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

We present the case of a 69-year-old man with a history of hypertension and a recent pelvic fracture who presented with acute chest pain, shortness of breath, and severe hypotension. The history of recent pelvic fracture and the clinical manifestations, including the sudden onset of acute respiratory distress, hypotension, and hypoxemia, indicated pulmonary embolism; however, at surgery the patient was found to have an acute dissection of the ascending aorta with obstruction and thrombosis of the right pulmonary artery. This case emphasizes the need to consider such a diagnosis in patients who have unilateral absence of perfusion to the right lung.
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PMID:Acute dissecting aneurysm of the ascending thoracic aorta causing obstruction and thrombosis of the right pulmonary artery. 1145 30

A 32-year-old infertility patient with a previous diagnosis of stage IV endometriosis experienced shortness of breath and chest pain. She was diagnosed with a pulmonary embolism by spiral volumetric computed tomography (SVCT) and anticoagulated during hospitalization, although no history of thrombosis was ever identified. She continued to have intermittent symptoms of chest pain, back pain, and shortness of breath for the next 1.5 months. Repeat SVCT revealed a large, right-sided pleural effusion with associated consolidation but no evidence of pulmonary embolism. To obtain a definitive diagnosis, a thoracoscopic pleural biopsy was performed and showed thoracic endometriosis involving the pleura. The patient desired to retain her fertility and opted for treatment with depot medroxyprogesterone. She has been asymptomatic for 2 years with this treatment. This case illustrates the importance of recognizing thoracic endometriosis syndrome and the difficulty diagnosing this condition considering its nonspecific features.
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PMID:Thoracic endometriosis syndrome resembling pulmonary embolism. 1150 91

A 62-year-old man presented to the Emergency Department (ED) after having three short syncopal episodes earlier that day soon after experiencing acute onset of shortness of breath. He had no significant past medical history and was a nonsmoker. Initially in the Emergency Department he was without any complaints, but then became acutely short of breath and hemodynamically unstable and died despite resuscitative efforts. His electrocardiogram showed ST segment elevations in leads V1 to V4, which is consistent with an anteroseptal myocardial infarction. Autopsy revealed that this patient did not have a myocardial infarction, but rather died of a pulmonary embolism (PE). This case demonstrates how a PE can mimic an anteroseptal myocardial infarction on electrocardiogram. This patient's lack of risk factors for PE also makes this case unusual.
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PMID:Pulmonary embolism with ST segment elevation in leads V1 to V4: case report and review of the literature regarding electrocardiographic changes in acute pulmonary embolism. 1160 80

A 62-year-old woman with a history of pulmonary embolism and primary antiphospholipid syndrome (PAPS) with positivity for lupus anticoagulant was admitted to hospital with shortness of breath. A filter had been implanted in her inferior vena cava (IVC) 5 years previously. Emergency echocardiography revealed a lobulated, mobile echogenic mass on the tricuspid valve, and on pulmonary perfusion scintigraphy several apparently new defects were noted. Fibrinolytic therapy improved her symptoms and the pulmonary perfusion, then intravenous heparinization was continued for a further week. Repeat echocardiography performed on the 7th day of the admission showed complete disappearance of the mass, which was retrospectively diagnosed as a thrombus based on its resolution with fibrinolytic and anticoagulant therapies.
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PMID:Thrombus on the tricuspid valve in a patient with primary antiphospholipid syndrome after implantation of an inferior vena cave filter. 1195 63

A rare case of inferior vena cava (IVC) thrombosis and pulmonary embolism secondary to acute exacerbation of chronic pancreatitis was reported. Radionuclide venography and lung perfusion scintigraphy were performed on a 46-year-old male with acute exacerbation of chronic pancreatitis who complained of mild swelling of a leg and shortness of breath. Scintigraphy showed an abnormal large hot spot at the level of the pancreas and a pulmonary embolism. Enhanced abdominal CT revealed an IVC thrombus and a cystic mass adjacent to the IVC. Despite the absence of severe abdominal pain, the serum amylase and elastase-1 levels were very high. These findings indicated that a pancreatic cyst had penetrated into the IVC, where it triggered the formation of a thrombus and caused a pulmonary embolism. Scintigraphic examination was useful for the evaluation of this rare condition.
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PMID:A case of inferior vena cava thrombosis and pulmonary embolism secondary to acute exacerbation of chronic pancreatitis: a rare finding in radionuclide venography. 1204 10

The incidence of venous thromboembolism (vein thrombosis [DVT] and pulmonary embolism [PE]) increases sharply in pregnant women. The 3 primary contributing factors in VTE--hypercoagulability, stasis and endothelial injury--can all occur in association with pregnancy. Symptoms that may suggest VTE are often inherent in pregnancy, such as leg pain and shortness of breath, making clinical diagnosis problematic. The use of objective diagnostic testing for VTE is complicated in pregnancy because many of the tests commonly used present a potential risk to the fetus. Heparin does not cross the placenta and is not teratogenic, making it the first-line treatment for VTE. Low-molecular-weight heparins are typically the drug of choice for prophylaxis and treatment of VTE in pregnant women.
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PMID:Venous thromboembolism in the pregnant woman. 1468 29

The authors describe a patient who experienced stereotypical episodes of dyspnea and presyncopal sensation without loss of consciousness during a 4-month period. Further evaluation established intermittent arterial O2 desaturations associated with this dyspnea. After an extensive cardiopulmonary workup was performed for presumptive diagnosis of pulmonary embolism, a brain magnetic resonance image revealed a right medial temporal lobe lesion. The patient's dyspnea was then suspected to be a symptom of a seizure. His shortness of breath and O2 desaturation resolved with administration of phenytoin. This case, to the authors' knowledge, is the first documented example of simple partial seizures presenting with episodic autonomic cardiopulmonary symptoms in the absence of other ictal behavior. This case may also illustrate one specific limbic autonomic network.
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PMID:Partial epilepsy presenting as episodic dyspnea: a specific network involved in limbic seizure propagation. Case report. 1503 97

Pulmonary embolism (PE) and deep venous thrombosis (DVT), venous thromboembolism (VTE) respectively, are relatively frequent diseases. Despite progress in early detection and treatment, the rates of mortality and recurrent PE, remain high. Clinical findings include oligosymptomatic conditions with unexplained chest discomfort or shortness of breath that cannot be recognized as PE, but also and massive embolism with hemodynamic colapse and sudden cardiac death (SCD). The time from the first symptoms, till PE diagnosis is the most important for prognosis. Diagnostic methods include non imaging methods as plasma d-dimer Elisa, electrocardiogram, and many imaging methods from roentgenography, echocardiography, lung scanning, spiral chest computed tomography, magnetic resonance imaging to pulmonary angiography as "the gold standard" for PE diagnosis. It is recommended integrated diagnostic approach and various algorithms according to medical equipment and staff skill of a hospital.
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PMID:[New aspects in the diagnosis of pulmonary embolism]. 1520 8

PRESENTING FEATURES: A 53-year-old man who had human immunodeficiency virus (HIV) presented to the Johns Hopkins Hospital with a 3-month history of increasing dysphagia, cough, dyspnea, chest pain, and an episode of syncope. His past medical history was notable for oral and presumptive esophageal candidiasis that was treated with fluconazole 6 months prior to presentation. Three months prior to presentation, he discontinued his medications, and his symptoms of dysphagia recurred. During that time he developed intermittent fevers and chills, progressively worsening dyspnea on exertion, and a cough productive of white sputum. He also reported a 40-lb weight loss over the past 3 months. On the day prior to presentation, he had chest pain and shortness of breath followed by weakness, dizziness, and a brief syncopal episode. He denied orthopnea, paroxysmal nocturnal dyspnea, lower extremity edema, jaundice, hemoptysis, hematemesis, melena, hematochezia, or diarrhea. There was no history of alcohol use, and he stopped smoking tobacco approximately 1 month previously. He smoked cocaine but denied injection drug use. The patient had never been on antiretroviral therapy and had never had his CD4 count or viral load measured. On physical examination, the patient was a thin, cachectic man who appeared older than his stated age. His vital signs were notable for blood pressure of 102/69 mm Hg, resting tachycardia of 102 beats per minute, resting oxygen saturation of 92% on room air, normal resting respiratory rate, and a temperature of 38.1 degrees C. His oropharynx was clear, with no signs of thrush or mucosal ulcers. His pulmonary examination was notable for diminished breath sounds in the lower lung fields bilaterally. Cardiac, abdominal, and neurologic examinations were normal. His skin was intact, with no visible petechiae, rashes, nodules, or ulcers. Laboratory studies showed a total white blood cell count of 3.2 x 10(3)/microL, with a total lymphocyte count of 330/microL, hematocrit of 30.2%, a serum sodium level of 129 mEq/L, and a serum lactate dehydrogenase level of 219 IU/L. The patient had an absolute CD4 count of 8 cells/mm3 and a HIV viral load of 86,457 copies/mL. His arterial blood gas on room air had a pH of 7.51, a PCO2 of 33 mm Hg, and a PO2 of 55 mm Hg. Electrocardiogram and serial serum cardiac enzymes were normal. A chest radiograph showed bilateral upper lobe patchy infiltrates with left upper lobe consolidation. Computed tomographic (CT) scan of the chest with contrast showed bilateral ground glass infiltrates with focal consolidation (Figure 1) and no evidence of pulmonary embolism. Induced sputum was negative for Pneumocystis carinii, fungi, or acid-fast bacilli. A bronchoalveolar lavage was performed. What is the diagnosis?
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PMID:Cases from the Osler Medical Service at Johns Hopkins University. Diagnosis: P. carinii pneumonia and primary pulmonary sporotrichosis. 1533 85

We describe a case of 63-year-old woman with pulmonary artery sarcoma successfully treated with chemotherapy. She developed acute shortness of breath, and left chest and shoulder pain. Although a diagnosis of acute pulmonary embolism was made at a local hospital and she received anticoagulation and thrombolysis therapy, no improvement was achieved. Thereafter, she underwent a pulmonary thromboectomy in our hospital, and the histological diagnosis was intimal sarcoma of the pulmonary artery. Since post-operative computed tomography (CT) scans of the chest showed obvious persistence of an intraluminal hypoattenuated area in the left main pulmonary artery, the patient was treated with four cycles of a doublet chemotherapy consisting of ifosfamide (2.5 g/m(2)/day) on days 1-5 and epirubicin (45 mg/m(2)/day) on days 2 and 3. CT scans of the chest after four cycles showed marked regression of the intraluminal hypoattenuated area in the left main pulmonary artery. This is the first case of pulmonary artery sarcoma responding to chemotherapy. Surgical resection is currently the most hopeful treatment for pulmonary artery sarcoma. However, intensive chemotherapy is worth trying in unresectable patients.
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PMID:Successful treatment of pulmonary artery sarcoma by a two-drug combination chemotherapy consisting of ifosfamide and epirubicin. 1597 70


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