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Query: UMLS:C0149871 (deep vein thrombosis)
 12,364 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In an effort to call attention to a lesion which is possibly provoked by ingestion of oral contraceptives, this case report of a 23-year-old woman, who had been taking Minovlar for 3 years admitted to the hospital after sudden onset of complete right-sided hemiplegia and total motor aphasia is presented. There was no clinical evidence of deep vein thrombosis or other cerebral, coronary, or other arterial occlusions due to embolism on admission. 1 week later, bilateral leg venography showed a normal left leg but the right leg showed nonfilling of the deep veins of the calf. In the process of a right-heart catherization, an atrial communication was crossed which proved to be a patent foramen ovale by pulmonary artery pressures and dilution indicator curves. Hence, a clinical diagnosis of paradoxical embolism was made on the grounds of combined evidence of deep vein thrombosis, electrocardiogram changes of acute cor pulmonale, which were entirely different from those known to accompany primary cerebrosvascular lesions, and catheter studies typical of embolism rather than thrombosis. This case prompted the authors to call for prospective studies to reveal paradoxical embolism in oral contraceptive users, rather than venous thrombosis.
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PMID:Paradoxical embolism associated with oral contraceptives: an underdiagnosed lesion? 48 90

The clinical and echocardiographic features of right atrial thrombi were examined in 9 patients, 5 men and 4 women aged 16 to 86 years. The 2D echocardiographic diagnosis was confirmed at autopsy (4 cases) or by the association of severe recurrent pulmonary embolism (5 cases). Three patients had associated ischaemic heart disease and on patient had dilated cardiomyopathy. The clinical presentation was: acute cor pulmonale (5 cases including 2 patients which biventricular myocardial infarction), chronic post-embolic cor pulmonale (1 case), tricuspid valve obstruction (1 case), general ill health with pyrexia (1 case) and heparin-induced thrombocytopenia (1 case). Predisposing factors included: absence of anticoagulent therapy (7 cases), previous supraventricular arrhythmias (2 cases) and right ventricular failure (6 cases, including 2 of right ventricular infarction). In 2 patients the thrombi were relatively immobile and had a wide base of implantation on the interatrial septum; in 1 patient, multiple thrombi were observed lining the right heart cavities from the inferior vena cava to the pulmonary infundibulum. In the other 6 patients, the thrombi were very mobile with a visible pedicule of implantation (2 cases) or totally free (4 cases). The variable polylobulated appearances, completely irregular whirling motion and intermittent prolapse into the tricuspid valve were characteristic features of the latter 4 cases. They disappeared spontaneously (2 cases) or after fibrinolytic therapy (2 cases) in under 36 hours. Three patients were operated with one postoperative death. The global hospital mortality was 22%. The present occasional detection of right atrial thrombosis will certainly become more common if patients with pulmonary embolism, right ventricular infarction or deep venous thrombosis are systematically examined by 2D echocardiography in the acute phase of their illness.
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PMID:[Clinical, echocardiographic and evolutive aspects of right atrial thrombosis]. 308 12

Pulmonary embolism is poorly diagnosed and therefore not treated in patients with chronic diseases, whereas it is overdiagnosed in formerly healthy patients. The diagnostic level is not satisfactory even in departments of cardiology. Insufficient use of auxiliary laboratory tests constitutes one of the main reasons for the unsatisfactory state of pulmonary embolism diagnostics. The clinical picture of pulmonary embolism depends on a) the size of pulmonary embolism, b) the previous state of the cardiopulmonary system. A massive pulmonary embolism can lead to a) sudden death, b) shock, c) acute cor pulmonale. The most typical diagnostic sign is suddenly developed or deteriorated dyspnea (present in 94% of patients). The presence of venous thrombosis and the appearance of sudden dyspnea always support the diagnosis very strongly. Dyspnea or tachypnea occur in more than 90% of patients. Dyspnea, tachypnea or deep venous thrombosis occur in 99% of patients with acute pulmonary embolism. Electrocardiographic signs of acute pulmonary embolism were present in 67% of our patients with hemodynamically significant pulmonary embolism. Electrocardiographic signs are most marked in cases in which pulmonary embolism originates suddenly, in patients with a normal cardiopulmonary system, if the pulmonary embolism is extensive and the electrocardiogram is carried out early and repeatedly. The electrocardiographic signs of pulmonary embolism in cardiac patients, however, are not specific and only rarely present. The principal advantages of the chest X-ray are simplicity, safety and low costs. A negative chest X-ray was found only in 16.6% of our patients with pulmonary embolism.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The diagnosis of pulmonary embolism. 653 69

Ten days after surgical treatment of a gastric perforation a 70-year-old woman developed progressive dyspnoea and hypertension without any signs of deep vein thrombosis. Emergency echocardiography revealed acute cor pulmonale with a dilated right atrium and ventricle, as well as paradoxical ventricular septal motion. In addition it demonstrated an elongated, extremely mobile thrombus stuck in a patent foramen ovale with most of it floating in the right atrium, the remainder in the left atrium. Within 2 hours of the ultrasound examination she went into fulminant pulmonary embolism with circulatory arrest and paradoxical embolization from the atria to the brain, after which the intraatrial thrombus was no longer detectable. She was successfully resuscitated and thrombolysis was immediately started with tissue-plasminogen activator (100 mg over 90 min), with ensuing stabilization of the circulation. The patient was gradually weaned off the ventilator over the following few days, but she died 10 days after the resuscitation from the severe cerebral damage.
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PMID:[Transient thrombus in patent foramen ovale with pulmonary and paradoxical embolization]. 824 45

Risk factors for pulmonary embolism include immobilization, trauma and surgery, particularly for hip fracture. Patients may present with acute respiratory symptoms, including tachypnea, tachycardia and rales. Chest radiographs and clinical and laboratory findings alone cannot provide a firm diagnosis. A completely normal chest radiograph may be seen in up to 40 percent of patients with pulmonary embolism, and as many as 30 percent of persons with pulmonary embolism and no prior cardiopulmonary disease will have a PaO2 greater than 80 mm Hg. The ventilation/perfusion (V/Q) lung scan is central to guiding clinical decisions. V/Q scans interpreted as either normal, near normal or high probability are reasonably diagnostic. A low probability V/Q scan can exclude the diagnosis of pulmonary embolism only if the patient has a clinically low probability of pulmonary embolism. Intermediate V/Q scans are not diagnostic and call for further evaluation. Compression ultrasonography is sensitive in detecting symptomatic deep venous thrombosis in the thigh. When clinical suspicion remains high and noninvasive imaging studies are uncertain, pulmonary angiography is likely to be diagnostic.
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PMID:An approach to diagnostic imaging of suspected pulmonary embolism. 862 70

The prognosis of thromboembolic disease depends, to a large degree, on the deep venous thrombosis. It is located in the legs in nearly 80% of cases and proximal to the popliteal vein in one out of two patients. It is the cause of recurrence and at longer term, of post-thrombotic disease, the frequency of which contrasts with the rarity of chronic post-embolic cor pulmonale. The deep vein thrombosis is often neglected, either because it has no clinical expression or because the symptoms it causes regress rapidly with treatment. Venous ultrasonography by a skilled operator, a painless and easily repeated investigation, is the method of first intention. When the thrombus is not well visualised, it is necessary to complete the investigation with bilateral phlebocavography in free flow or with a computerised tomography scan if the vena cava is poorly seen. The treatment of the pulmonary embolism depends on its size, its tolerance, the embolic source and sites of embolism. Severe pulmonary embolism may require surgical embolectomy at the outset, during which inferior vena cava interruption should be systematic. When thrombolytic therapy is considered, the implantation of a temporary caval filter should be proposed, especially if the thrombus is "floating" or extends into the inferior vena cava. If pulmonary embolism is associated with a recent proximal venous thrombosis it would seem logical to propose surgical thrombectomy or thrombolysis, at least in young patients. Conversely, distal deep vein thrombosis only requires heparin therapy. Interruption of the inferior vena cava is essential when embolism complicates well-treated deep vein thrombosis or when the thrombosis becomes more extensive despite effective treatment. It is also advisable when pulmonary sequellae are severe, long-term anticoagulant therapy is contra-indicated or when the aetiology of the thromboembolism cannot be determined.
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PMID:[Management of the venous pole in pulmonary embolism]. 881 40

A current problem associated with pulmonary thromboembolism is the absence of a decrease in the mortality rate, which seems due to overlooking of the disease and subsequent sudden death. This study tried to find methods to decrease the mortality rate through a clinical investigation of sudden death. Of 162 patients, 44 suffered sudden death (within 24 hours of onset). Among these, 28 patients died within 1 hour and 9 within 1 to 24 hours. In the remaining seven patients, the time until death could not be determined because the subject was detected postmortem. Pathological examination revealed occlusion of the pulmonary trunk or the bilateral pulmonary arteries in 58% (23/40). All patients who did not receive adequate cardiopulmonary resuscitation suffered occlusion at these sites. Occlusion of one of the pulmonary arteries or of the peripheral arteries alone was found in 42% (17/40) and all these patients received adequate cardiopulmonary resuscitation. In addition, the incidence of cardiopulmonary disease was 56% in this group, which was higher than the rate of 35% for the group with central occlusion. Of the nine patients with sudden death after 1 to 24 hours, five died at 5 or more hours after the onset and none had been examined by a physician. Among patients dying within 1 hour, 60% of those with onset outside hospital had preexisting symptoms, suggesting sudden death can be avoided by educating the general population about the major symptoms. In contrast, the frequency of preexisting symptoms in the inpatients was low. As it is difficult to differentiate preexisting symptoms from symptoms caused by the underlying disease, it may be impossible to predict sudden death due to acute pulmonary thromboembolism. Therefore, better measures to prevent deep vein thrombosis are required.
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PMID:[Sudden death in acute pulmonary embolism]. 930 14

Severe pulmonary hypertension due to tumor cell microemboli or lymphangitic carcinomatosis is a rare complication of malignant disease. In most of the reported cases, a clinical picture of subacute cor pulmonale developed. A 57-year-old man with deep vein thrombosis in his left calf developed acute progressive dyspnea with hypoxemia, cyanosis and the clinical picture of acute cor pulmonale, while he was on full heparinization. Respiratory failure with the need for mechanical ventilatory support developed within 2 days. Chest radiography revealed the development of acute cardiac enlargement, dilated pulmonary artery and diffuse opacities in the fields of both lungs. Open lung biopsy disclosed massive tumor cell microemboli and lymphangitic carcinomatosis. No parenchymal metastases were found. This case is extremely rare because of the rapid development of the patient's respiratory signs and symptoms of acute cor pulmonale due to pulmonary tumor cell microemboli and lymphangitic carcinomatosis. It is also most atypical because of the rare pulmonary radiographic presentation.
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PMID:Acute cor pulmonale due to tumor cell microemboli. 931 Oct 58

A patient with a pulmonary embolism due to deep vein thrombosis of a lower extremity developed hypotension and cor pulmonale despite prior placement of an inferior vena caval filter and treatment with a thrombolytic agent. After failure of percutaneous guidewire fragmentation and thrombosuction, self-expandable bilateral Z stents were positioned into the lower branches through the pulmonary arterial trunks. The patient experienced immediate relief of her cor pulmonale and successful recovery from hypotension.
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PMID:Emergent Z stent placement for treatment of cor pulmonale due to pulmonary emboli after failed lytic treatment: technical considerations. 962 47

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare, congenital disorder characterized by the triad of varicose veins, cutaneous hemangiomas, and hypertrophy of soft tissue and bone. We present the case of a woman with KTWS, cor pulmonale, and death due to recurrent pulmonary embolism (PE). The risk of deep venous thrombosis and PE in patients with KTWS is evaluated, and treatment recommendations are made with emphasis on the role of early, aggressive management in the subset of patients with KTWS known to have thromboembolic disease.
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PMID:Recurrent pulmonary embolism associated with Klippel-Trenaunay-Weber syndrome. 1020 31


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