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3.
Int Heart J ; 62(1): 211-215, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33518660

RESUMO

Anticoagulation is recommended for the treatment of pulmonary embolism (PE) and deep vein thrombosis (DVT). In some cases, an inferior vena cava (IVC) filter is used to prevent PE. We report the case of a 70-year-old woman who developed non-massive PE and proximal DVT, which were treated using an IVC filter; two filters were placed owing to the fracture of the filters. Few previous reports have discussed IVC fractures and the difficulty in detecting such fractures on computed tomography before retrieval. Based on our experience, we suggest that a temporary IVC filter for DVT treatment should be considered carefully.


Assuntos
Filtros de Veia Cava/efeitos adversos , Idoso , Feminino , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/terapia , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
4.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563693

RESUMO

A 54 year-old man was admitted after being found on the floor of his home, thought to have been there for approximately 5 days. He was diagnosed with a non-ST elevation myocardial infarction and bilateral cerebral ischaemic infarcts, as well as an acute kidney injury driven by rhabdomyolysis. The following day, bilateral lower limb ischaemia was observed. A full body CT angiogram revealed a complete thromboembolic shower with bilateral arterial occlusion in the lower limbs, bilateral pulmonary emboli, a splenic infarct and mesenteric ischaemia. An echocardiogram revealed a large thrombus in the left ventricle as the likely thromboembolic source. Bilateral lower limb amputations were recommended, commencing a complex discussion regarding the best course of management for this patient. The discussion was multifaceted, owing to the patient's lack of capacity, and input from multiple teams and the patient's relatives was required. Both ethical and clinical challenges arise from this case of a thromboembolic shower.


Assuntos
Tromboembolia/diagnóstico por imagem , Tromboembolia/terapia , Amputação , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/terapia , Biomarcadores/sangue , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/terapia , Angiografia por Tomografia Computadorizada , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/terapia , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/terapia , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/terapia , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/terapia
5.
Medicine (Baltimore) ; 100(1): e24230, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429821

RESUMO

INTRODUCTION: Although venous thromboembolism (VTE) is relatively rare after unicompartmental knee arthroplasty (UKA), symptomatic pulmonary embolism (PE) can be fatal. Whether routine thromboprophylaxis or thrombolytic treatment is necessary for patients undergoing UKA remains unclear. Here, we present a case of delayed pulmonary embolism after UKA. PATIENT CONCERNS: A 57-year-old women underwent cemented UKA for left localized medial knee pain. There were no risk factors of VTE besides high BMI before surgery. 2 months after surgery, the patient presented with dyspnea and palpitation, and these symptoms could not be alleviated after rest. DIAGNOSIS: An arterial blood gas analysis showed decreased PO2, SO2 and PCO2. Pulmonary CTA showed multiple pulmonary embolism in the trunk of the right lower pulmonary artery and the branch of the left lower pulmonary arteries. The final diagnosis was delayed pulmonary embolism after UKA. INTERVENTIONS: Urokinase thrombolysis was administered intravenously. Low molecular weight heparin and warfarin were prescribed for anticoagulation. OUTCOMES: The patient's symptoms abated, and chest CTA showed that the pulmonary embolism had dissolved. No further thrombosis has been observed for more than 6 years. CONCLUSIONS: We presented an unusual case of delayed pulmonary embolism after UKA. Despite the low incidence, its life-threatening nature makes it imperative for surgeons to be well-informed about thrombosis and pay more attention to its prevention strategies.


Assuntos
Artroplastia do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Embolia Pulmonar/diagnóstico , Anticoagulantes/uso terapêutico , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Infusões Intravenosas , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Varfarina/uso terapêutico
6.
BMJ Case Rep ; 14(1)2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33452066

RESUMO

A 53-year-old man with diabetes came to the emergency department with fever and dry cough for 5 days, swelling of the left leg for 2 days, shortness of breath and chest pain for 1 hour. He had raised temperature, tachycardia, tachypnoea, reduced oxygen saturation and swollen tender left leg on examination. The frontal chest radiograph showed bilateral ground-glass opacities; he tested positive for COVID-19 with elevated D-dimer. The colour Doppler examination of the left leg revealed acute deep vein thrombosis (DVT) of the common femoral and the popliteal veins. The chest CT showed bilateral diffuse ground-glass opacities predominantly involving peripheral zones and the lower lobes. The CTPA revealed left pulmonary thromboembolism (PTE), treated with low-molecular-weight heparin. COVID-19 predominantly affects the respiratory system. DVT and PTE are common in COVID-19 but lethal. They should be diagnosed early by clinical and radiological examinations and treated promptly with anticoagulants.


Assuntos
/complicações , Embolia Pulmonar/etiologia , Trombose Venosa/etiologia , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Antiparasitários/uso terapêutico , Antivirais/uso terapêutico , /diagnóstico , /terapia , Angiografia por Tomografia Computadorizada , Diabetes Mellitus Tipo 2/complicações , Doxiciclina/uso terapêutico , Veia Femoral , Produtos de Degradação da Fibrina e do Fibrinogênio , Glucocorticoides/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Ivermectina/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Oxigenoterapia , Veia Poplítea , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/terapia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
9.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509878

RESUMO

We present a case of a 38-year-old man with a history of chronic thromboembolic pulmonary hypertension on therapeutic anticoagulation and recent hospitalisation for COVID-19 disease who was hospitalised for recurrent acute pulmonary embolism despite therapeutic anticoagulation with warfarin (International Normalized Ratio (INR) of 3.0). Our case highlights the hypercoagulable state associated with COVID-19 disease and the absence of standardised approaches to anticoagulation treatment for this population.


Assuntos
Anticoagulantes/uso terapêutico , Embolia Pulmonar/complicações , Embolia Pulmonar/tratamento farmacológico , Varfarina/uso terapêutico , Adulto , Doença Crônica , Diagnóstico Diferencial , Humanos , Masculino , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
10.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495170

RESUMO

It is recognised that infective endocarditis is frequently a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged man was admitted with an 8-day history of profuse non-bloody diarrhoea and vomiting. He had no medical history and no identifiable risk factors for infective endocarditis, and so this in combination with the patient's atypical symptoms presented a diagnostic challenge. The patient was eventually diagnosed with a Staphylococcus aureus right-sided infective endocarditis. This case report explores the events which led to this diagnosis and demonstrates a number of unique learning points. It also highlights the importance of maintaining an open mind and being prepared to revise an initial diagnosis in the face of medical uncertainty.


Assuntos
Bacteriemia/diagnóstico , Disenteria/diagnóstico , Endocardite Bacteriana/diagnóstico por imagem , Pneumonia/diagnóstico , Embolia Pulmonar/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Bacteriemia/complicações , Hemocultura , Proteína C-Reativa , Diagnóstico Diferencial , Diarreia/fisiopatologia , Escore de Alerta Precoce , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/fisiopatologia , Humanos , Hipóxia , Ácido Láctico , Leucocitose , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/etiologia , Infecções Estafilocócicas , Insuficiência da Valva Tricúspide/etiologia , Vômito/fisiopatologia
11.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472803

RESUMO

Granulicatella adiacens, which occurs as part of the oral microflora, is an uncommon cause of infection. However, it can cause serious bloodstream infections including infective endocarditis. Although oral bacteria, most commonly the Fusobacterium spp, can cause internal jugular vein (IJV) thrombophlebitis, there are no reported cases of IJV thrombosis caused by G. adiacens Here we report a patient with septic IJV thrombosis with G. adiacens bacteraemia. A middle-aged man presented to our hospital with fever and altered mental status. Blood cultures were positive for G. adiacens, and pan-scan CT with contrast showed left IJV thrombosis, pulmonary embolism and abscesses in the gluteal muscles. The patient was successfully treated with antibiotics. When confronted with G. adiacens bacteraemia in patients with poor oral hygiene, it is necessary to be cautious of the fact that this organism can cause IJV thrombophlebitis.


Assuntos
Abscesso/diagnóstico por imagem , Carnobacteriaceae , Infecções por Bactérias Gram-Positivas/diagnóstico , Veias Jugulares , Embolia Pulmonar/diagnóstico por imagem , Tromboflebite/diagnóstico por imagem , Abscesso/terapia , Antibacterianos/uso terapêutico , Hemocultura , Nádegas , Drenagem , Duração da Terapia , Inibidores do Fator Xa/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/etiologia , Piridinas/uso terapêutico , Tiazóis/uso terapêutico , Tromboflebite/tratamento farmacológico , Tomografia Computadorizada por Raios X
12.
Respir Res ; 22(1): 27, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33478514

RESUMO

BACKGROUND: Although pulmonary vascular bed has been the main subject of research for many years in pulmonary hypertension (PH), interest has recently started to divert towards the possibility of a co-existing peripheral microangiopathy. The aim of the current study was to investigate the presence of nailfold video-capillaroscopic (NVC) structural changes in patients with precapillary PH and to identify possible associations of NVC measurements with markers of disease severity. METHODS: Α prospective case-control study was performed in 28 consecutive patients with precapillary PH [14 with idiopathic pulmonary arterial hypertension (IPAH) and 14 with chronic thromboembolic pulmonary hypertension (CTEPH)] and 30 healthy controls. NVC quantitative and qualitative parameters were evaluated using Optilia Digital Capillaroscope. To ensure inter-observer repeatability capillaroscopic images were reviewed by two independent investigators. For multiple comparisons among continuous variables, one-way ANOVA or the Kruskal-Wallis test were used. Differences between the groups were tested with post-hoc analysis with adjustment for multiple comparisons (Bonferroni test). RESULTS: Both IPAH (71.4% were women, mean age 53.1 ± 13.4 years) and CTEPH (64.3% women, mean age 60.9 ± 14.4 years) groups presented reduced capillary density compared to healthy controls (8.4 ± 1.2 loops/mm and 8.0 ± 1.2 loops/mm vs. 9.7 ± 0.81 loops/mm, p < 0.001) and increased loop width (15.7 ± 3.9 µm and 15.8 ± 1.9 µm vs. 11.5 ± 2.3 µm, p < 0.001). More than half of patients with IPAH presented microhaemorrhages on capillary nailfold, while increased shape abnormalities in capillary morphology and more capillary thrombi per linear mm were detected in patients with CTEPH compared to patients with IPAH and healthy controls. All PH patients presented a non-specific NVC pattern compared to controls (p < 0.001). CONCLUSION: The findings of the study reveal a degree of significant peripheral microvascular alterations in patients with IPAH and CTEPH, suggesting a generalized impairment of peripheral microvasculature in pulmonary vascular disease.


Assuntos
Capilares/diagnóstico por imagem , Capilares/fisiologia , Hipertensão Pulmonar Primária Familiar/diagnóstico por imagem , Microcirculação/fisiologia , Angioscopia Microscópica/métodos , Embolia Pulmonar/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Hipertensão Pulmonar Primária Familiar/fisiopatologia , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/fisiopatologia
14.
PLoS One ; 16(1): e0245565, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33481902

RESUMO

BACKGROUND AND AIMS: Several studies reported a high incidence of pulmonary embolism (PE) among patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but detailed data about clinical characteristics, risk factors of these patients and prognostic role of PE are still lacking. We aim to evaluate the occurrence of pulmonary embolism among patients with SARS-CoV-2 infection, and to describe their risk factors, clinical characteristics, and in-hospital clinical outcomes. METHODS: This is a multicenter Italian study including 333 consecutive SARS-CoV-2 patients admitted to seven hospitals from February 22 to May 15, 2020. All the patients underwent computed tomography pulmonary angiography (CTPA) for PE detection. In particular, CTPA was performed in case of inadequate response to high-flow oxygen therapy (Fi02≥0.4 to maintain Sp02≥92%), elevated D-dimer (>0.5µg/mL), or echocardiographic signs of right ventricular dysfunction. Clinical, laboratory and radiological data were also analyzed. RESULTS: Among 333 patients with laboratory confirmed SARS-CoV-2 pneumonia and undergoing CTPA, PE was detected in 109 (33%) cases. At CTPA, subsegmental, segmental, lobar and central thrombi were detected in 31 (29%), 50 (46%), 20 (18%) and 8 (7%) cases, respectively. In-hospital death occurred in 29 (27%) patients in the PE-group and in 47 (21%) patients in the non-PE group (p = 0.25). Patients in PE-group had a low rate of traditional risk factors and deep vein thrombosis was detected in 29% of patients undergoing compression ultrasonography. In 71% of cases with documented PE, the thrombotic lesions were located in the correspondence of parenchymal consolidation areas. CONCLUSIONS: Despite a low rate of risk factors for venous thromboembolism, PE is present in about 1 out 3 patients with SARS-CoV-2 pneumonia undergoing CTPA for inadequate response to oxygen therapy, elevated D-dimer level, or echocardiographic signs of right ventricular dysfunction. In most of the cases, the thromboses were located distally in the pulmonary tree and were mainly confined within pneumonia areas.


Assuntos
/complicações , Embolia Pulmonar/etiologia , Doença Aguda , Idoso , /diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico por imagem , Fatores de Risco , /isolamento & purificação
16.
Arch. bronconeumol. (Ed. impr.) ; 57(supl.1): 35-46, ene. 2021. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-193097

RESUMO

OBJETIVO: Evaluar la capacidad diagnóstica de la angiografía pulmonar con tomografía computarizada multidetector (TCMD) y mapa de yodo en el diagnóstico del tromboembolismo pulmonar (TEP), en pacientes con enfermedad por coronavirus COVID-19. MÉTODOS: Estudio observacional retrospectivo sobre 81 pacientes consecutivos ingresados con infección respiratoria por COVID-19, a los que se realizó TCMD ante la sospecha clínica de TEP [disnea súbita, dolor torácico, hemoptisis, insuficiencia respiratoria grave (IRG) que no corrige con flujo elevado de O2] y/o elevación del D-dímero. RESULTADOS: De los 81 pacientes estudiados, 64 (79,01%) varones, identificamos TEP agudo en 22 (27,16%), en 13 (59,09%) bilateral y en 13 (59,09%) con áreas de hipoperfusión. De los 59 (72,83%) pacientes sin TEP en 41 (69,49%) se observó hipoperfusión (en un caso atribuible a enfisema pulmonar). En 18 (22,2%) del total de pacientes no se vio ni TEP ni hipoperfusión. El patrón «crazy paving» es un factor de riesgo para desarrollar TEP (OR1,94; IC95% 0,28-13,57), así como los patrones «consolidaciones» (OR 1,44; I C95% 0,24-8,48) y «engrosamiento septos/bronquiectasias» (OR 1,47; IC 95% 0,12-17,81). Los pacientes con IRG refractaria al O2 mostraron un riesgo 6,36 veces superior para el hallazgo de hipoperfusión en el mapa de yodo. CONCLUSIÓN: La angiografía pulmonar con TCMD y mapa de yodo, al añadir la imagen funcional a la anatómica, es capaz de demostrar, además del TEP en arterias principales, lobares y segmentarias, la presencia de hipoperfusión en vasos distales, lo cual la convierte en una herramienta de gran utilidad para la adecuada orientación diagnóstica y terapéutica de los pacientes con afectación pulmonar por COVID-19


OBJECTIVE: To evaluate the diagnostic capacity of pulmonary angiography with multidetector computed tomography (MDCT) and iodine mapping in the diagnosis of pulmonary thromboembolism (PTE) in patients with Covid-19 disease. METHODS: Retrospective observational study of 81 consecutive patients admitted with Covid-19 respiratory infection who underwent MDCT for clinical suspicion of PTE (sudden dyspnea, chest pain, hemoptysis, severe respiratory failure (SRF) not corrected with high O2 flow) and/or raised D-dimer. RESULTS: Of the 81 patients studied [64 (79.01%) men], acute PTE was identified in 22 (27.16%), bilaterally in 13 (59.09%), and 13 (59,09%) showed areas of hypoperfusion. Of the 59 (72.83%) patients without PTE, hypoperfusion was observed in 41 (69.49%) (attributable in one case to pulmonary emphysema). In 18 (22.2%) of the total number of patients, neither PTE nor hypoperfusion were seen. A crazy paving pattern is a risk factor for developing PTE (OR 1.94; 95% CI 0.28-13.57), as are consolidations (OR 1.44; 95% CI 0.24-8.48) and septal thickening/bronchiectasis (OR 1.47; 95% CI 0.12-17.81). Patients with O2-refractory SRF showed a 6.36-fold higher risk for hypoperfusion on the iodine map. CONCLUSION: By adding the functional image to the anatomical image, pulmonary angiography with MDCT and iodine mapping can demonstrate not only PTE in main, lobar and segmental arteries, but also the presence of hypoperfusion in distal vessels. This makes it a highly useful tool for the accurate diagnosis and therapeutic orientation of patients with Covid-19 lung involvement


Assuntos
Humanos , Masculino , Feminino , Idoso , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Iodo , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/virologia , Angiografia por Tomografia Computadorizada , Tomografia Computadorizada Multidetectores , Índice de Gravidade de Doença , Estudos Retrospectivos , Fatores de Risco
17.
Radiology ; 298(2): E70-E80, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33320063

RESUMO

Background The association of pulmonary embolism (PE) with deep vein thrombosis (DVT) in patients with coronavirus disease 2019 (COVID-19) remains unclear, and the diagnostic accuracy of D-dimer tests for PE is unknown. Purpose To conduct meta-analysis of the study-level incidence of PE and DVT and to evaluate the diagnostic accuracy of D-dimer tests for PE from multicenter individual patient data. Materials and Methods A systematic literature search identified studies evaluating the incidence of PE or DVT in patients with COVID-19 from January 1, 2020, to June 15, 2020. These outcomes were pooled using a random-effects model and were further evaluated using metaregression analysis. The diagnostic accuracy of D-dimer tests for PE was estimated on the basis of individual patient data using the summary receiver operating characteristic curve. Results Twenty-seven studies with 3342 patients with COVID-19 were included in the analysis. The pooled incidence rates of PE and DVT were 16.5% (95% CI: 11.6, 22.9; I2 = 0.93) and 14.8% (95% CI: 8.5, 24.5; I2 = 0.94), respectively. PE was more frequently found in patients who were admitted to the intensive care unit (ICU) (24.7% [95% CI: 18.6, 32.1] vs 10.5% [95% CI: 5.1, 20.2] in those not admitted to the ICU) and in studies with universal screening using CT pulmonary angiography. DVT was present in 42.4% of patients with PE. D-dimer tests had an area under the receiver operating characteristic curve of 0.737 for PE, and D-dimer levels of 500 and 1000 µg/L showed high sensitivity (96% and 91%, respectively) but low specificity (10% and 24%, respectively). Conclusion Pulmonary embolism (PE) and deep vein thrombosis (DVT) occurred in 16.5% and 14.8% of patients with coronavirus disease 2019 (COVID-19), respectively, and more than half of patients with PE lacked DVT. The cutoffs of D-dimer levels used to exclude PE in preexisting guidelines seem applicable to patients with COVID-19. © RSNA, 2020 Supplemental material is available for this article. See also the editorial by Woodard in this issue.


Assuntos
/complicações , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , /sangue , Angiografia por Tomografia Computadorizada/métodos , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Embolia Pulmonar/sangue , Trombose Venosa/sangue
19.
Radiología (Madr., Ed. impr.) ; 63: 0-0, 2021. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196553

RESUMO

Los pacientes con COVID-19 presentan una evolución muy variable: desde enfermos con síntomas leves de corta duración a pacientes con enfermedad grave que desarrollan un síndrome de distrés respiratorio agudo, con ingresos prolongados en unidades de críticos. Desde el punto de vista radiológico, la etapa inicial se caracteriza por una neumonía viral poco expresiva. No obstante, en algunos pacientes, con el inicio de la respuesta inmunitaria se produce un daño pulmonar agudo con patrones radiológicos de neumonía organizada y daño alveolar difuso. La enfermedad moderada-grave se asocia con una incidencia alta de tromboembolismo pulmonar, generalmente de distribución periférica y asociado al daño endotelial, encamamiento prolongado y coagulopatía de la enfermedad. Otras complicaciones relativamente frecuentes son: el neumotórax y el neumomediastino espontáneos por rotura de paredes alveolares, y el barotrauma en pacientes con ventilación mecánica. La sobreinfección es más frecuente en pacientes graves, generalmente de origen bacteriano y menos frecuente fúngico


Outcomes vary widely in patients with COVID-19. Whereas some patients have only mild symptoms of short duration, others develop severe disease that leads to acute respiratory distress syndrome requiring prolonged stays in intensive care units. Radiologically, the initial stage is characterized by viral pneumonia with mild expression. In some patients, however, the onset of the immune response results in acute lung damage with organizing pneumonia and diffuse alveolar damage. Moderate-severe disease is associated with a high incidence of pulmonary embolisms, generally peripherally distributed and associated with endothelial damage, prolonged stays in bed, and coagulopathy. Other relatively common complications are spontaneous pneumothorax and pneumomediastinum due to the rupture of alveolar walls and barotrauma in mechanically ventilated patients. Superinfection, generally bacterial and less commonly fungal, is more common in patients with severe disease


Assuntos
Humanos , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pandemias , Embolia Pulmonar/virologia , Pneumotórax/virologia , Enfisema Mediastínico/virologia , Síndrome do Desconforto Respiratório do Adulto/virologia , Índice de Gravidade de Doença , Embolia Pulmonar/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Enfisema Mediastínico/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Radiografia
20.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(12): 1055-1060, 2020 Dec 12.
Artigo em Chinês | MEDLINE | ID: mdl-33333639

RESUMO

Objective: To compare the values of the YEARS algorithm and the simplified Wells combined with age-adjusted D-dimer (sWells-Age) algorithm in the evaluation of patients with suspected acute pulmonary embolism (APE). Methods: Patients with suspected APE receiving CT pulmonary angiography (CTPA) were enrolled from 2016 to 2017. With CTPA results as the gold standard, we evaluated and compared the performance of the two algorithms in the whole population and in symptom-onset site (in-hospital, out-of-hospital) subgroups. Results: Among the 285 patients included, APE was confirmed by CTPA in 80 patients (28.1%). The two algorithms had a high level of diagnostic agreement (κ=0.855, P<0.05). The evaluated performance of the YEARS algorithm and the sWells-Age algorithm was as follows: 21.8% and 17.2% for the efficiencies; 1.6% and 0.0% for the failure rates; 29.8% and 23.9% for the specificities(P<0.05); 98.8% and 100.0% for the sensitivities. The efficiencies and the specificities of the two algorithms differed in the subgroups divided by symptom-onset sites (in-hospital, out-of-hospital). For the patients with symptoms-onset outside the hospital, the YEARS algorithm and the sWells-Age algorithm showed efficiencies of 33.0% and 26.9%, respectively, and specificities of 44.7% and 37.1%, respectively, (P<0.05).For the patients with symptoms-onset in hospital, the YEARS algorithm and the sWells-Age algorithm showed efficiencies of 1.9% and 0.0%, respectively, and specificities of 2.7% and 0.0%, respectively. Conclusions: The YEARS algorithm and the sWells-Age algorithm had a good diagnostic agreement and low failure rates and both could safely rule out APE. More patients with suspected APE could be safely excluded by the YEARS algorithm than the sWells-Age algorithm, especially in those suspected APE patients with out-of-hospital symptom-onset. However, both two algorithms were not applicable to suspected APE patients with in-hospital symptom-onset.


Assuntos
Angiografia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Embolia Pulmonar/diagnóstico por imagem , Algoritmos , China/epidemiologia , Medicina de Emergência , Serviço Hospitalar de Emergência , Hospitais , Humanos , Pneumologia , Tomografia Computadorizada por Raios X
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