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

Effort thrombosis of the axillary and subclavian veins is an uncommon cause of upper extremity swelling. Prompt recognition and treatment of this disorder is important in order to minimize the complications of pulmonary embolism and postphlebitic syndrome that can occur with this condition. This can be very challenging while underway or in the field. A sailor who developed effort vein thrombosis while underway on board the aircraft carrier USS Abraham Lincoln is presented to review the presentation and management of this disorder, particularly as it applies to active duty military personnel.
Mil Med 1991 Oct
PMID:Effort thrombosis: recognition and management while underway. 174 4

A case of pulmonary embolism from a venous thrombosis distal to the popliteal vein is reported. This occurred despite venographic and ultrasound verification that the thrombus had not extended to the popliteal vein. The medical literature supports expectant treatment of "calf-only" venous thrombi. Our case clearly demonstrates that clinically significant pulmonary emboli can arise from calf vein thrombi without popliteal involvement.
Mil Med 1991 May
PMID:Pulmonary embolism from a venous thrombosis distal to the popliteal vein. 205 79

An active duty male presented to the emergency room with dyspnea for 2 days after undergoing liposuction surgery. Upon presentation, the patient was afebrile, tachycardic, tachypneic, and hypoxemic. The initial chest radiograph demonstrated bilateral patchy opacities and the PaO2/FiO2 ratio was <200. The patient was admitted to the medical intensive care unit for supportive care. He was treated empirically for pneumonia. Blood and sputum cultures were negative. A computed tomography angiogram of the chest was negative for pulmonary embolism but did reveal a bilateral, perihilar air space process. The patient's oxygen requirement improved and the abnormal chest radiographic findings resolved over the next 48 hours. Given his clinical presentation, negative workup, and rapid recovery, the patient was given a presumptive diagnosis of pulmonary fat embolism. Fat embolism occurs when adipocytes and small blood vessels are damaged during the liposuction procedure. Patients may present with low-grade fever, tachycardia, tachypnea, hypoxemia, and hypocapnia. The differential diagnosis includes venous thromboembolism, aspiration pneumonitis, and pneumonia. The mainstay of treatment for pulmonary fat embolism is supportive care. The risk of mortality is 5 to 15%.
Mil Med 2007 Jun
PMID:Acute respiratory distress following liposuction. 1761 55

After an 18-hour bus ride, a 29-year-old soldier complained of leg pain. Ten days later, he collapsed. After cardiopulmonary resuscitation (CPR), he revived but complained of chest pain and shortness of breath. Computed tomography revealed massive thrombus in the right pulmonary artery, emboli in the left pulmonary artery, and right ventricle ballooning. Adequate anticoagulation required repeated boluses and continuous infusion (1,600 units/hour) of heparin. Vena caval filter was not available, and possible additional clot in the legs could not be completely assessed. After no improvement in 24 hours, alteplase was given (10 mg IV bolus and 90 mg over 2 hours). At 12 hours, tachycardia, tachypnea, and dyspnea resolved and computed tomography revealed marked resolution. This case illustrates both the value of CPR and aggressive fibrinolytic therapy in patients who suddenly collapse from massive pulmonary embolism. The collapse was likely due to a saddle embolus. Chest compressions probably fractured the large clot. Although not completely reestablished, enough flow occurred for successful resuscitation. Even though delayed, fibrinolytic therapy was effective and should be considered even in patients where vena caval filter placement is not feasible and/or complete evaluation of the extremity deep venous system is not possible.
Mil Med 2011 Dec
PMID:Treatment of massive pulmonary embolism in a soldier in Kosovo: the potential value of cardiopulmonary resuscitation and fibrinolytic therapy. 2233 66

Phlegmasia cerulea dolens (PCD) is a rare entity that refers to a painful, edematous, and cyanotic limb due to a massive deep vein thrombosis (DVT). Due to its rarity, the exact incidence is unknown; however, it is vital that the military health care provider recognize it as the condition can be limb and life threatening. Due to the recent increase in combat-related operations, DVT has had a steady increase in the past 10 years in the military population, and as such has become a condition of special interest and surveillance in the armed forces. PCD is part of a spectrum that consists of distal DVT, more proximal DVT, phlegmasia alba dolens (PAD), and finally PCD with venous gangrene. PAD is an early stage of PCD, in which although there is a massive DVT present, the collateral and superficial circulation are not yet involved; this in turn results in a painful, edematous, white leg. PCD is preceded by PAD in approximately 50% to 60% of the cases. PCD has an amputation rate of up to 50% and a mortality rate of up to 40%. The patient will present with a swollen, cyanotic, painful leg that may or may not show signs of venous gangrene. In PCD, the collateral circulation is not spared and this causes severe congestion and fluid sequestration in the limb leading to venous hypertension. This can lead to circulatory shock and arterial insufficiency as it progresses. We review a case report of a 66-year-old woman that presented to small community army hospital after a 26-hour bus drive with knee pain and leg swelling. The diagnosis of PCD was made after Doppler ultrasonography showed bilateral iliofemoral, common, femoral, and saphenous veins thrombosis. The patient's left lower extremity was discolored, tender, and swollen, although it had not progressed to venous gangrene or dermal necrosis. While the management of PCD is not standardized due to the rarity of the condition, several options are available. These options include anticoagulation, minimally invasive procedures such as catheter-directed thrombolysis, or more invasive procedures such as surgical thrombectomy. In the active duty military population, clot reduction techniques would be preferred to long-standing anticoagulation, as the morbidity is greater with anticoagulation alone as well as the probability of major hemorrhage. Besides pulmonary embolism, which is a complication in up to 30% of the patients with PCD, one must keep in mind the extent and duration of the thrombus when choosing a treatment method, as these factors are directly related to the morbidity associated with post-thrombotic syndrome. Functional impairment after a massive DVT or PCD is an important factor that must be kept in mind for troop readiness.
Mil Med 2017 05
PMID:Rare Case of Unilateral Phlegmasia Cerulea Dolens With Bilateral Deep Vein Thrombosis at a Community Military Hospital Emergency Department. 2908 34

The purpose of this case presentation is to discuss right upper quadrant pain as an atypical presenting symptom in pulmonary infarction and review the typical computed tomography (CT) imaging features of pulmonary infarction to improve diagnostic accuracy. Pulmonary infarction results from occlusion of distal arterial vasculature within the lung parenchyma leading to ischemia, hemorrhage, and ultimately necrosis. Patients with lung infarction typically present with pleuritic chest pain and may have associated signs or symptoms of pulmonary thromboembolism or deep vein thrombosis. In this case study, a 34-yr-old female devoid of any symptoms indicative of either pulmonary embolism or deep vein thrombosis presented with right upper quadrant pain 1 mo status post open reduction internal fixation for a left ankle fracture. Multiple clinic visits spanning approximately 7 d were significant for a right lower lobe opacity seen on CT of the abdomen which was presumed to represent community acquired pneumonia as a source for the patient's RUQ pain. The patient presented to the emergency department 1 wk later (6 wk following her initial surgery) complaining of left lower extremity swelling and was subsequently diagnosed with a left lower extremity DVT via ultrasound. CT of the pulmonary arteries was negative for PE but identified a right lower lobe opacity which in retrospect was consistent with pulmonary infarction.
Mil Med 2018 11 01
PMID:Pulmonary Infarction: Right Upper Quadrant Pain as a Presenting Symptom With Review of Typical Computed Tomography Imaging Features. 2988 60

The nature of many combat wounds puts patients at a high risk of developing deep venous thrombosis (DVT) and pulmonary embolism (PE), which fall under the broader disease category of venous thromboembolism (VTE). In addition to the hypercoagulable state induced by trauma, massive injuries to the extremities, prolonged immobility, and long fixed wing transport times to higher echelons of care are unique risk factors for venous thromboembolism in the combat-injured patient. These risk factors mandate aggressive prophylaxis for DVT and PE that can effectively be achieved by the use of lower extremity sequential compression devices and low dose unfractionated heparin or low molecular weight heparin. In addition, inferior vena cava filters are often used for PE prophylaxis when chemical DVT prophylaxis fails or is contraindicated. The following Department of Defense (DoD) Joint Trauma System (JTS) Clinical Practice Guideline (CPG) discusses the current recommendations for the prevention of DVT and PE including the use of inferior vena cava filters (IVCFs).
Mil Med 2018 09 01
PMID:Prevention of Deep Venous Thromboembolism. 3018 59