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

A patient with shortness of breath had a high probability lung scan for pulmonary embolism, but no obvious embolic source. Whole-body scintigraphy using Tc-99m labeled Fab' antifibrin monoclonal antibody showed large central pulmonary emboli as well as tracer uptake in the right atrium and aortic arch. No lower extremity clot was detected. This case shows significant differences in the appearance of pulmonary embolism as assessed by direct clot and ventilation-perfusion scintigraphy. It shows the importance of the heart as the origin of pulmonary emboli and the utility of direct thrombus visualization.
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PMID:Cardiopulmonary thromboembolism detected by Tc-99m MH-1 antifibrin antibody. 919 7

A case of successfully treated fungal tricuspid infective endocarditis with repeated pulmonary embolism is reported. A 60-year-old man had received along term intravenous hyperalimentation for the treatment of the complication after hepatopancreatoduodenectomy, associated with Candida sepsis. He was once discharged, successfully treated with antifungal agents. But he was readmitted to our hospital due to fever, cough and chest pain. Blood culture revealed Candida tropicalis. Pulmonary scintigraphy and angiography revealed multiple infarcts of the right lung, and echocardiography showed vegetation on the tricuspid valve. Because of exacerbation of shortness of breath, tricuspid valvuloplasty and thromboembolectomy in the pulmonary arteries was performed. Postoperative course was uneventful and he had a marked improvement of dyspnea after operation.
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PMID:[A case of successfully treated fungal tricuspid infective endocarditis with repeated pulmonary embolism]. 925 38

Pulmonary embolism can be a catastrophic event leading to early death or serious hemodynamic instability. Thrombolytic therapy, in addition to heparin therapy, may improve the clinical condition and reduce the chance of recurrent pulmonary embolism in some cases. However, the acceptable "time window" for thrombolytic therapy is not well documented, though it has been used successfully as late as 14 days after pulmonary embolism. Successful delayed thrombolytic therapy beyond this "time window" in patients with massive pulmonary embolism has not been reported. We report a case of massive pulmonary embolism in which thrombolytic therapy was delayed more than 1 month after symptom onset. A 56-year-old woman was taken to National Cheng Kung University Hospital because of an episode of recurrent syncope, followed by progressive shortness of breath of 1 month's duration. Hypoxemia and hemodynamic instability were noted on admission. Echocardiography and a lung perfusion scan provided strong evidence of pulmonary embolism. Subsequent pulmonary angiography confirmed the diagnosis of multiple pulmonary emboli. The patient received a standard dose of intravenous tissue plasminogen activator 7 days after admission because of persistent symptoms and hypoxemia. Her clinical condition dramatically improved after treatment. Follow-up imaging studies showed resolution of the emboli. She was discharged in good condition. This case suggests that delayed thrombolytic therapy in patients with massive pulmonary embolism can still be beneficial in selected cases, even if given more than 2 weeks after symptom onset.
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PMID:Successful delayed thrombolytic therapy in a patient with massive pulmonary embolism. 979 33

May-Thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, resulting in left iliofemoral deep vein thrombosis and severe leg edema. We report the case of a 41-year-old female who presented with severe left leg edema present for 1 day. One week earlier she had experienced acute shortness of breath and pleuritic chest pain. Duplex ultrasound revealed a left iliofemoral deep vein thrombosis. A computed tomography (CT) scan performed for abdominal pain revealed thrombosis of the entire left common and external iliac veins. A ventilation-perfusion scan diagnosed a pulmonary embolism. The patient was treated with systemic intravenous heparin and catheter-directed thrombolysis of the iliofemoral deep vein thrombosis. Complete thrombolysis and iliofemoral vein patency was achieved over 5 days. A persistent stenosis in the left common iliac vein consistent with May-Thurner syndrome was alleviated with percutaneous balloon angioplasty and placement of a Wallstent. Heparin therapy was terminated at the time of stenting because of suspected heparin-induced thrombocytopenia. The patient was started on a continuous infusion of 10% dextran 40, and warfarin therapy was initiated. Heparin-induced antibodies were confirmed by a C-14 serotonin release assay. The endovascular reconstruction remains patent 4 months later. Heparin-induced thrombocytopenia complicating endovascular reconstruction of the iliofemoral venous system in a patient with May-Thurner Syndrome is an uncommon occurrence. This case and a review of the literature are discussed.
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PMID:Treatment of May-Thurner syndrome with catheter-directed thrombolysis and stent placement, complicated by heparin-induced thrombocytopenia. 1039 65

We report a case of a 32-year-old woman who presented with shortness of breath and pleuritic chest pain, and mismatched perfusion defects on a ventilation-perfusion scan suspicious for pulmonary embolism. However, subsequent data revealed the diagnosis of acute myelogenous leukemia with hyperleukocytosis and associated pulmonary leukostasis. Unfortunately, the patient died despite urgent leukopheresis. Autopsy examination revealed extensive infiltration of leukemic cells in all major organs with no evidence of pulmonary embolism. This case highlights the clinical, radiographic and histologic features of pulmonary leukostasis, and reminds the clinician that not all ventilation-perfusion mismatching is due to thromboembolic disease.
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PMID:Pulmonary leukostasis mimicking pulmonary embolism. 1065 54

The diagnostic evaluation of pulmonary embolism has recently been modified to include contrast-enchanced spiral computed tomography of the chest. CT has found acceptance as not only an imaging modality for diagnosing pulmonary embolus, but is also useful in depicting alternate diagnoses to explain acute shortness of breath. This article describes a unique pattern of contrast enhancement observed during a routine spiral contrast-enhanced CT to evaluate suspected pulmonary embolism. The appearance has been named the "yin-yang" sign due to the alternating areas of contrast enhancement seen in the cardiac chambers on sagittal and coronaly reformatted images. This article describes the appearance of the sign and attempts to explain how intravenous contrast assumes this configuration with rapid spiral acquisition of images. The importance of recognizing this normal variant of contrast enhancement which may appear on routine examinations for pulmonary embolus is also discussed.
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PMID:Case report: the "yin-yang" sign-seen with spiral computed tomography for pulmonary embolus. 1089 19

Most episodes of acute pulmonary embolism completely resolve, through thrombolytic mechanisms. When adequate thrombolysis fails, however, residual obstruction to pulmonary vascular flow by fibrotic remnants may result in pulmonary hypertension. The genesis of this pulmonary hypertension is complex. Apart from the simple mechanical obstruction to blood flow that may occur from occlusion of significant areas of the pulmonary vascular bed, secondary vascular changes eventually may result from increased flow and pressure in nonobstructed areas of the lung, or factors generated by localized hypoxia in occluded segments. Chronic pulmonary hypertension from thromboembolism, regardless of the mechanism, is much more prevalent than is generally appreciated. Patients develop increasing shortness of breath, and the diagnosis is often missed. Pulmonary endarterectomy offers a cure for the condition, and wider recognition of the efficacy of the operation and the entity are therefore important. Pulmonary endarterectomy is a technically demanding procedure, now performed with success at only a handful of centers. However, with proper patient selection, meticulous surgical technique, and careful postoperative management, excellent results can be obtained. A true endarterectomy (not an embolectomy) of all affected parts of the lung is performed, and cardiopulmonary bypass, systemic cooling, and circulatory arrest are essential for the visibility necessary to clear all affected areas of the pulmonary vasculature. Medical treatment is ineffective for this condition, and the alternative surgical treatment is lung transplantation. Pulmonary endarterectomy appears to be permanently curative, though an inferior vena caval filter should be placed in all patients to prevent recurrence, and the patients must have life-long anticoagulation.
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PMID:Indications for and the results of pulmonary thromboendarterectomy for thromboembolic pulmonary hypertension. 1100 69

A 30-year-old HBsAg-positive woman was admitted to the hospital because of 6 days of progressive shortness of breath. She was in severe respiratory distress with circulatory collapse. She had an enlarged liver but no stigmata of chronic liver disease or signs of cirrhosis. She had rapidly developed respiratory arrest and was transferred to intensive care unit. Heart ultrasonography and Doppler scan showed right heart straining and high pulmonary artery pressure. Despite cardiovascular and respiratory support she died a few hours after admission. Autopsy revealed combined hepatocellular-cholangiocarcinoma infiltrating the entire liver, metastatic invasion of lung blood vessels and absence of right ventricular hypertrophy. The incidence of hepatocellular-cholangiocarcinoma, a variant of hepatocellular carcinoma, is roughly 2-3% and the presenting symptoms are abdominal pain, weight loss, jaundice, fever or decompensation of liver disease. Associated HBsAg positivity and cirrhosis are reported in 20-30% and 60% of patients, respectively. Metastases to lungs are relatively frequent but this is the first report of hepatocellular-cholangiocarcinoma presented with acute respiratory distress due to massive pulmonary embolism.
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PMID:Combined hepatocellular-cholangiocarcinoma presented with massive pulmonary embolism. 1102 Aug 95

A patient with a history of tachycardiac atrial fibrillation and pulmonary embolism was admitted to the emergency unit with acute shortness of breath. The patient was on coumarin medication. Pulmonary embolism, heart failure, or pulmonary edema could be ruled out. Laryngoscopy revealed a huge hematoma of both valleculae extending to the lateral pharyngeal wall and the epiglottis. The epiglottic cartilage was displaced to the posterior pharyngeal wall. The INR was > 6. Prothrombin complex, vitamin K1, corticoids, and fresh frozen plasma were administered immediately. The patient was monitored--without tracheotomy--in the intensive care unit and received oxygen. In a patient with dyspnea, impaired ventilation has to be considered besides impaired perfusion or diffusion.
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PMID:[Dyspnea caused by spontaneous hematoma of the oropharynx and larynx during marcumar therapy]. 1132 Jun 26

This report describes a patient admitted with shortness of breath due to cardiac tamponade, which masked concomitant pulmonary embolism that was diagnosed only after right heart pressures failed to decrease after successful pericardiocentesis. The patient was found to have widely metastatic adenocarcinoma of colon (with metastases to pericardium) and a paraneoplastic syndrome of deep vein thrombosis.
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PMID:Cardiac tamponade masking pulmonary embolism. 1140 12


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