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

Subacute massive thromboembolic occlusion of the left main pulmonary artery in a 52-year-old woman is described. This disease remains a rare entity with a much less dramatic presentation than acute massive pulmonary embolus. The presenting symptom was unexplained dyspnea. Physical signs and laboratory tests were nonspecific. The perfusion scan is the best screening test for this disorder. Antemortem diagnosis is established by pulmonary angiography. A literature review undertaken to ascertain the incidence of this entity as well as to recommend treatment of choice, be it medical or surgical therapy, was unrewarding. We decided to use thrombolytic therapy and found a marked improvement in the patient's symptoms and perfusion scan after 24 hours. Although thrombolytic therapy is commonly indicated for acute massive pulmonary embolism, we believe this mode of therapy should also be the initial treatment for subacute massive pulmonary thromboembolism.
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PMID:Subacute massive thromboembolic occlusion of a main pulmonary artery. Report of a case successfully treated by thrombolytic therapy and review of the literature. 402 19

The study analyses 58 consecutive (1971-1981) cases with haemodynamically significant pulmonary embolism (PE) treated in a coronary unit. The diagnosis was confirmed either by pulmonary angiography or a combination of scintigraphy with haemodynamic examination, or by autopsy. In 75.8% of cases there were present predisposing factors. A combination of sudden dyspnoea with venous thrombosis or with recurrent thrombophlebitis in the anamnesis was present in 59.3% acute cor pulmonale in 1/3 of the patients. The chest X-ray showed in 83.9% of the patients one of the following signs: pulmonary infarction, oligaemia, elevation of the diaphragm, enlargement of the hili, amputation of the hili, pleural effusion. In 62.7% of the patients, PE could be diagnosed on the basis of the ECG. Most patients had elevated pulmonary artery pressure, with a worse prognosis in patients exhibiting a pressure higher than 40 mmHg. For suspecting the presence of haemodynamically significant PE, it is in most patients sufficient to rely on the anamnesis and the results of physical, ECG and X-ray examination. The diagnosis should be confirmed by scintigraphy or angiography and haemodynamic examination.
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PMID:Clinical diagnosis of haemodynamically significant pulmonary embolism in a coronary care unit. 407 98

This paper discusses causes, hemodynamics, symptoms, and signs of pulmonary embolism. Severe cases obstruct at least 60 percent of the pulmonary vascular bed. Small or moderate cases may be easily overlooked. Symptoms may be only slight chest pain or dyspnoea, fever, giddiness, or irregular heart beat. In the author's experience with 35 cases of acute massive pulmonary embolism at the Bromptom Hospital oral contraceptives were considered a predisposing factor in 5 cases (14 percent), pregnancy was a possible cause in 2 (6 percent), a recent operation in 24 (68 percent). No other recognized factor was thought to have predisposed more than a single case. Clinical features included cyanosis, collapse, sever chest pain, dyspnoea, sweating, rapid heart rate, falling blood pressure, and occasional coughing up of blood. Electrocardiograms sometimes gave helpful information. Chest x-ray was usually not helpful except to exclude other causes. Heart catheterization and pulmonary arteriography have been done to assess the extent of the embolism. Emergency surgical pulmonary embolectomy is recommended for extreme cases. Fibrinolytic agents such as streptokinase may be adequate for less severe cases who have not had a recent operation of do not suffer from a hemorrhagic disorder.
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PMID:Pulmonary embolism. 535 32

A patient with dyspnea, skin rash, hypoxemia and mononucleosis was shown to have acute cytomegalovirus infection. The chest X-ray was normal, but the lung scan showed perfusion defects. Although pulmonary embolism cannot be ruled out, it seems likely that the CMV infection was responsible for the abnormalities observed.
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PMID:Cytomegalovirus infection with perfusion defects on the lung scan. 609 77

A 75-year-old man complaining of dyspnea and having sings of postcapillary pulmonary hypertension was diagnosed as pulmonary veno-occlusive disease and confirmed at autopsy. This is the oldest case ever reported. Almost all the small veins 2 mm or less in external diameter were partially or nearly completely occluded by intimal fibrous tissue, and the obstructive changes in the pulmonary arteries were much more limited. Pulmonary veno-occlusive disease is a rare, almost inevitably fatal disease of unknown etiology which has only recently been separated clearly from primary pulmonary hypertension as a distinct entity. Chest roentgenogram finding suggesting postcapillary pulmonary hypertension is a clue to a diagnosis and differentiates this from two other causes of clinical primary pulmonary hypertension, that is, recurrent pulmonary embolism and plexogenic pulmonary arteriopathy.
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PMID:Pulmonary veno-occlusive disease in an elderly man: case report and review of the literature. 623 4

In a series of 250 consecutive open-heart operations, three cases of late cardiac tamponade were noted following the operation. This led the authors to review the literature pertaining to this complication. Ninety-nine cases were collected. The frequency of late tamponade associated with cardiac surgery was 0.62% and was fatal in 16.2% of those cases. The delay before the tamponade appeared varied from 3 days to 3 months (mean 14.5 +/- 7.8 days). The initial clinical picture is insidious and vague, and this constitutes the danger of late cardiac tamponade. The clinical signs are of the respiratory (dyspnea, chest pain), gastrointestinal (anorexia, vomiting) and central nervous (mental confusion, even coma) systems. Pallor with a drop in hematocrit in patients on anticoagulant therapy suggests occult bleeding. A definitive diagnosis depends on catheterization of the right side and on mono- and bidimensional echocardiography. The authors believe that computerized axial tomography represents an interesting noninvasive and reliable examination technique when it can be used during emergency treatment. Pericardial puncture, which is both a diagnostic and therapeutic technique, was useful in one third of the cases; it produced a false-negative result in 12%. The resulting differential diagnoses are pulmonary embolism, myocardial insufficiency and septic shock. Late cardiac tamponade may be produced by one of two mechanisms: hemopericardium due to overdosage of anticoagulants or an exacerbated form of the post-pericardiotomy syndrome. Emergency treatment is always necessary. Pericardiocentesis is a useful diagnostic aid and provides temporary stabilization preoperatively. A wide surgical approach is always indicated. The mortality in untreated patients is 100%. The frequency of immediate relapse or, occasionally, of delayed relapse is estimated to be 11%; relapse may be lethal.
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PMID:[Late tamponade after heart surgery: a dreadful diagnostic pitfall]. 634 35

Massive pulmonary embolism causes an acute pressure overload for the right ventricle associated with a drop in cardiac output leading, if untreated, to cardiogenic shock. Main symptoms of acute pulmonary embolism comprise dyspnea, hyperventilation, tachycardia, hypotension and cyanosis, which are the consequences of tissue hypoxia caused by hypoperfusion. Mild to moderate arterial hypoxemia, which is observed in most of the cases, can be explained by intrapulmonary venous admixture.
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PMID:[Pathophysiology of pulmonary embolism]. 644 Dec 49

In a retrospective study over the years 1978-1982, 729 cases of acute pulmonary embolism were analyzed in relation to history, clinical signs and laboratory findings and the results compared with the findings of the urokinase pulmonary embolism trial. As far as history and clinical symptoms were concerned, breathlessness, chest pain, tachypnea, tachycardia and cyanosis were the dominating features. Among laboratory tests, the radiological and electrocardiographic findings of pulmonary hypertension were of little value. In contrast, arterial hypoxemia and isotope scanning provided the most reliable diagnostic information. The most frequent problem in differential diagnosis was acute myocardial infarction.
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PMID:[Diagnostic problems in acute pulmonary embolism]. 652

Recurrent pulmonary embolism sometimes (3% of hospital autopsies) determines a progressive obstruction of the pulmonary vascular bed, which in turn causes pulmonary arterial hypertension and in time right ventricular hypertrophy and failure. The first stages of this process are characterized by slight pulmonary arterial hypertension at rest and by few and deceiving symptoms which make the diagnosis very difficult. Regarding anatomy, in most cases recurrent thromboembolism obstructs one of the main branches of the pulmonary artery. At the beginning pulmonary embolism usually manifests itself in a spontaneous and atypical manner: paroxysmal dyspnea, tachycardia, lateral chest pain, mild hemoptysis and recurrent fever. The clinical signs of peripheral thrombophlebitis are not very frequent. The chest roentgenogram supplies diagnostic information in 20% of cases, the electrocardiogram in 10%. Very important is the contribution of the analysis of arterial blood gases: hyperventilation, moderate hypoxia associated with shunting, hypocapnia with a widened difference between alveolar and arterial CO2. Pulmonary perfusion scintiphotography shows vast unperfused areas, different to the "plexogenic" appearance in primitive pulmonary arterial hypertension, in about 50% of cases. Pulmonary angiography discloses the exact site and extension of the obstruction in 80-90% of cases. On catheterization pulmonary arterial hypertension results to be inconstant and may appear only during stress. Regarding the evolution of pulmonary embolism, the forms associated with pulmonary arterial hypertension may last several years, although recurrent embolism may shorten its course. When the stage of right ventricular hypertrophy is reached, the evolution is generally rapid (from 1 to 4 years).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic pulmonary thromboembolism. 653 60

Pulmonary embolism is poorly diagnosed and therefore not treated in patients with chronic diseases, whereas it is overdiagnosed in formerly healthy patients. The diagnostic level is not satisfactory even in departments of cardiology. Insufficient use of auxiliary laboratory tests constitutes one of the main reasons for the unsatisfactory state of pulmonary embolism diagnostics. The clinical picture of pulmonary embolism depends on a) the size of pulmonary embolism, b) the previous state of the cardiopulmonary system. A massive pulmonary embolism can lead to a) sudden death, b) shock, c) acute cor pulmonale. The most typical diagnostic sign is suddenly developed or deteriorated dyspnea (present in 94% of patients). The presence of venous thrombosis and the appearance of sudden dyspnea always support the diagnosis very strongly. Dyspnea or tachypnea occur in more than 90% of patients. Dyspnea, tachypnea or deep venous thrombosis occur in 99% of patients with acute pulmonary embolism. Electrocardiographic signs of acute pulmonary embolism were present in 67% of our patients with hemodynamically significant pulmonary embolism. Electrocardiographic signs are most marked in cases in which pulmonary embolism originates suddenly, in patients with a normal cardiopulmonary system, if the pulmonary embolism is extensive and the electrocardiogram is carried out early and repeatedly. The electrocardiographic signs of pulmonary embolism in cardiac patients, however, are not specific and only rarely present. The principal advantages of the chest X-ray are simplicity, safety and low costs. A negative chest X-ray was found only in 16.6% of our patients with pulmonary embolism.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The diagnosis of pulmonary embolism. 653 69


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