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

Pulmonary embolism (PE) is a potentially lethal condition that presents in patients with chest pain or shortness of breath. Although electrocardiograms (ECGs) typically demonstrate abnormalities associated with PE, ST-segment elevation, which can indicate anteroseptal acute myocardial infarction (AMI), has-on rare occasions-been noted on ECGs of patients with acute PE. The current report documents the case of a 57-year-old man who presented to the emergency department with chest pain. Findings from an ECG suggested anteroseptal AMI; however, cardiac catheterization indicated that the patient did not have critical ischemic heart disease. On further examination, the patient was found to have a massive bilateral PE. The present report emphasizes that physicians must investigate PE in all patients presenting with chest pain, dyspnea, or both, even in the face of ECG changes that are suggestive of a cardiac etiology. A brief discussion of the current theories of ST-segment elevation in the setting of PE is also included.
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PMID:Pulmonary embolism mimicking anteroseptal acute myocardial infarction. 1864 28

A 50-year-old male with sudden syncope and witnessed seizure activity was discovered to have pulmonary emboli. Although he denied shortness of breath, d-dimer testing was positive and a ventilation-perfusion scan was positive for bilateral pulmonary emboli; cardiac ECHO also confirmed elevated right ventricular pressures. The literature on this unusual presentation for seizures as the initial manifestation of pulmonary embolism is reviewed. Clinicians need to be more aware that pulmonary embolism is important to consider within the differential diagnosis for unexplained new onset of seizure activity.
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PMID:Seizure as the presenting sign for massive pulmonary embolism: case report and review of the literature. 1865 85

Primary sarcomas of the pulmonary artery are rare, with few series correlating histologic features with follow-up data. We present a series of 43 pulmonary artery sarcomas with primary intraluminal growth, 32 with follow-up information. Symptoms were generally related to shortness of breath and often attributed to recurrent pulmonary embolism. There was no sex predilection. There were 28 pleomorphic-fascicular sarcomas, ranging from relatively differentiated spindle cell myxofibrosarcoma to undifferentiated round-cell sarcoma, often with histologic heterogeneity and overlap. The remaining tumors were 7 osteosarcomas, 4 leiomyosarcomas, 1 rhabdomyosarcoma, and 3 intravascular low-grade myofibroblastic sarcomas. Of the pleomorphic-fascicular sarcomas, 2 demonstrated extensive fibrosis with hyalinization and pleomorphic tumor cells were confined to a luminal rim of neoplastic cells. Histologically, mitotic rate was significantly lower in low-grade myofibroblastic sarcoma than in the other histologic subtypes. Follow-up revealed that 2 of 3 intra-arterial low-grade myofibroblastic sarcomas were cured with no evidence of disease at long-term follow-up. The other tumor subtypes, which represented intermediate and high-grade sarcomas, demonstrated 5 survivors of greater than 3 years, none surviving without disease. The only parameters associated with prolonged survival, other than low-grade myofibroblastic phenotype, was age less than 40 years at onset of symptoms. We conclude that survival beyond 3 years is possible for primary pulmonary artery sarcoma, but cure without evidence of disease is currently possible only for the select subtype of intravascular low-grade myofibroblastic sarcoma.
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PMID:Pulmonary artery sarcoma: a histologic and follow-up study with emphasis on a subset of low-grade myofibroblastic sarcomas with a good long-term follow-up. 1877 32

Venous thromboembolism is a major cause of maternal morbidity and mortality, and accurate diagnostic workup upon suspicion of deep vein thrombosis or pulmonary embolism in a pregnant woman is of utmost importance. The diagnostic repertoire for venous thromboembolism is, however, less well studied in pregnant women. The clinical assessment is influenced by common symptoms of pregnancy such as leg swelling or shortness of breath. The role of D-Dimer is limited, since - even during uncomplicated pregnancy - D-Dimer levels increase with gestational age. Preliminary data indicate that a normal D-Dimer in a healthy pregnant woman with a low clinical probability may exclude deep vein thrombosis. Compression ultrasonography and ventilation perfusion scanning or helical computed tomography are the imaging techniques of choice in a pregnant woman with suspected deep vein thrombosis or pulmonary embolism, respectively. The role of magnetic resonance imaging for the diagnosis of venous thromboembolism during pregnancy is uncertain and contraindications particularly to contrast media have to be considered.
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PMID:Diagnostic issues of VTE in pregnancy. 1921 73

We report a 44-year-old woman who developed a fatal pulmonary embolus after uterine artery fibroid embolisation (UAE). Bilateral UAE was carried out through a single right-femoral artery puncture. The largest fibroid in the anterior fundal wall measured 4.5 cm, and the largest fibroid in the posterior fundal wall measured 6 cm. The appearances after UAE were satisfactory, and the procedure was apparently uneventful. No immediate complications were noted. The patient developed sudden-onset shortness of breath and went into cardiac arrest 19 h after the procedure. Postmortem autopsy confirmed that the cause of a death was a pulmonary embolism. To our knowledge this is the first reported case in the United Kingdom in which death occurred from a pulmonary embolus after UAE.
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PMID:Fatal pulmonary embolus after uterine artery fibroid embolisation. 1944 63

Orthopedic surgery is associated with a significant risk of postoperative pulmonary embolism (PE) and/or deep vein thrombosis (DVT). This study was performed to compare the clinical presentations of a suspected versus a documented PE/DVT and to determine the actual incidence of PE/DVT in the post-operative orthopedic patient in whom CT was ordered. All 695 patients at our institution who had a postoperative spiral CT to rule out PE/DVT from March 2004 to February 2006 were evaluated and information regarding their surgical procedure, risk factors, presenting symptoms, location of PE/DVT, and anticoagulation were assessed. Statistical analysis was performed using an independent samples t test with a two-tailed p value to examine significant associations between the patient variables and CT scans positive for PE. Logistic regression models were used to determine which variables appeared to be significant predictors of a positive chest CT. Of 32,854 patients admitted for same day surgery across all services, 695 (2.1%) had a postoperative spiral CT based on specific clinical guidelines. The incidence of a positive scan was 27.8% (193/695). Of these, 155 (22.3%) scans were positive for PE only, 24 (3.5%) for PE and DVT, and 14 (2.0%) for DVT only. The most common presenting symptoms were tachycardia (56%, 393/695), low oxygen saturation (48%, 336/695), and shortness of breath (19.6%, 136/695). Symptoms significantly associated with DVT were syncope and chest pain. A past medical history of PE/DVT was the only significant predictor of a positive scan. Patients who have a history of thromboembolic disease should be carefully monitored in the postoperative setting.
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PMID:Detection of Pulmonary Embolism in the Postoperative Orthopedic Patient Using Spiral CT Scans. 1977 19

Patent foramen ovale (PFO) in the setting of venous thromboembolism is associated with paradoxical embolization. We describe a patient who presented with pulmonary embolism, underwent pulmonary embolectomy, and postoperatively developed paradoxical embolization to the lower extremity.A 27-year-old African American male presented to the hospital with shortness of breath and midsternal chest pain along with neck vein distention. A CT scan with contrast showed the presence of a saddle embolus in both pulmonary arteries. The next day, the patient developed right ventricular failure and hypotension. The patient was taken to the operating room for a pulmonary embolectomy. Postoperatively, the patient developed acute left lower extremity ischemia. The origin of the embolus was suspected to be cardiac. A transesophageal echocardiogram (TEE) revealed thrombus on the mitral valve and a PFO with right to left shunt. At this point vascular surgery for revascularization of the left lower extremity was performed. Two days later, the patient was taken for a repeat cardiac surgery and the left-sided thrombus was removed along with a closure of the PFO.This case signifies the importance of complete TEE and a search for PFO in patients with massive pulmonary embolism especially prior to surgical embolectomy because hemodynamic disturbances of pulmonary embolism and surgical embolectomy may cause migration of the thrombus from the right side to the left side of the heart.
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PMID:Massive pulmonary embolism and paradoxical migration during surgical embolectomy: role of transesophageal echocardiogram. 2001 72

Massive pulmonary embolism with haemodynamic instability has a high mortality. Traditionally these patients are treated with i.v. thrombolytic therapy. When this therapeutic approach is contraindicated, surgical embolectomy and most recently, percutaneous mechanical interventions are alternative treatment options. This case report presents a 73-year-old female with a residual hemiparesis secondary to a meningioma resection 45 days previously, who presented with progressive shortness of breath, accompanied by oppressive chest pain, hypotension, tachycardia and severe hypoxaemia. CT pulmonary angiogram confirmed a massive pulmonary embolism extending into the lobar branches bilaterally. The patient was treated with percutaneous mechanical thrombectomy with excellent haemodynamic and clinical outcomes.
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PMID:Successful percutaneous mechanical thrombectomy in a haemodynamically unstable patient with massive pulmonary embolism. 2014 54

We report the case of an 87-year-old white woman with myasthenia gravis who presented with nausea, shortness of breath, azotemia, and hyperkalemia shortly after completing a course of intravenous immunoglobulin (IVIG). She had been receiving monthly transfusions of IVIG, but this time had received daily infusions for 5 days rather than 1 day. She had received this same dose in the past without incident. Her history was significant for coronary artery disease, atrial fibrillation, deep venous thrombosis, pulmonary embolism, chronic steroid use, and recurrent urinary tract infection. On examination, she was slightly confused, mildly dehydrated, had a grade II systolic ejection murmur along the upper left sternal border, had bilateral and symmetric mild weakness of the upper and lower extremities, and exhibited mild edema of the lower extremities. Before transfer from the emergency room, she was found to have an elevated serum urea nitrogen and creatinine of 55 and 5.8 mg/dL (19.6 mmol/L and 512.7 micromol/L, respectively). Creatinine 8 days earlier was 0.9 mg/dL (79.6 micromol/L). The hospital course of the acute renal failure is presented with a review of the literature on cases of acute renal failure after IVIG.
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PMID:Case report: acute renal failure after administering intravenous immunoglobulin. 2020 65

Pulmonary embolism (PE) is an important cause of morbidity and mortality during pregnancy. A 21-year-old pregnant woman presented with chest pain and progressive shortness of breath at 35 weeks of gestation. Her respiratory rate was 26 breaths/min. Electrocardiography showed sinus tachycardia and nonspecific ST-T changes. Her plasma D-dimer level was elevated (1,325 ng/ml). Transthoracic echocardiography revealed enlargement of the right ventricle and a large, highly mobile thrombus in the right atrium moving during diastole into the right ventricle. Doppler ultrasonography of the lower extremities showed bilateral acute deep femoral vein thrombosis. Following the diagnosis of right heart thrombosis with massive PE, low-dose and prolonged infusion of tissue-type plasminogen activator (25 mg in three hours) was administered. Echocardiography performed six hours after thrombolysis showed a significant decrease in the right ventricular size and complete lysis of the thrombus in the right heart. Thrombosis risk panel studies showed factor V Leiden homozygote mutation. A live newborn was delivered by cesarean section at 37 weeks of gestation. No complications were seen during a 6-month follow-up.
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PMID:Successful treatment of massive pulmonary embolism in a pregnant woman, with low-dose, slow infusion of tissue plasminogen activator. 2021 40


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