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

A wide spectrum of acute cardiovascular disorders is seen in patients who are hospitalized in a critical care setting. Imaging plays a central role in the diagnosis and management of these conditions. The most frequently used imaging remains chest radiography; however, more advanced modalities, including coronary angiography, echocardiography, and radioisotope scintigraphy, have well established roles in the assessment of patients in the critical care setting. More recently, multidetector row CT (MDCT) and MRI are being used increasingly for evaluation of coronary artery disease, cardiac structure and function, coronary artery anomalies, cardiac masses, pericardial disease, valvular disease, postoperative cardiovascular abnormalities, venous thromboembolism and acute aortic syndromes, often with other ancillary findings that can provide important clinical information. The three most common life-threatening cardiovascular processes in which advanced imaging plays a role, particularly CT, are discussed, including pulmonary embolism, aortic dissection, and coronary artery disease.
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PMID:CT and MRI of acute thoracic cardiovascular emergencies. 1796 65

Brainstem gliomas in adults are rare tumors, with heterogeneous clinical course; only a few studies in the MRI era describe the features in consistent groups of patients. In this retrospective study, we report clinical features at onset, imaging characteristics and subsequent course in a group of 34 adult patients with either histologically proven or clinico-radiologically diagnosed brainstem gliomas followed at two centers in Northern Italy. Of the patients 18 were male, 14 female, with a median age of 31. In 21 of the patients histology was obtained and in 20 it was informative (2 pilocytic astrocytoma, 9 low-grade astrocytoma, 8 anaplastic astrocytoma and 1 glioblastoma). Contrast enhancement at MRI was present in 14 patients. In all of the 9 patients who were investigated with MR spectroscopy, the Cho/NAA ratio was elevated at diagnosis. In 8 of the patients, an initial watch and wait policy was adopted, while 24 were treated shortly after diagnosis with either radiotherapy alone [4] or radiotherapy and chemotherapy [20] (mostly temozolomide). Only minor radiological responses were observed after treatments; in a significant proportion of patients (9 out of 15) clinical improvement during therapy occurred in the context of radiologically (MRI) stable disease. Grade III or IV myelotoxicity was observed in 6 patients. After a follow-up ranging from 9 to 180 months, all but 2 patients have progressed and 14 have died (12 for disease progression, 2 for pulmonary embolism). Median overall survival time was of 59 months. Investigation of putative prognostically relevant parameters showed that a short time between disease onset and diagnosis was related to a shorter survival. Compared with literature data, our study confirms the clinical and radiological heterogeneity of adult brainstem gliomas and underscores the need for multicenter trials in order to assess the efficacy of treatments in these tumors.
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PMID:Natural history and management of brainstem gliomas in adults. A retrospective Italian study. 1829 27

Acute coronary syndrome, with an estimated prevalence of 300 000 cases annually in France, is one of the principal diagnostic and therapeutic emergencies in atheroma. In cases of atypical chest pain, with or without signs of severity, coronary, aortic and pulmonary CT should allow emergency specialists to rule out rapidly diagnoses of coronary disease, pulmonary embolism, aortic dissection or other chest conditions. Should acute coronary syndrome develop after immediate therapeutic management, a cardiac MRI will provide the cardiologist with the additional data necessary to assess the patient's prognosis--especially by assessing myocardial viability--and decide on subsequent management. In cases of acute coronary syndrome with normal coronary angiography, cardiac MRI can distinguish myocardial infarction from myocarditis or from Tako Tsubo syndrome.
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PMID:[Cardiac CT and MRI in acute coronary syndrome]. 1831 1

Popliteal venous aneurysm is a rare cause of recurrent pulmonary embolism, although the true incidence of aneurysm is probably underestimated. One-third of patients suffer further embolic events despite therapeutic anticoagulation. We report the case of a 59-year-old male who presented with recurrent PEs over a period of 12 years despite anticoagulation therapy. A thrombophilia screen and abdominal ultrasound were normal at that time. He reattended with recurrent pulmonary emboli, left calf swelling, and a mass in his left popliteal fossa causing limitation of knee movement. Venous duplex and MRI of his popliteal fossa demonstrated a thrombosed true popliteal venous aneurysm with popliteal and superficial femoral vein occlusion. In view of the mass effect we proceeded to surgical excision of his aneurysm after prophylactic placement of an IVC filter. The patient regained normal knee function with intensive inpatient physiotherapy. He has been recommenced on lifelong anticoagulant. The presentation, investigation, and management of the condition are briefly discussed. We suggest that a bilateral lower limb duplex is performed to exclude venous aneurysm in all patients presenting with pulmonary embolism in which an underlying source cannot otherwise be identified and no thrombophilic tendency is detected.
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PMID:Popliteal venous aneurysm: a rare cause of recurrent pulmonary emboli and limb swelling. 1836 74

Thrombus (blood clot) is implicated in a number of life threatening diseases, e.g., heart attack, stroke, pulmonary embolism. EP-2104R is an MRI contrast agent designed to detect thrombus by binding to the protein fibrin, present in all thrombi. EP-2104R comprises an 11 amino acid peptide derivatized with 2 GdDOTA-like moieties at both the C- and N-terminus of the peptide (4 Gd in total). EP-2104R was synthesized by a mixture of solid phase and solution techniques. The La(III) analogue was characterized by and 1D and 2D NMR spectroscopy and was found to have the expected structure. EP-2104R was found to be significantly more inert to Gd(III) loss than commercial contrast agents. At the most extreme conditions tested (pH 3, 60 degrees C, 96 hrs), less than 10% of Gd was removed from EP-2104R by a challenge with a DTPA based ligand, while the commercial contrast agents equilibrated within minutes to hours. EP-2104R binds equally to two sites on human fibrin (Kd = 1.7 +/- 0.5 microM) and has a similar affinity to mouse, rat, rabbit, pig, and dog fibrin. EP-2104R has excellent specificity for fibrin over fibrinogen (over 100-fold) and for fibrin over serum albumin (over 1000-fold). The relaxivity of EP-2104R bound to fibrin at 37 degrees C and 1.4 T was 71.4 mM(-1) s(-1) per molecule of EP-2104R (17.4 per Gd), about 25 times higher than that of GdDOTA measured under the same conditions. Strong fibrin binding, fibrin selectivity, and high molecular relaxivity enable EP-2104R to detect blood clots in vivo.
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PMID:EP-2104R: a fibrin-specific gadolinium-Based MRI contrast agent for detection of thrombus. 1839 3

A 40-year-old man was admitted with a massive pericarditis constrictiva calcarea. Transthoracic and transoesophageal echocardiography demonstrated a double-layered pericardial calcification with interspacial effusion, a massive compression of the right ventricle, and a thrombus formation in the ventricle. In addition, severe pulmonary embolism due to this right ventricular thrombus formation was diagnosed by CT. This case demonstrates the importance of a multimodal imaging approach (echocardiography, TDI, MRI, CT) in the diagnosis of constrictive pericarditis and pericardial masses. In respect to the severe pericardial calcification with the massive interspacial mass, and the compression of the right ventricle with thrombus formation and consecutive pulmonary embolism, this case appears to be a very rare and uncommon clinical finding.
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PMID:Massive pericarditis constrictiva calcarea with compression of the right ventricle and consecutive pulmonary embolism. 1916 61

In this study, we evaluated patients with pulmonary arterial hypertension (PAH) and impaired right ventricular function. We used cardiac MRI for the detection of myocardial delayed enhancement (MDE) and its possible association with other clinical variables. 20 patients (6 males and 14 females, aged 44.5+/-11 years; 15 New York Heart Association class III, 5 class IV) with known PAH (13 idiopathic, 7 resulting from chronic pulmonary embolism) were evaluated for the detection of MDE. Short-axis cine images of the heart were made for ventricular function assessment using a steady-state free precession sequence. For MDE evaluation, a short-axis phase-sensitive inversion recovery sequence was performed 10 min after intravenous administration of 0.2 mmol kg(-1) gadodiamide. Right ventricle (RV) systolic dysfunction, RV enlargement and RV hypertrophy were present in 20 patients (RV ejection fraction, 21.5+/-7.2%; RV diastolic diameter, 5.97+/-0.79 cm; RV wall thickness, 0.73+/-0.10 cm). 13 of the 20 patients (65%) were positive for MDE (10 anterior, 12 inferior). All 13 positive patients with MDE demonstrated small hyperintense areas at the insertion points of the RV free wall in the interventricular septum. We found no significant correlation between MDE and ejection fraction or other haemodynamic variables. In this study, MDE correlated positively only with the duration of disease. We found that septal MDE can be present in patients with PAH and impaired ventricular function. However, further studies are necessary to investigate this possible association and its prognostic implication.
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PMID:Myocardial delayed enhancement in patients with pulmonary hypertension and right ventricular failure: evaluation by cardiac MRI. 1939 66

Isolated ventricular non-compaction (IVNC) is a rare, congenital, unclassified cardiomyopathy characterized by prominent trabecular meshwork and deep recesses. Major clinical manifestations of IVNC are heart failure, atrial and ventricular arrhythmias, and thrombo-embolic events. We describe a case of a 69-year-old woman in whom the diagnosis of IVNC was discovered late, whereas former echocardiographic examinations were considered normal. She was known for systolic left ventricular dysfunction for 3 years and then became symptomatic (NYHA III). In the past, she suffered from multiple episodes of deep vein thrombosis and pulmonary embolism. Electrocardiogram revealed a wide QRS complex, and transthoracic echocardiography showed typical apical thickening of the left and right ventricular myocardial wall with two distinct layers. The ratio of non-compacted to compacted myocardium was >2:1. Cardiac MRI confirmed the echocardiographic images. Cerebral MRI revealed multiple ischaemic sequellae. In view of the persistent refractory, heart failure in medical treatment of patients with classical criteria for cardiac re-synchronization therapy, as well as the ventricular arrhythmias, a biventricular automatic intracardiac defibrillator (biventricular ICD) was implanted. The 2-year follow-up period was characterized by improvement of NYHA functional class from III to I and increasing in left ventricular function. We hereby present a case of IVNC with favourable outcome after biventricular ICD implantation. Cardiac re-synchronization therapy could be considered in the management of this pathology.
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PMID:Cardiac re-synchronization therapy in a patient with isolated ventricular non-compaction: a case report. 1940 40

Commonly, pulmonary hypertension is clinically suspected because of unexplained exertional dyspnoea or as a chance finding in clinical examination revealing signs of right heart failure. The systematic diagnostic approach and exact classification is based on the Venice classification. Basic investigations include ECG, chest radiograph, lung function studies and echocardiography. Echocardiography is the most important investigation for the diagnosis of pulmonary hypertension. It also serves as non invasive control during treatment and as the main screening test for pulmonary hypertension. Echocardiographic criteria of pulmonary hypertension are a dilated and hypertrophied right ventricle, paradoxic septum movement, a dilated right atrium, and a distended inferior Vena cava. Using Doppler echocardiography, the right ventricular and thus pulmonary arterial systolic pressure can be determined from the tricuspid regurgitant jet velocity. CT of the chest serves to exclude pulmonary embolism and interstitial lung disorders. Cardiac MRI is increasingly being used for analysis of right ventricular morphology, function and haemdynamics. The 6 minute walk test and cardiopulmonary exercise test are used to assess severity and response to treatment and give prognostic information. For the definite diagnosis of pulmonary hypertension, right heart catheterisation is required for the determination of the pulmonary vascular resistance and pharmacological testing of "reversibility".
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PMID:[Diagnostics in pulmonary hypertension]. 1959 Aug 42

Hydatidosis is a parasitic disease found worldwide, particularly in Mediterranean countries, caused by Echinococcus granulosis infection. Humans are an intermediate and accidental host in the cycle of this parasite. The hydatid pulmonary arterial embolism is extremely rare, usually arising in the heart or the liver. We report a case of hydatid pulmonary embolism explored with multidetector scanner and MRI, and confirmed at pathology of the operative specimen. To our knowledge, this is the first case of inaugural hydatid pulmonary arterial embolism found on CT scan establishing the diagnosis of the disease in a patient who had no other location of hydatid cyst.
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PMID:[Hydatid disease diagnosed following a pulmonary embolism]. 1961 35


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