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

A 25-year-old woman with severe parenchymal lung disease of unknown etiology and existing for more than a decade was referred for ventilation-perfusion scintigraphy because of suspicion of pulmonary embolism. Both ventilation and perfusion images showed, apart from perfusion defects from her severe lung disease, a left apical pneumothorax and signs of recurrent pneumonia of the left lower lobe. Noteworthy was the periumbilical uptake of the Tc-99m macroaggregated albumin (MAA). Her medical history revealed iatrogenic superior vena cava (SVC) obstruction. In this case, the main collateral pathway of portosystemic shunting is probably, after recanalization of the left umbilical vein, a network of smaller paraumbilical veins.
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PMID:Periumbilical uptake of Tc-99m MAA on lung perfusion scanning in a patient with superior vena cava obstruction. 1655 19

The clinical characteristics and 3-month clinical outcome of 7,664 patients with acute deep vein thrombosis(DVT), 3,968 patients with pulmonary embolism(PE), and 2,287 with signs of both DVT and PE were compared. As compared to patients with DVT signs, PE patients were more commonly females, older and had less often cancer, prior VTE or recent surgery. By contrast, they had more often chronic lung disease,chronic heart failure or renal insufficiency. Patients with both DVT and PE signs were also more commonly females and older than those with only DVT signs, but they had more often a prior episode VTE, cancer, chronic lung disease, chronic heart failure or renal insufficiency. As for the 3-month clinical outcome,patients with PE signs had a significantly higher incidence of major bleeding, recurrent PE, fatal PE and overall death than those with only DVT signs,but a lower incidence of recurrent DVT. Besides, patients with DVT and PE signs had an even worse clinical outcome.
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PMID:Deep vein thrombosis and pulmonary embolism: the same disease? 1685 58

Patients with heart failure (HF) are particularly vulnerable to the development of venous thromboembolism (VTE) and its related complications of pulmonary embolism and right ventricular failure. To improve our understanding of the clinical characteristics, prophylaxis, and initial management of patients with HF and deep vein thrombosis (DVT), we compared 685 patients with a history of HF with 3,890 patients without HF in a prospective registry of 5,451 consecutive patients with ultrasound-confirmed DVT. We excluded 876 patients for whom data regarding HF status were incomplete. Patients with HF had an increased frequency of co-morbid conditions such as neurologic disease including stroke (33% vs 26%, p = 0.0002), acute lung disease including pneumonia (31% vs 15%, p <0.0001), and acute coronary syndrome (11% vs 4%, p <0.0001) contributing to a higher medical acuity than in patients without HF. Furthermore, patients with HF were more likely to have VTE risk factors of immobilization (53% vs 42%, p <0.0001), acute infection (33% vs 27%, p = 0.01), and chronic obstructive pulmonary disease (29% vs 12%, p <0.0001). Patients with and without HF and DVT had a high frequency of recent hospitalization (48% vs 47%, p = 0.96). Fewer than 12 of patients with HF (46%) who subsequently developed DVT received any VTE prophylaxis. In conclusion, the combination of higher medical acuity, increased frequency of VTE risk factors, and low rate of VTE prophylaxis presents a "triple threat" to patients with HF.
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PMID:Heart failure in patients with deep vein thrombosis. 1835 31

Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is a clinical entity defined by rapid deterioration of IPF during the course of the disease that is not due to infections, pulmonary embolism, or heart failure. The condition needs to be differentiated from acute interstitial pneumonia (or Hamman-Rich syndrome), which occurs in patients with no underlying lung disease. The exact etiology and pathogenesis remain unknown, but the condition is characterized by diffuse alveolar damage (on a background of IPF) that probably occurs as a result of a massive lung injury due to some unknown etiologic agent. High-resolution computed tomography can help in prognostication and management of this condition. Once infections and other causes of worsening have been excluded, treatment involves enhanced immunosuppression with pulse doses of methylprednisolone and cytotoxic agents. Our systematic review shows that the outcome, however, is poor, with 1-month and 3-month mortality around 60% and 67%, respectively. Few studies have shown beneficial effects of cyclosporine, pirfenidone, and anticoagulants in the management and prevention of AE-IPF. The etiology, risk factors, pathogenesis, therapy, prognosis, and predictors need to be studied and the potential role of newer agents in the management and prevention of AE-IPF needs to be further clarified.
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PMID:Acute exacerbation of idiopathic pulmonary fibrosis: a systematic review. 1847 69

In the setting of suspected or confirmed nonmassive pulmonary embolism (PE), transthoracic echocardiography (TTE) is an important tool to identify patients who could benefit from thrombolytic therapy, because of right ventricle (RV) dysfunction, and to monitor the dynamic response of the RV to reperfusion therapy. Unfortunately, certain patient characteristics such as obesity, lung disease, postsurgical state, or respiratory distress often lead to inadequate ultrasonographic imaging quality. In such patients, multidetector-row spiral computed tomography (MSCT) may become even more important. We present a female obese patient with acute nonmassive PE in whom TTE did not allow a reliable evaluation of the RV. Conversely, MSCT, beyond a direct demonstration of intravascular thrombi, detected multiple signs suggesting RV dysfunction. According to these findings, thrombolysis was safely performed, obtaining a rapid clinical improvement and a regression of RV dysfunction.
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PMID:Thrombolysis in acute nonmassive pulmonary embolism: potential role of multidetector-row spiral computed tomography in decision making. 1860 83

A 76-year-old ex-manager of a shipping company with preexisting pneumopathy suffered from massive pulmonary embolism after an operation in Germany and had to be mechanically ventilated. His wife requested a transportation by helicopter to the intensive care unit of a smaller hospital in the Engadin, Grisons, Switzerland, where he was later tracheotomized. Weeks later, the wife insisted on a transfer to another, even smaller hospital in the area. During that stay an emergency pericardiocentesis had to be performed. Thereafter, he was transferred to the intensive care unit of our hospital. The last journey was again by request of his wife against medical advices a flight back to his home in Germany, what he survived only for a few hours and was followed by the suicide of his wife. Why could nobody prevent or stop this insane odyssey?
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PMID:[An unconscious odyssey]. 1904 28

The burden of venous thromboembolism (VTE) remains high in the United States (US). This study assesses the rate of VTE prophylaxis in a large real-world population of medically ill patients and identifies factors which confer VTE risk to this population. Discharges from the PharMetrics database were included if they were aged > or =40 years and had a hospitalisation claim (Jan 2001-Dec 2005) for cancer, congestive heart failure (CHF), severe infectious disease (SID), or lung disease. Discharges with incomplete records in the prior year to the index hospitalisation claim date were excluded. VTE rate, type (deep venous thrombosis [DVT] or pulmonary embolism [PE]), and time to VTE were compared between groups. Multivariate logistic regression analysis was used to identify independent predictors of VTE occurrence. A total of 158,325 patients were included in the study. Cancer patients had the highest incidence of VTE (7.6%), with the average for all patients being 5.6% (1.5% PE). VTE occurred most frequently post discharge, with the median time being 74 days. Post-discharge prophylaxis was provided to 13.1% of CHF patients and < 5% of all other patients. Independent predictors of VTE included a pre-index VTE (odds ratio [OR] 9.06, 95% confidence interval [CI] 8.28-9.91) and a primary diagnosis of cancer compared with a diagnosis of SID (OR 1.34, 95% CI 1.24-1.46). In conclusion, commercially insured medical patients in the US are at high risk of VTE following hospital discharge. One-quarter of medical patients who developed a VTE are at high risk of developing the more severe form of the disease, namely PE, with independent predictors of VTE in the post-discharge period including previous VTE and cancer.
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PMID:Rates of venous thromboembolism occurrence in medical patients among the insured population. 1988 34

Platypnea-orthodeoxia syndrome is a rare and poorly understood condition related to the development of a right-to-left intracardiac shunt at the atrial level through a benign and silent patent foramen ovale. It is usually recognized after major lung resection, recurrent pulmonary embolism or chronic lung disease. Orthostatic dyspnea and cyanosis is the prominent clinical presentation. Symptoms increase in the upright position and are relieved by recumbency. Our report describes the clinical course of a patient with severe hypoxemia after left pneumonectomy attributable to a right-to-left shunting through an atrial septal defect.
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PMID:What the cardiologist should know about the management of platypnea-orthodeoxia syndrome. 2010 81

With ongoing technical improvements such as multichannel MRI, systems with powerful gradients as well as the development of innovative pulse sequence techniques implementing parallel imaging, MRI has now entered the stage of a radiation-free alternative to computed tomography (CT) for chest imaging in clinical practice. Whereas in the past MRI of the lung was focused on morphological aspects, current MRI techniques also enable functional imaging of the lung allowing for a comprehensive assessment of lung disease in a single MRI exam. Perfusion imaging can be used for the visualization of regional pulmonary perfusion in patients with different lung diseases such as lung cancer, chronic obstructive lung disease, pulmonary embolism or for the prediction of postoperative lung function in lung cancer patients. Over the past years diffusion-weighted MR imaging (DW-MRI) of the thorax has become feasible with a significant reduction of the acquisition time, thus minimizing artifacts from respiratory and cardiac motion. In chest imaging, DW-MRI has been mainly suggested for the characterization of lung cancer, lymph nodes and pulmonary metastases. In this review article recent MR perfusion and diffusion techniques of the lung and mediastinum as well as their clinical applications are reviewed.
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PMID:Diffusion and perfusion MRI of the lung and mediastinum. 2062 35

The aim of this retrospective study was to investigate the use of thoracic Computed Tomography (CT) in the Emergency Department of a Dublin Academic Teaching Hospital over a six month period. Data was retrieved using the hospital's computerised information system. There were 202 referrals in total for thoracic CT from the Emergency Department during this time period. The most common indication for thoracic CT referral was for the investigation of pulmonary embolism with 127 (63%) referrals. There were 40 (25%) referrals for suspected malignancy and lung disease, whilst 8 (4%) of the referrals were for investigation of thoracic aortic dissection, 8 (4%) for infection, and 6 (3%) were for investigation of thoracic injury. Only 8 (4%) of all referrals were for investigation of injury as a result of chest trauma.
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PMID:Thoracic CT in the ED: a study of thoracic computed tomography utilisation. 2066 52


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