusion (i.e. at 6 months of anticoagulation)...
January 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/29299826/differentiation-of-antemortem-pulmonary-thromboembolism-and-postmortem-clot-with-unenhanced-mri-a-case-report
#13
Ingo von Both, Silvio Giancarlo Bruni, Jayantha C Herath
We report a case of a 39-year-old woman who died of fulminant pulmonary thromboembolism (PE). Autopsy showed classical findings of fulminant PE with occlusion of the bilateral main stem pulmonary arteries. Ancillary testing revealed inherited thrombophilia (Prothrombin 20,210 G > A and MTHFR 677 C > T mutation). Pre-autopsy postmortem computed tomography was used to test whether virtual imaging studies alone (virtual autopsy) would be sufficient to detect PE. Our studies show that computed tomography (CT) can differentiate antemortem clots from a postmortem clot in certain cases, particularly when combined with magnetic resonance imaging (MRI), which is superior in the assessment of soft tissue...
January 4, 2018: Forensic Science, Medicine, and Pathology
https://www.readbyqxmd.com/read/29299093/systemic-air-embolism-after-percutaneous-lung-biopsy-a-manageable-complication
#14
Lucas Fiore, Nathan Elie Frenk, Guilherme Lopes Pinheiro Martins, Publio Cesar Cavalcante Viana, Marcos Roberto de Menezes
CT-guided percutaneous biopsy is a resourceful and widely used tool to evaluate pulmonary nodules that frequently avoids costly and unnecessary surgeries. Severe complications occur in less than 1% of cases and include gas embolism, which is rarely documented. We report a case of gas embolism after transthoracic biopsies and discuss the pathophysiology and the benefits of early diagnosis and proper management.
June 2017: Journal of Radiology Case Reports
https://www.readbyqxmd.com/read/29296166/multimodal-imaging-for-the-assessment-of-a-cardiac-mass-a-case-of-primary-cardiac-sarcoma
#15
Benjamin Abels, Steffen Pfeiffer, Jana Stix, Johannes Schwab
We present a case of an 85-year-old patient who underwent clinical work-up for chronic heart failure, acute coronary syndrome, and pulmonary embolism, until she was diagnosed with a cardiac mass that was histologically identified as sarcoma. The aim of this educational case report is to raise awareness of cardiac masses and to point out diagnostic hints towards a cardiac tumor on chest X-ray, coronary angiography, echocardiography, and chest CT. Moreover, the vital role of cardiac magnetic resonance for the diagnosis of a cardiac mass is highlighted...
November 2017: Journal of Radiology Case Reports
https://www.readbyqxmd.com/read/29296053/nonfatal-pulmonary-embolism-associated-with-the-use-of-compression-stockings-in-the-lithotomy-position-after-spinal-anesthesia
#16
I-Wen Chen, Cheuk-Kwan Sun, Jen-Yin Chen, Chien-Ming Lin, Kuo-Chuan Hung
A 73-year-old male (height, 156 cm; body weight, 51 kg), without a history of cardiovascular disease or thromboembolic events, was scheduled for transurethral resection of the prostate under spinal anesthesia. Spinal anesthesia was administered with hyperbaric bupivacaine, resulting in an upper anesthetic level of T6. Before surgery, compression stockings were applied to both lower limbs, and the patient was placed in the lithotomy position. Approximately 15 min later, he complained of intolerable chest tightness, followed by tachycardia (heart rate, 110 beats/min) and desaturation (oxygen saturation [SaO2], 90%)...
October 2017: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
https://www.readbyqxmd.com/read/29291427/pulmonary-embolism-care-standards-in-2018
#17
REVIEW
Ariel Borohovitz, Mitchell D Weinberg, Ido Weinberg
Pulmonary embolism (PE) is a leading cause of cardiovascular mortality worldwide. Clinical presentation can be diverse, and clinicians should have a high index of suspicion regarding the diagnosis. Evaluation should include detailed history of possible risk factors, physical examination and laboratory tests that would support the diagnosis and help risk-stratify patients. Finally, a dedicated imaging study should be performed in order to make a definitive diagnosis. Decisions regarding short-term, immediate, treatment are dictated by PE risk category...
December 29, 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/29285876/metabolomic-analysis-of-92-pulmonary-embolism-patients-from-a-nested-case-control-study-identifies-metabolites-associated-with-adverse-clinical-outcomes
#18
O A Zeleznik, E M Poole, S Lindstrom, P Kraft, A Van Hylckama Vlieg, J A Lasky-Su, L B Harrington, K Hagan, J Kim, B A Parry, N Giordano, C Kabrhel
BACKGROUND: Patients with acute pulmonary embolism (PE) exhibit wide variation in clinical presentation and outcomes. Our understanding of the pathophysiologic mechanisms differentiating low-risk and high-risk PE is limited, so current risk-stratification efforts often fail to predict clinical deterioration and are insufficient to guide management. OBJECTIVES: To improve our understanding of the physiology differentiating low-risk from high-risk PE, we conducted the first-ever high-throughput metabolomics analysis (843 named metabolites) comparing PE patients across risk strata within a nested case-control study...
December 29, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29279787/acute-chest-syndrome-in-children-with-sickle-cell-disease
#19
REVIEW
Shilpa Jain, Nitya Bakshi, Lakshmanan Krishnamurti
Acute chest syndrome (ACS) is a frequent cause of acute lung disease in children with sickle cell disease (SCD). Patients may present with ACS or may develop this complication during the course of a hospitalization for acute vaso-occlusive crises (VOC). ACS is associated with prolonged hospitalization, increased risk of respiratory failure, and the potential for developing chronic lung disease. ACS in SCD is defined as the presence of fever and/or new respiratory symptoms accompanied by the presence of a new pulmonary infiltrate on chest X-ray...
December 1, 2017: Pediatric Allergy, Immunology, and Pulmonology
https://www.readbyqxmd.com/read/29279077/platypnea-orthodeoxia-syndrome-after-complicated-cholecystectomy-an-unsuspected-diagnosis
#20
Catarina Queirós, Elsa Francisco, João Almeida
A 65-year-old woman with no significant prior medical history presented, in the postoperative course of a complicated cholecystectomy, several episodes of arterial desaturation. Pulmonary embolism was repeatedly suspected, but there was no evidence of pulmonary thrombus on the chest computed tomography angiographies obtained. As these episodes were mainly induced by postural changes, a platypnea-orthodeoxia syndrome was suspected. A transthoracic echocardiogram was performed and revealed a patent foramen ovale...
November 29, 2017: Acta Médica Portuguesa
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