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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Radiographic manifestations of aspiration of gastric contents were reviewed in 60 patients. The findings were extremely variable, and there was no typical or characteristic appearance. Confluent and acinar infiltrates, as well as infiltrates composed of small irregular shadows, occurred singly or in a variety of combinations; the third pattern predominated in the majority of cases. Distribution was most commonly bilateral and multicentric and usually favored perihilar or basal regions, but localized or atypical densities were also observed. Patients with the most extensive radiographic abnormalities on initial studies tended to have the worst prognosis; however, mild early pulmonary infiltrates occasionally progressed to life-threatening abnormalities, and extensive initial involvement was frequently followed by a benign clinical and radiographic course. Radiographic changes often worsened for several days in uncomplicated cases, but improvement was generally manifested within the first week after aspiration. Worsening of infiltrates after initial improvement was associated with the development of bacterial pneumonia, the adult respiratory distress syndrome, and pulmonary embolism. In the appropriate clinical setting, aspiration of gastric contents should be an important diagnostic consideration in the presence of a wide variety of radiographic changes.
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PMID:Pulmonary manifestations of acute aspiration of gastric contents. 10 45

Postmortem chest roentgenograms in approximately 3,500 cases of a random autopsy population were reviewed. Pneumothorax was found in 77 cases (2.2%). Simple pneumothorax was present in 38 cases, and tension pneumothorax or combined simple and tension pneumothorax was present in 39 cases. Only 40 of the 77 patients had been clinically diagnosed as having pneumothorax. Pulmonary conditions most often present in cadavers with pneumothorax were bacterial pneumonia, pulmonary emphysema, and pulmonary embolism, with or without infarcts and infarct abscesses. Procedures most frequently associated with pneumothorax were mechanical ventilation and attempts at cardiorespiratory resuscitation. Rib fractures (iatrogenic and noniatrogenic) were found in 23 of the 77 cases.
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PMID:Pneumothorax in a large autopsy population. A study of 77 cases. 69 69

Medical complications may account for 30% or more of the deaths resulting from acute ischemic stroke in the elderly. In descending order of frequency, the most deadly complications are bacterial pneumonia, pulmonary embolism, myocardial infarction, and sepsis without pneumonia (often in the setting of a urinary tract infection or a necrotic decubitus). Normal aging is associated with declining pulmonary and cardiovascular functions as well as declining immunocompetence and physical barriers to infection. The neurological effects of acute ischemic brain injury compound these susceptibilities. Accordingly, a high degree of vigilance is emphasized in the diagnostic and therapeutic guidelines provided for care of the lungs, the heart, the urinary tract, and the skin. Guidelines are also provided for management of blood pressure during the first hours and days following stroke onset. Treatment should be withheld unless specific medical indications are identified. When antihypertensive agents are administered, the appropriate dose may be lower than usually recommended (e.g. labetalol) in order to minimize abrupt drops in blood pressure that may result in further injury to potentially viable ischemic brain tissue.
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PMID:Prevention and management of medical complications of the hospitalized elderly stroke patient. 186 5

Ventilation perfusion scanning fails to diagnose pulmonary embolism in matched defects. In 61 patients (19 with pulmonary embolism proved by angiography, 32 with chronic obstructive lung disease and 10 with acute bacterial pneumonia) we computed the ventilation perfusion ratio (V/Q) in these matched defects, using Krypton 81 m. This analysis demonstrated that the diagnosis of pulmonary embolism could be made with a specificity of 100% when the V/Q ratio was greater than 1.2 in the matched defects. Pulmonary embolism was characterized by a perfusion defect with a high V/Q ratio, even in Laennec infarction. In contrast, the analysis excluded the diagnosis of pulmonary embolism and suggested another disease when the V/Q was less than 0.95 with a specificity of 95%. Perfusion defects in acute pneumonia always had a V/Q less than 1. The diagnosis remained difficult in chronic obstructive lung disease when pulmonary embolism was suspected on subsegmental defects. Nevertheless this could be solved in about 50% of the cases by quantitative analysis. We feel, therefore, that ventilation perfusion scanning should be quantified by V/Q analysis to improve the diagnosis of pulmonary embolism.
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PMID:[Calculation of the ventilation-perfusion ratio in the scintigraphic diagnosis of pulmonary embolism]. 295 94

Between 1912 and 1980, many English language publications analyzed the correlation between clinicians' diagnoses and postmortem examinations. Surprisingly, the percentage of cases with undiagnosed principal underlying diseases or primary causes of death has not diminished during this period. The autopsy's unvarying percentage yield does not indicate a lack of progress, however, since bacterial pneumonia, hepatic cirrhosis, and common tumors were missed routinely in earlier eras but were rarely missed after 1970. Pulmonary embolism remains commonly missed, but the striking recent finding is the emergence of fungal and other systemic infections that were rarely noted in prior eras. Progress in diagnosis and treatment may allow patients to live longer and new or obscure diseases may develop that will often be missed clinically. An appropriately high autopsy rate will be required if medical progress is to continue.
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PMID:Diagnostic advances v the value of the autopsy. 1912-1980. 637 22

The concentration of fibrinogen/fibrin degradation products (FDP/fdp) was measured using a direct latex agglutination tests in 40 critically ill patients with pulmonary arteriography and possible acute pulmonary embolism. All of them were admitted with signs of severe heart and/or respiratory insufficiency, and 12 (30%) of the patients required mechanical ventilation. The concentration of FDP/fdp was significantly higher in 28 of 29 patients with positive arteriography (mean 145 microgram/ml), that in those whose arteriography was negative (in every cases the FDP/fdp level was lower than 10 microgram/ml). To help differentiate pulmonary embolism from other acute heart or pulmonary diseases, the authors measured the FDP/fdp in 10 patients with bacterial pneumonia, 24 patients with acute myocardial infarction, 4 patients with extrinsic asthma, and 18 normal control subjects. The authors found high levels of FDP/fdp (more than 10 microgram/ml) in only 2 patients with pneumonia and in 6 with myocardial infarction. In no case was the level of FDP/fdp higher than 40 microgram/ml. On the other hand, in patients with pulmonary embolism, 23 (79%) had levels higher than 40 microgram/ml. The study indicates that this test is a helpful screening method for pulmonary embolism, especially in situations where other emergency diagnosis tests are inconclusive or impractical; it also provides justification for beginning anticoagulant therapy and for recommending pulmonary arteriography.
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PMID:Fibrinogen/fibrin degradation products in the diagnosis of pulmonary embolism in critically ill patients. 742 89

In order to examine the feasibility and safety of undertaking a larger prospective study to compare the diagnostic yield from concurrent open lung biopsy (OLB) and bronchoalveolar lavage (BAL) in febrile neutropenic patients with pulmonary infiltrates and the impact of such knowledge on clinical outcome, a pilot exploratory study was performed. 13 immunocompromised patients (mainly with haematological malignancy or bone marrow transplantation recipients) were investigated. At least one diagnostic finding in 12 of 13 patients was provided by OLB compared to 4 of 13 patients by BAL. BAL provided 7 specific diagnoses (pneumocystis 1, fungal infection 3, bacterial pneumonia 1, pulmonary haemorrhage 2) whilst OLB provided 12 specific diagnosis (CMV 2, pneumocystis 3, fungal infection 1, bacterial pneumonia 1, pulmonary haemorrhage 4, pulmonary embolism 1). Five patients with nonspecific interstitial/alveolar inflammation were diagnosed only by OLB. The concordance that the exact same specific diagnoses present in the OLB were found in the BAL was zero. There were 2 minor complications (1 wound infection by OLB, 1 moderate haemorrhage by BAL). Mortality at 28 days was 8 of 13 patients which in no case was related to either procedure. We suggest that OLB is a safe procedure in such patients, provides superior and more complete diagnostic information compared to BAL and a larger controlled study to investigate the impact of early OLB on the outcome of these patients appears to be justified.
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PMID:Open lung biopsy provides a higher and more specific diagnostic yield compared to broncho-alveolar lavage in immunocompromised patients. Fungal Study Group. 766 81

A case is reported of a 9-year-old girl admitted with a subarachnoid haemorrhage. Her neurological recovery was favourable after the embolization of a cerebral arterio-venous malformation. She stayed in ICU with mechanical ventilation because of a bacterial pneumonia and a post-extubation laryngeal oedema. She required insertion of a polyurethane subclavian catheter, as a peripheral venous access was not available. Five days later, the child suffered a sudden respiratory distress without changes of the electrocardiogram and the chest X-ray. The diagnosis of pulmonary embolism was suspected because of the presence of the central venous catheter, a catheter dysfunction and a superior vena cava syndrome. A catheter tip thrombus was shown by angiography as well as a thrombus in the pulmonary artery, a 90% obstruction of the proximal valvular tree of the right lung, a 10 to 15% distal obstruction in the left lung, a complete obstruction of the superior vena cava (SCV). The thrombolytic therapy was contra-indicated in this case because of the neurological pathology. Heparin was given by continuous intravenous infusion. When heparin concentration was at an appropriate level, the catheter was removed. Its microbiological culture remained negative. The next day, another angiography showed a partial permeability of the SVC and a better right pulmonary perfusion. During this procedure, the haemodynamic assessment showed only moderate abnormalities. Therefore the surgical treatment was not indicated and the heparin continued. The child recovered gradually with a normalization of the lung scintigraphy.
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PMID:[Massive pulmonary embolism caused by thrombosis formed on a central catheter in a child]. 831 58

Fat embolism is a known complication of traumatology, especially in long bone fractures. It may also occur in liposuction and articular surgery (0.1%). Fat embolic events are most often clinically insignificant and difficult to recognize since clinical manifestations are varied and there is no routine laboratory or radiographic diagnosis. Classically, fat embolism syndrome presents with the triad of pulmonary distress, mental status changes, and cutaneous manifestations. We report the case of a 33-year-old woman who developed acute respiratory distress 10 days after hip arthroplasty. Several aetiologies such as fibrinocruoric pulmonary embolism, pulmonary aspiration and bacterial pneumonia were discussed. Fat embolism was diagnosed, based on suggestive clinical manifestations, radiographic and laboratory findings, although fat embolism after hip arthroplasty without intramedullary pressurization is infrequent.
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PMID:[Fat embolism after total hip prosthesis replacement preserving the femoral stem]. 1461 71

A retrospective cohort study and chart review were performed to estimate the absolute and relative prevalence of the serious diagnoses that might cause a patient to present to the Emergency Department (ED) with a chief complaint of chest pain. In this study, we queried a database of 347,229 complete visits to the San Francisco General Hospital Emergency Department between July 1, 1993 and June 30, 1998 for visits by patients > 35 years old with a chief complaint of chest pain and no history of trauma. Visits for chest pain that resulted in hospitalization were assigned to one of nine diagnostic groups according to final diagnoses as coded in the database. Manual chart review by trained abstractors using explicit criteria was done when group assignment based on coded diagnoses was unclear and in all diagnoses of pulmonary embolism and aortic dissection. Of 8,711 visits (2.5% of all visits) with a chief complaint of non-traumatic chest pain, 3,271 (37.6%) resulted in hospitalization. Of the 3,078 (94.1% of those hospitalized) assigned a final diagnosis, 329 (10.7% of hospitalizations, 3.8% of all visits) had acute myocardial infarction, 693 (22.5%) had either unstable angina or stable coronary artery disease, and 345 (11.2%) had pulmonary causes (mainly bacterial pneumonia) deemed serious enough to require hospitalization. Pulmonary embolism and aortic dissection were diagnosed in only 12 (0.4%) and 8 (0.3%) patients, respectively. In 905 (29.4%) hospitalizations for chest pain, myocardial infarction was "ruled out" and no cardiac ischemia or other serious etiology for the chest pain was diagnosed. Among patients presenting with chest pain, those in older age groups had dramatically increased risk of acute myocardial infarction. Women presenting with chest pain had a lower risk of acute myocardial infarction than men. In conclusion, the prevalence of acute myocardial infarction in the undifferentiated ED patient with a chief complaint of chest pain is only about 4%. An equal number of patients will have a serious pulmonary cause as the etiology of their pain. Pulmonary embolism and aortic dissection are important but extremely rare causes of a chest pain presentation to the ED.
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PMID:Prevalence of acute myocardial infarction and other serious diagnoses in patients presenting to an urban emergency department with chest pain. 1624 93


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