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1.
Vasc Endovascular Surg ; 54(2): 135-140, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31769352

RESUMO

PURPOSE: Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis (USAT) appears to provide promising results for the management of acute submassive pulmonary embolisms (ASMPEs) at tertiary care centers. This study assessed outcome measures at a community-based hospital systems and compared results to known studies. MATERIALS AND METHODS: This is a single-center, retrospective study assessing clinical outcomes of the EkoSonic Endovascular System intervention for ASMPEs performed by three surgical 3 subspecialties (interventional radiology, interventional cardiology, and vascular surgery) part of a pulmonary embolism response team (PERT). We reviewed 146 PERT activations from June 2013 to December 2017. Eighty-three patients with ASMPEs underwent USAT. RESULTS: Our study showed greater differences (P = .01) between baseline and follow-up pulmonary artery systolic pressures (20.9 ± 9.8 mm Hg [n = 14]) compared to the ULTIMA study (12.3 ± 10 mm Hg [n = 30]). Our length-of-stay measures were shorter (6.1 ± 5.1 [n = 83]; P = .0001) compared to the SEATTLE II study (8.8 ± 5.0 [n = 150]). Preprocedure transthoracic echocardiograms (TTEs) were performed for 54 (65%) of 83 patients. Postprocedure TTEs at 48 hours was performed for 52 (62%) of 83 patients. Use of TTEs before and after intervention did not change outcomes. Intracranial hemorrhage was not observed in our patient population. There was no difference in outcomes between the three subspecialties in our study. CONCLUSIONS: Use of USAT in a community-based hospital PERT has similar outcomes to tertiary care centers. Furthermore, similar outcomes were observed between the three subspecialties suggesting development of a comprehensive care team for management of ASMPEs.


Assuntos
Cateterismo Periférico , Fibrinolíticos/administração & dosagem , Hospitais Comunitários , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Terapia por Ultrassom , Doença Aguda , Adulto , Idoso , Cardiologistas , Cateterismo Periférico/efeitos adversos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Masculino , Michigan , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Radiologistas , Estudos Retrospectivos , Especialização , Cirurgiões , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos
2.
Vasc Endovascular Surg ; 54(1): 58-64, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31500542

RESUMO

A retrospective review from July 2016 to April 2018 was performed of 23 patients with submassive pulmonary embolism (PE) who received catheter-directed thrombolysis (CDT). Five (22%) of the 23 patients were discharged the same day from the intensive care unit (ICU) following thrombolysis completion. Their presentation, hospital courses, complications, and follow-up are reviewed. All 5 patients were diagnosed using chest computed tomography (CT) demonstrating a clot in the pulmonary vasculature and right ventricle dysfunction based on abnormal right ventricle to left ventricle (RV/LV) ratio. Patients with severe right heart dysfunction (RV/LV ratio ≥1.4) were protocolized to receive CDT via EkoSonic catheters (EKOS Corporation). Postoperatively, patients were admitted to the ICU with continuous alteplase at 1 mg/h. Echocardiography was then performed after 24 hours of therapy to assess right ventricle function and removal of EkoSonic catheters. Patients with reversal of right heart dysfunction and symptomatic improvement received bedside removal of catheters. The mean patient age was 50.6 years and body mass index was 33.6. Mean RV/LV ratio on admission via CT imaging was 1.56, with a mean troponin of 0.44. Interval mean RV/LV ratio on echocardiography after thrombolysis therapy was 0.91. There was a 0% incidence of periprocedural complications. One (20%) patient out of 5 had an emergency department visit 10 days postdischarge for acute shortness of breath, with workup revealing no evidence of recurrent PE. No patient required hospital readmission within 30 days. At the 6-week follow-up, all patients had continued normal right ventricular function noted on echocardiography. This case series demonstrates that for a select population of patients with severe submassive PE, the use of CDT and echocardiography monitoring can facilitate same-day discharge from the ICU.


Assuntos
Fibrinolíticos/administração & dosagem , Unidades de Terapia Intensiva , Tempo de Internação , Alta do Paciente , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica/métodos , Adulto , Ecocardiografia , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Sistema de Registros , Estudos Retrospectivos , Índice de Gravidade de Doença , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/instrumentação , Fatores de Tempo , Resultado do Tratamento , Dispositivos de Acesso Vascular
3.
Radiol Clin North Am ; 58(1): 93-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731905

RESUMO

This article describes an approach to analyzing the distribution of intravenous contrast on chest computed tomography and illustrates the various pathologies and pitfalls that may be encountered by the imager, especially in the hospitalized patient. Understanding normal and abnormal distribution of intravenous contrast can be used as a clue to detect alterations in physiology and flow.


Assuntos
Meios de Contraste , Cardiopatias/diagnóstico por imagem , Pacientes Internados , Embolia Pulmonar/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X/métodos , Coração/diagnóstico por imagem , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Radiografia Torácica/métodos
4.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(4): 159-162, oct.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184304

RESUMO

La hipertensión pulmonar es una enfermedad compleja, grave y de baja incidencia. Es un estado hemodinámicamente patológico con una presión de arteria pulmonar que supera los 25 mmHg. La presencia de hipertensión pulmonar en el puerperio es poco frecuente y conlleva un alto riesgo para la madre. Se presenta el caso de una mujer de 31 años en puerperio mediato patológico post parto eutócico con datos de bajo gasto cardiaco. El ecocardiograma demostró la presión de la arteria pulmonar que iguala a la sistémica. La angiotomografía helicoidal de tórax descarta tromboembolismo pulmonar, y se realiza diagnóstico de hipertensión de la arteria pulmonar de etiología desconocida


Pulmonary hypertension is a complex, serious and low incidence disease. It is a haemodynamically pathological state with a pulmonary artery pressure that exceeds 25 mmHg. The presence of pulmonary hypertension in the puerperium is rare, and carries a high risk to the mother. The case is presented of a 31 year-old female in the subacute postpartum period of a normal delivery with data of low cardiac output. The echocardiogram showed that the pressure of the pulmonary artery was equal to the systemic. A thoracic helical angio-tomography ruled out pulmonary thromboembolism, making a diagnosis of pulmonary artery hypertension of unknown aetiology


Assuntos
Humanos , Feminino , Adulto , Hipertensão Pulmonar/etiologia , Período Pós-Parto , Embolia Pulmonar/diagnóstico por imagem , Hipertensão/etiologia , Embolia Pulmonar/complicações , Radiografia Torácica/métodos , Débito Cardíaco
5.
N Engl J Med ; 381(22): 2125-2134, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31774957

RESUMO

BACKGROUND: Retrospective analyses suggest that pulmonary embolism is ruled out by a d-dimer level of less than 1000 ng per milliliter in patients with a low clinical pretest probability (C-PTP) and by a d-dimer level of less than 500 ng per milliliter in patients with a moderate C-PTP. METHODS: We performed a prospective study in which pulmonary embolism was considered to be ruled out without further testing in outpatients with a low C-PTP and a d-dimer level of less than 1000 ng per milliliter or with a moderate C-PTP and a d-dimer level of less than 500 ng per milliliter. All other patients underwent chest imaging (usually computed tomographic pulmonary angiography). If pulmonary embolism was not diagnosed, patients did not receive anticoagulant therapy. All patients were followed for 3 months to detect venous thromboembolism. RESULTS: A total of 2017 patients were enrolled and evaluated, of whom 7.4% had pulmonary embolism on initial diagnostic testing. Of the 1325 patients who had a low C-PTP (1285 patients) or moderate C-PTP (40 patients) and a negative d-dimer test (i.e., <1000 or <500 ng per milliliter, respectively), none had venous thromboembolism during follow-up (95% confidence interval [CI], 0.00 to 0.29%). These included 315 patients who had a low C-PTP and a d-dimer level of 500 to 999 ng per milliliter (95% CI, 0.00 to 1.20%). Of all 1863 patients who did not receive a diagnosis of pulmonary embolism initially and did not receive anticoagulant therapy, 1 patient (0.05%; 95% CI, 0.01 to 0.30) had venous thromboembolism. Our diagnostic strategy resulted in the use of chest imaging in 34.3% of patients, whereas a strategy in which pulmonary embolism is considered to be ruled out with a low C-PTP and a d-dimer level of less than 500 ng per milliliter would result in the use of chest imaging in 51.9% (difference, -17.6 percentage points; 95% CI, -19.2 to -15.9). CONCLUSIONS: A combination of a low C-PTP and a d-dimer level of less than 1000 ng per milliliter identified a group of patients at low risk for pulmonary embolism during follow-up. (Funded by the Canadian Institutes of Health Research and others; PEGeD ClinicalTrials.gov number, NCT02483442.).


Assuntos
Angiografia por Tomografia Computadorizada , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Probabilidade , Estudos Prospectivos , Embolia Pulmonar/diagnóstico por imagem
6.
J Cardiothorac Surg ; 14(1): 196, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718656

RESUMO

BACKGROUND: Primary thrombosis of the pulmonary vasculatures without extra-pulmonary sources of embolism are uncommon. Here, we report 2 cases of thrombosis of the stump of the remnant pulmonary vasculatures after lung resection complicated by embolic events with review of the literature. CASE PRESENTATION: A 75-year-old female was consulted to evaluate cardiac source of embolism for acute cerebral infarction. The patient underwent left upper lobectomy because of lung cancer 2 years ago. Cardiovascular imaging revealed about 1.6 cm × 1.4 cm sized thrombus within the remnant stump of the left superior pulmonary vein. The patient was treated by anticoagulation with warfarin, because the patients refused surgical removal of thrombus. A 57-year-old female who had a history of right pneumonectomy 10 years ago presented with dyspnea. Cardiovascular imaging revealed 1.7 × 1.5 cm sized thrombus in the right pulmonary artery stump and small pulmonary embolism in the left lower segmental pulmonary artery. The patient was treated by long-term anticoagulation with warfarin, and the thrombus and pulmonary embolism were resolved. CONCLUSION: The present cases demonstrated that very late thrombosis of the remnant pulmonary vascular structures and subsequent fatal embolic complications can develope even several years later after lung resection. Therefore, the dead space of the remnant vascular structures should be minimized during lung resection surgery, and the developement of delayed thromboembolic complications associated with vascular stump thrombosis should be carefully monitored.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Embolia Pulmonar/etiologia , Veias Pulmonares/diagnóstico por imagem , Trombose Venosa/etiologia , Idoso , Infarto Encefálico/etiologia , Dispneia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Veias Pulmonares/cirurgia , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem
7.
Medicine (Baltimore) ; 98(48): e17953, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770203

RESUMO

Chronic thromboembolic pulmonary hypertension (CTEPH), a late complication of pulmonary embolism (PE), is associated with high mortality. However, whether the right ventricular (RV) echocardiographic parameters can predict - in the short- and long-term - the development of CTEPH and mortality after PE remains unknown. Herein, we aim to investigate the incidence of CTEPH after acute PE and to evaluate the risk factors of CTEPH. In this retrospective cohort, patients with PE were followed for 10 years for the onset of CTEPH. The screening was initially conducted through echocardiography and confirmed by right heart catheterization. Also, transient and permanent risk factors were identified. Among 358 patients with PE, 8 patients (4%) were subsequently diagnosed with CTEPH at a median time of 36 months and 47 died during the follow-up period. Notably, both short- and long-term RV dilatation, hypertrophy, and increased pulmonary pressure increased the incidence of CTEPH. However, RV echocardiographic parameters failed to differentiate survivors from non-survivors. Instead, malignancy, respiratory, or chronic heart failure was strongly associated with post PE mortality in the multivariable analysis. According to our findings, post PE screening of CTEPH may facilitate early diagnosis and intervention for patients at high risk of developing CTEPH. Also, RV echocardiographic parameters are associated with subsequent CTEPH, but mortality is mainly dependent on underlying comorbidities.


Assuntos
Ecocardiografia/estatística & dados numéricos , Hipertensão Pulmonar/diagnóstico por imagem , Embolia Pulmonar/mortalidade , Disfunção Ventricular Direita/diagnóstico por imagem , Idoso , Doença Crônica , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/mortalidade , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/mortalidade
8.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(10): 755-759, 2019 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-31594109

RESUMO

Objective: To analyze the clinical characteristics of pulmonary embolism patients from different altitudes in plateau areas. Methods: A retrospective cross-sectional study was used to analyze the patients with acute pulmonary embolism diagnosed definitely by pulmonary angiography or pulmonary artery CT angiography admitted to Tibet Autonomous Region People's Hospital from August 2014 to December 2018. The subjects were divided into 3 groups according to the altitude of long-term residence before onset, i.e. low-altitude group (group 1, 2 700 m ≤ altitude ≤3 700 m, n=44), medium-altitude group (group 2, 3 700 m

Assuntos
Altitude , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Dor no Peito/epidemiologia , China/epidemiologia , Angiografia por Tomografia Computadorizada , Estudos Transversais , Dispneia/epidemiologia , Humanos , Hipóxia , Incidência , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos
9.
Br J Radiol ; 92(1104): 20190526, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31595778

RESUMO

OBJECTIVE: Unsuspected pulmonary embolism (UPE) has been increasingly diagnosed as an incidental finding on CT scans for routine staging in cancer patients. Previous studies suggest that obesity is an independent risk factor for venous thromboembolism in patients with malignant tumors. In this study, we aimed to investigate the association between abdominal adipose tissue, especially visceral adipose tissue (VAT) and the occurrence of UPE in hospitalized patients with gastrointestinal cancer. METHODS: Routine contrast-enhanced chest and abdominal CT scans of 1974 patients were retrospectively assessed for the presence of UPE, of which 58 patients were identified with UPE and 108 non-UPE patients were selected as the non-UPE control group based on several matching criteria. Abdominal adipose tissue was measured by volumes of VAT and subcutaneous adipose tissue (SAT) at the navel level. RESULTS: VAT, SAT, indwelling venous catheters, surgery, chemotherapy, and bed rest or immobilization were associated with the occurrence of UPE. Higher VAT volumes were associated with increased risk of UPE (odds ratio: 1.96; 95% confidence interval: 1.25, 3.06; p = 0.003) adjusting body mass index (BMI), bed rest or immobilization, surgery, chemotherapy and smoking, while SAT was not associated with UPE adjusting the same confounders (p = 0.117). No statistical association was found between BMI and UPE (p = 0.102). CONCLUSION: Higher VAT rather than SAT is associated with an increased risk of unsuspected pulmonary embolism on routine CT scans in hospitalized gastrointestinal cancer patients. ADVANCES IN KNOWLEDGE: Our findings indicate that VAT is a stronger risk factor for unsuspected pulmonary embolism than BMI and SAT in hospitalized patients with gastrointestinal cancer.


Assuntos
Embolia Gordurosa/etiologia , Gordura Intra-Abdominal/diagnóstico por imagem , Embolia Pulmonar/etiologia , Gordura Subcutânea Abdominal/diagnóstico por imagem , Idoso , Repouso em Cama/efeitos adversos , Índice de Massa Corporal , Estudos de Casos e Controles , Cateteres de Demora/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Embolia Gordurosa/diagnóstico por imagem , Feminino , Neoplasias Gastrointestinais , Humanos , Imobilização/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco
10.
Medicine (Baltimore) ; 98(38): e17219, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567979

RESUMO

RATIONALE: Retained placenta accreta is an increasing obstetric problem in recent years, and pulmonary embolism (PE) during pregnancy and the postpartum period is a vital condition, but lack of standard therapy guidelines. This report describes a case of postpartum PE combined with retained placenta accreta. PATIENT CONCERNS: A 27-year-old woman presenting with fever and dyspnea after delivery was admitted to our hospital with retained placenta accreta. DIAGNOSES: The patient was diagnosed with the infection, postpartum PE, and residual placenta. INTERVENTIONS: The antibiotics and low molecular weight heparin were initially started to cure the infection and control PE. Mifepristone was then used to promote the necrosis of residual placenta while long-term use of warfarin was served as continuous anticoagulant therapy. Hysteroscopic resection of retained placenta was not performed until thrombi had been almost disappeared after more than 2 months of anticoagulation therapy. OUTCOMES: The patient's menstruation returned to normal within several weeks after hysteroscopic resection and she completely recovered from PE after 3 months of anticoagulant therapy. LESSONS: Treatment of retained placenta accreta can be postponed when encountering complicated cases, such as postpartum PE. PE in perinatal stage can be managed referring to nonmaternal PE.


Assuntos
Placenta Acreta/terapia , Placenta Retida/terapia , Período Pós-Parto , Embolia Pulmonar/terapia , Adulto , Feminino , Humanos , Placenta Acreta/diagnóstico , Placenta Retida/diagnóstico , Gravidez , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Tomografia Computadorizada por Raios X
11.
Can Assoc Radiol J ; 70(4): 388-393, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31540752

RESUMO

OBJECTIVES: Guidelines and high-quality studies recommend using clinical decision-making (CDM) tools over clinical gestalt when evaluating a patient for pulmonary embolism. The purpose of this study is to investigate our computed tomography pulmonary angiogram (CTPA) utilization patterns and identify causal factors. METHODS: A retrospective cohort study of CTPA studies ordered by emergency physicians in January, April, July, and October 2017 was undertaken. All necessary information to categorize patients by Wells' score, revised Geneva score, and pulmonary embolism rule-out criteria (PERC) was collected. In addition, various bloodwork, chest radiograph, and computed tomography results were collected. This data was analysed by the Pearson chi-square test or Fisher's exact test for categorical data and independent-samples t test for continuous variables. RESULTS: A total of 510 CTPA studies were performed, with a mean age was 61.6 and a 50.6% female population. 136 studies (26.7%) failed to appropriately follow any CDM tool. CDM tool failure rate was dependent on whether the study was ordered from a community (14.9%) or tertiary hospital (University of Alberta Hospital, 27.9% and Royal Alexandra Hospital, 24.6%) (P = .038). Of these 136 studies, 31 were low/moderate risk and the d-dimer was negative. The remainder were either PERC-negative or low/moderate risk without d-dimer performed. The cumulative positive pulmonary embolism rate was 12.5%. With utilization of a CDM tool, the positive pulmonary embolism rate was 15.0%, compared to 5.9% when using gestalt (P = .026). CONCLUSIONS: This study confirms a high rate of CDM tool use failure, and a higher positive CTPA rate for CDM tools compared to clinical gestalt.


Assuntos
Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Embolia Pulmonar/diagnóstico por imagem , Alberta , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Revisão da Utilização de Recursos de Saúde
14.
BMC Med Imaging ; 19(1): 65, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412797

RESUMO

BACKGROUND: Computed tomography pulmonary angiography (CTPA) is the gold standard for the diagnosis of pulmonary embolism (PE). However, contrast is contraindicated in some patients. The purpose of this study was to determine the diagnostic accuracy of unenhanced multidetector CT (MDCT) for diagnosis of central PE using CTPA as the gold standard. METHODS: The records of patients with suspected PE seen between 2010 and 2013 were retrospectively reviewed. Inclusion criteria were an acute, central PE confirmed by CTPA and non-enhanced MDCT before contrast injection. Patients with a PE ruled out by CTPA served as a control group. MDCT findings studied were high-attenuation emboli in pulmonary artery (PA), main PA dilatation > 33.2 mm, and peripheral wedge-shaped consolidation. Receiver operating characteristic (ROC) analysis was used to determine the sensitivity and specificity of unenhanced MDCT to detect PE. Wells score of all patients were calculated using data extracted from medical records prior to imaging analysis. RESULTS: Thirty-two patients with a PE confirmed by CTPA and 32 with a PE ruled out by CTPA were included. Among the three main MDCT findings, high-attenuation emboli in the PA showed best diagnostic performance (Sensitivity 72.9%; Specificity 100%), followed by main PA dilatation > 33.2 mm (sensitivity 46.9%; specificity 90.6%), and peripheral wedge-shaped consolidation (sensitivity 43.8%; specificity 78.1%). Given any one or more positive findings on unenhanced MDCT, the sensitivity was 96.9% and specificity was 71.9% for a diagnosis of PE in patients. The area under the curve (AUC) of a composite measure of unenhanced MDCT findings (0.909) was significantly higher than that of the Wells score (0.688), indicating unenhanced MDCT was reliable for detecting PE than Wells score. CONCLUSIONS: Unenhanced MDCT is an alternative for the diagnosis of acute central PE when CTPA is not available.


Assuntos
Tomografia Computadorizada Multidetectores/métodos , Artéria Pulmonar/patologia , Embolia Pulmonar/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Angiografia por Tomografia Computadorizada , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
Am J Case Rep ; 20: 1152-1154, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31383838

RESUMO

BACKGROUND Renal vein thrombosis is uncommon and can be associated with nephrotic syndrome. It is associated with high patient morbidity , and it may lead to thromboembolic event. CASE REPORT A 44-year-old woman presented with shortness of breath, chest pain and tightness, due to bilateral pulmonary embolism originating from right renal vein thrombosis. The diagnosis was made by transthoracic echocardiography and enhanced computed tomography (CT) scan of chest, abdomen, and pelvis. No underlying diseases were found. She was treated with heparin infusion therapy and rivaroxaban with good clinical outcome. CONCLUSIONS A rare case is presented of isolated unilateral right renal vein thrombosis diagnosed following bilateral pulmonary embolism in a previously healthy 44-year-old woman, which was successfully treated with the DOAC, rivaroxaban.


Assuntos
Anticoagulantes/uso terapêutico , Embolia Pulmonar/tratamento farmacológico , Veias Renais/patologia , Rivaroxabana/uso terapêutico , Trombose Venosa/tratamento farmacológico , Adulto , Dor no Peito , Dispneia , Feminino , Humanos , Embolia Pulmonar/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem
17.
J Med Case Rep ; 13(1): 225, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31337440

RESUMO

BACKGROUND: The pathophysiology of pulmonary edema is generally considered to result from elevated pulmonary capillary hydrostatic pressure due to increased left atrial pressure in consequence of a failing left ventricle. CASE PRESENTATION: We present a case of pulmonary edema secondary to severe hypalbuminemia under excessive respiratory drive in a 29-year-old Caucasian woman in respiratory distress with detected bilateral central pulmonary embolism. CONCLUSION: In conjunction with severe hypalbuminemia, even the negative intrathoracic pressure swings of respiratory distress may cause pulmonary edema. Detrimental consequences of non-invasive ventilation due to uncontrolled tidal volume and pressure swings need to be considered when treating patients in hypoxemic respiratory failure with low serum albumin.


Assuntos
Embolia Pulmonar/complicações , Insuficiência Respiratória/etiologia , Adulto , Feminino , Humanos , Pulmão/irrigação sanguínea , Edema Pulmonar/etiologia , Embolia Pulmonar/diagnóstico por imagem , Albumina Sérica/deficiência
18.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340942

RESUMO

Right ventricular thrombus (RVT) can be life-threatening, since it has the potential to embolise and cause saddle pulmonary embolism (PE). We present a patient who initially presented with haemodynamically stable PE with evidence of RVT on echocardiogram. She was placed on heparin drip; however, she later developed cardiac arrest and died due to embolisation of RVT to the pulmonary vasculature. Although management of haemodynamically stable PE in patients with RVT is still a matter of debate, 1 given the outcome we suggest that thrombolysis or emergent embolectomy at the presentation, in this case, may have had a favourable outcome.


Assuntos
Tomada de Decisão Clínica , Parada Cardíaca/mortalidade , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Trombose/diagnóstico por imagem , Trombose/terapia , Idoso de 80 Anos ou mais , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia/métodos , Embolectomia/métodos , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Parada Cardíaca/etiologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Hemodinâmica/fisiologia , Heparina/uso terapêutico , Humanos , Embolia Pulmonar/diagnóstico por imagem
19.
Medicine (Baltimore) ; 98(28): e16318, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305418

RESUMO

RATIONALE: Although Factor V Leiden (FVL) mutation is a major cause of inherited thrombophilia in Western populations; the mutation is extremely rare in Asia. PATIENT CONCERNS: Here we report a case of a 28-year old Korean woman admitted to our hospital with extensive pulmonary embolism. DIAGNOSIS: She was heterozygous for FVL mutation up on evaluation, and screening for asymptomatic family members also revealed heterozygous FVL mutation for her mother. INTERVENTIONS: Enoxaparin 1 mg/kg was initiated, followed by rivaroxaban 15 mg every 12 hours. OUTCOMES: The patient showed improvement in both subjective dyspnea and right ventricular dysfunction and was successfully discharged after five hospital days. LESSONS: FVL mutation screening may be considered in Asian patients with thrombophilia of uncertain etiology in the future.


Assuntos
Fator V/genética , Mutação , Embolia Pulmonar/genética , Trombofilia/genética , Adulto , Grupo com Ancestrais do Continente Asiático/genética , Diagnóstico Diferencial , Feminino , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , República da Coreia , Trombofilia/diagnóstico por imagem , Trombofilia/tratamento farmacológico
20.
Medicine (Baltimore) ; 98(28): e16385, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305442

RESUMO

RATIONALE: Invasive thymoma with intraluminal tumor thrombus may cause pulmonary artery thrombus if the tumor thrombus shed off during operation. However, there is no clinical case report focused on such complication. PATIENT CONCERNS: A 40-year-old woman presented with repeated chest pain. DIAGNOSIS: Chest computer tomography showed huge mediastinal mass. Postoperative pathology revealed type B2 and B3 thymoma, with B3 as the main type. INTERVENTIONS: The patient underwent tumor resection through midline sternotomy in our hospital on September 17, 2018. She received emergent pulmonary artery exploration because the tumor thrombus in superior vena cava shed off unexpectedly during operation. Postoperative pulmonary computer tomography angiography showed right pulmonary artery embolism. Then emergent right pulmonary artery embolectomy was performed through lateral thoracic incision on September 29, 2018. OUTCOMES: The patient recovered well after surgery. D-dimer reduced rapidly and returned to normal 1 month after the second operation. LESSONS: Intraluminal tumor thrombus in invasive thymoma patients has a risk of shedding off during operation. Prevention strategy should be made beforehand. Pulmonary artery exploration is necessary once happened.


Assuntos
Complicações Intraoperatórias , Embolia Pulmonar/etiologia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Reoperação , Timoma/diagnóstico por imagem , Timoma/patologia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia
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