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Pulmonary embolus

Seth H Richman, Marcelo Bogliolo Piancastelli Siqueira, Kirk A McCullough, Mark J Berkowitz
BACKGROUND: K-wire fixation has been the most common method of fixation for hammertoe deformity. However intramedullary devices are gaining ground in both number of available choices and in procedures performed. This study aimed to compare the outcomes of hammertoe correction performed with K-wire fixation versus a novel intramedullary fusion device (CannuLink). METHODS: A retrospective review of hammertoe correction by a single surgeon was performed from June 2011 to December 2013...
October 18, 2016: Foot & Ankle International
Adam J Singer, Henry C Thode, W Frank Peacock
OBJECTIVE: Introduction of target specific anticoagulants and recent guidelines encourage outpatient management of low risk patients with venous thromboembolism. We describe hospital admission rates over time for patients presenting to US emergency departments (EDs) with deep vein thrombosis (DVT) and pulmonary embolism (PE) and estimate the proportion of low-risk PE patients who could potentially be managed as outpatients. METHODS: We performed a structured analysis of the National Hospital Ambulatory Medical Care Survey (a nationally representative weighted sampling of US ED visits) database for the years 2006-2010 including all adult patients with a primary diagnosis of DVT or PE...
September 2016: Clin Exp Emerg Med
Tao Peng, Liming Dong, Zhihua Zhu, Jing Cui, Qian Li, Xin Li, Heshui Wu, Chunyou Wang, Zhiyong Yang
RATIONALE AND OBJECTIVES: Some deep pelvic abscesses are not accessible through anterior or lateral approaches because of the presence of organs and structures. The objective of this study was to assess the feasibility, safety, tolerability, and efficacy of a percutaneous presacral space approach by reviewing our clinical experience and the literature. MATERIALS AND METHODS: The outcomes of 12 patients, who have undergone computed tomography (CT)-guided percutaneous presacral space drainage, were retrospectively reviewed, including demographic, clinical, and morphological data in the medical records...
October 12, 2016: Academic Radiology
Firas Yassin, Chris Sawh, Pankaj Garg
There is increasing role of computed tomographic (CT) in the assessment of acute chest pain in the emergency department especially when the diagnosis is not clear. We report a case where non ECG gated contrast enhanced CT in the emergency department for rule-out of pulmonary embolus guided to the actual diagnosis, which was, acute coronary event, as evidenced by the presence of perfusion defect.
2016: Open Cardiovascular Medicine Journal
Tony S Brar, Neeka Akhavan
This is a 78 year old male with a past medical history of coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), hypertension (HTN), and gastroesophageal reflux disorder (GERD) who presented to the emergency room with worsening shortness of breath (SOB) and low-grade fevers for one week prior to admission. He was originally diagnosed with healthcare associated pneumonia (HCAP) and an acute on chronic COPD exacerbation and treated with prednisone, inhalers, ipratropium/albuterol, and broad-spectrum antibiotics...
2016: Respiratory Medicine Case Reports
Kota Talla, Adam A Dmytriw, Elsie Nguyen
No abstract text is available yet for this article.
October 6, 2016: International Journal of Cardiovascular Imaging
Christopher S Graffeo, Ross C Puffer, Eelco F M Wijdicks, William E Krauss
BACKGROUND: Ischemic stroke following anterior cervical diskectomy and fusion (ACDF) is an exceedingly rare complication. There are only three previous cases focusing on this problem in the literature; here, we present the fourth case. CASE DESCRIPTION: A patient, cared for at an outside institution, developed a delayed ischemic stroke 3 days following an ACDF. This complication was attributed to carotid manipulation precipitating vascular injury in the setting of multiple comorbid vascular and coagulopathic risk factors, including previously undiagnosed carotid atherosclerosis, a prior history of pulmonary embolus requiring Warfarin anticoagulation (held perioperatively), acute dehydration, and atrial fibrillation...
2016: Surgical Neurology International
Erika B Rosenzweig, Mauer Biscotti, Kirsten Cleary, Richard Smiley, Matthew D Bacchetta
It is well described that patients with group 1 forms of pulmonary arterial hypertension have a high risk of mortality during pregnancy and in the early postpartum period. However, to the authors' knowledge, the diagnosis and management of group 4 pulmonary hypertension due to chronic thromboembolic pulmonary hypertension (CTEPH) during pregnancy with early postpartum pulmonary endarterectomy (PEA) has not been previously reported. We report the case of a 28-year-old woman who received a diagnosis of CTEPH during her pregnancy, was managed as an inpatient by a multidisciplinary team throughout the pregnancy and early postpartum period, and underwent PEA 6 weeks after delivery...
September 2016: Pulmonary Circulation
Chukwudi O Chiaghana, Justin M Bremer, Joshua W Sappenfield, Adam L Wendling
OBJECTIVE: Neuraxial hematoma is a rare complication of spinal or epidural anesthesia. However, variable coagulation factor defects are relatively common in patients with Fontan circulation, and may predispose such patients to either increased risk of thrombosis or coagulopathy. These defects may indirectly increase their risk of neuraxial hematoma. CASE REPORT: We report a case of delayed neuraxial hematoma after the start of full-dose anticoagulation for pulmonary embolus on a postpartum patient with Fontan physiology who had continuous spinal anesthesia for cesarean delivery 4 days earlier...
September 22, 2016: Regional Anesthesia and Pain Medicine
David H MacIver, Ismail Adeniran, Iain R MacIver, Alistair Revell, Henggui Zhang
Pulmonary hypertension is usually related to obstruction of pulmonary blood flow at the level of the pulmonary arteries (eg, pulmonary embolus), pulmonary arterioles (idiopathic pulmonary hypertension), pulmonary veins (pulmonary venoocclusive disease) or mitral valve (mitral stenosis and regurgitation). Pulmonary hypertension is also observed in heart failure due to left ventricle myocardial diseases regardless of the ejection fraction. Pulmonary hypertension is often regarded as a passive response to the obstruction to pulmonary flow...
October 2016: American Heart Journal
Hasan Rehman, Elizabeth John, Payal Parikh
Pulmonary embolism (PE) is a frequent diagnosis made in the emergency department and can present in many different ways. Abdominal pain is an unusual presenting symptom for PE. It is essential to maintain a high degree of suspicion in these patients, as a delay in diagnosis can be devastating for the patient and confers a high risk of mortality if left untreated. Here, we report the case of a 53-year-old male who presented to the emergency department with worsening right upper quadrant abdominal pain with fevers...
2016: Case Reports in Emergency Medicine
Alexander C Egbe, Heidi M Connolly, Christopher J McLeod, Naser M Ammash, Talha Niaz, Vidhushei Yogeswaran, Joseph T Poterucha, Muhammad Y Qureshi, David J Driscoll
BACKGROUND: There are limited data about the risk of thrombotic and embolic complication (TEC) in adults with atrial arrhythmia after Fontan operation. OBJECTIVES: This study sought to determine the risk of TEC in this population and the role of anticoagulation therapy in TEC prevention. METHODS: This was a retrospective review of adults with atrial arrhythmia after Fontan operation who were evaluated at the Mayo Clinic between 1994 to 2014...
September 20, 2016: Journal of the American College of Cardiology
Christian Lilje, Aman Chauhan, Jason P Turner, Thomas H Carson, Maria C Velez, Christopher Arcement, Joseph Caspi
A rare case of massive pulmonary embolism is presented in an oligosymptomatic teenager with predisposing factors. Computed tomography pulmonary angiography supported by three-dimensional reconstruction was diagnostic. The embolus qualified as massive by conventional anatomical guidelines, but as low risk by more recent functional criteria. Functional assessment has complemented morphologic assessment for risk stratification in adult patients. Such evidence is scarce in pediatrics. The patient underwent surgical embolectomy, followed by prophylactic anticoagulation, without further events...
September 12, 2016: World Journal for Pediatric & Congenital Heart Surgery
Yoel Siegel, Russ Kuker, Gary Danton, Javier Gonzalez
BACKGROUND: Patients with lung cancer present to the emergency department (ED) in a variety of ways. Symptoms are often nonspecific and can lead to a delay in diagnosis. Here, a lung cancer mimicked two illnesses, adding to the diagnostic complexity. This case highlights diagnostic pitfalls as well as advantages and limitations of imaging utilized in the emergency setting. CASE REPORT: We report a case of an occult lung cancer occluding a pulmonary vein, which at first mimicked pneumonia and later a pulmonary embolism (PE) and arterial lung infarction...
August 2016: Journal of Emergency Medicine
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
Matthew Goodwin, Kaori Ito, Arielle H Gupta, Emanuel P Rivers
PURPOSE OF REVIEW: Protocolized care for early shock resuscitation (PCESR) has been intensely examined over the last decade. The purpose is to review the pathophysiologic basis, historical origin, clinical applications, components and outcome implications of PCESR. RECENT FINDINGS: PCESR is a multifaceted systems-based approach that includes early detection of high-risk patients and interventions to rapidly reverse hemodynamic perturbations that result in global or regional tissue hypoxia...
October 2016: Current Opinion in Critical Care
Jason R Dutton, Nicholas A Kusenzov, Joseph T Lanzi, E'Stephan J Garcia, Mark P Pallis
PURPOSE: To examine the outcomes of arthroscopic treatment of the hip in a young, active military population. Specifically, the ability to return to duty was the prime indicator of success. In addition, an objective evaluation of various demographic and surgery-related variables was performed to identify predictors for success or failure of treatment in this military population. METHODS: A retrospective chart review was undertaken to ascertain the results of hip arthroscopy at a single academic military medical center...
August 23, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Neal S Gerstein, Ran Zhang, Michael S Davis, Harish Ram
Renal cell carcinoma (RCC) is the most common primary renal neoplasm and is associated with the intraluminal growth into the venous system with possible extension into the inferior vena cava or even right heart. Intraoperative pulmonary embolism is a complication of resection of RCC, which may be mitigated by the use of the cardiopulmonary bypass with or without deep hypothermic circulatory arrest. We present a case of unexpected pulmonary embolism diagnosed during RCC surgery. The case highlights the central importance of intraoperative transesophageal echocardiography use and the need for proper preoperative planning for the use of cardiopulmonary bypass...
October 15, 2016: A & A Case Reports
Shawn Karls, Hani Hassoun, Vilma Derbekyan
A 67-year-old male presented with dyspnea for which lung scintigraphy was ordered to rule out pulmonary embolus. Planar images demonstrated abnormal midline uptake of Tc-99m macroaggregated albumin, which SPECT/CT localized to several thoracic vertebrae. Thoracic vertebral uptake on perfusion lung scintigraphy was previously described on planar imaging. Radionuclide venography and contrast-enhanced CT subsequently demonstrated superior vena cava (SVC) obstruction with collateralization through the azygous/hemiazygous system and vertebral venous plexus...
September 2016: Nuclear Medicine and Molecular Imaging
Charles J Glueck, Kevin Lee, Marloe Prince, Vybhav Jetty, Parth Shah, Ping Wang
BACKGROUND: When exogenous testosterone or treatments to elevate testosterone (human chorionic gonadotropin [HCG] or Clomid) are prescribed for men who have antecedent thrombophilia, deep venous thrombosis and pulmonary embolism often occur and may recur despite adequate anticoagulation if testosterone therapy is continued. CASE PRESENTATION: A 55-year-old white male was referred to us because of 4 thrombotic events, 3 despite adequate anticoagulation over a 5-year period...
July 2016: Journal of Investigative Medicine High Impact Case Reports
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