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1.
Medicine (Baltimore) ; 100(1): e24235, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429823

RESUMO

RATIONALE: Catheter-related thrombosis is a serious complication of lung transplantation under venovenous extracorporeal membrane oxygenation (ECMO). Although ECMO-related thrombosis is not uncommon, there are few reports of giant hollow catheter thrombosis in lung transplantation under venovenous ECMO (ECMO). Blood loss and transfusion of coagulation factors may promote ECMO-related thrombosis. Hollow catheter thrombus was not detected on ultrasonography performed after initiation of ECMO. Therefore, it is essential to identify, manage, and reduce or avoid such thrombosis. PATIENT CONCERNS: We report a rare case of a 43-year-old man with advanced silicosis who developed a massive hollow catheter thrombus during lung transplantation. Anticoagulant therapy did not affect the size of the thrombus. DIAGNOSIS: Giant hollow catheter thrombosis was diagnosed by ultrasonography. Thrombosis from the right external iliac vein to the inferior vena cava was found in the shape of the ECMO pipe. INTERVENTIONS: Heparin was prescribed as an anticoagulant. OUTCOMES: Anticoagulant therapy did not affect the size of the thrombus during 2 weeks. The patient developed an infection and died of multiple organ failure. CONCLUSION: It is uncommon for massive hollow thrombus to occur during venovenous-ECMO-assisted lung transplantation. Fibrinogen and prothrombin complexes promote the formation of thrombus, and the measurement of the wall thickness of ECMO catheter may help to detect such thrombus.


Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Transplante de Pulmão , Trombose/diagnóstico , Adulto , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Cateteres/efeitos adversos , Diagnóstico Diferencial , Evolução Fatal , Heparina/administração & dosagem , Heparina/uso terapêutico , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/tratamento farmacológico , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico
3.
No Shinkei Geka ; 48(12): 1157-1163, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33353878

RESUMO

An 89-year-old man underwent carotid artery stenting for symptomatic left internal carotid artery stenosis. His postoperative course was uneventful;however, on postoperative day 4, he developed a food allergy rash throughout his body after consuming sushi. He developed right hemiplegia and aphasia the following day, and magnetic resonance imaging revealed left internal carotid artery occlusion. Angiography revealed stent thrombosis, and endovascular thrombectomy achieved partial recanalization;however, right hemiplegia and aphasia persisted. Eosinophilia and increased platelet aggregation suggested allergic stent thrombosis(Kounis syndrome type 3).


Assuntos
Estenose das Carótidas , Hipersensibilidade Alimentar , Trombose , Idoso de 80 Anos ou mais , Artéria Carótida Interna , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Hipersensibilidade Alimentar/complicações , Humanos , Masculino , Stents/efeitos adversos , Trombose/diagnóstico por imagem , Trombose/etiologia
6.
Methodist Debakey Cardiovasc J ; 16(3): e8-e10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133369

RESUMO

Sinus of Valsalva aneurysm (SOVA) is an unusual cardiac anomaly that is potentially fatal with rupture. It is often asymptomatic but has various presentations. We describe a case of a 67-year-old male who presented with atypical chest pain. Transthoracic echocardiogram and cardiac computed tomography scan confirmed a large SOVA complicated by thrombus formation and compression of the left atrium and left ventricular outflow tract. The patient successfully underwent a Bentall procedure-surgical aortic aneurysm repair with mechanical aortic valve conduit. We discuss several clinical decision-making branch points to highlight the complexity of managing this condition. Even in asymptomatic or minimally symptomatic patients with SOVA, surgery may be indicated if the aneurysm meets the criteria for size or has thrombus formation or compressive effects.


Assuntos
Aneurisma Aórtico/complicações , Seio Aórtico , Trombose/etiologia , Idoso , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Humanos , Masculino , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/cirurgia , Trombose/diagnóstico por imagem , Trombose/cirurgia , Resultado do Tratamento
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2565-2568, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018530

RESUMO

In this study, we developed and analyzed different patient-specific 3D anatomical models of the left atrium including left atrial Appendage, in order to investigate the local hemodynamics. Particularly, we focused on the left atrial appendage and its impact on thrombus formation due to wall shear stress alterations. A 3D semi-automated reconstruction approach was carried out to segment and reconstruct the left atrium from CT scans. Six different patients were studied applying their patient-specific clinical data. Three different velocity profiles simulated for each patient case, representing one normal and two abnormal conditions. Simulations varied significantly according to different appendage morphologies. Our scope is to describe the hemodynamic behavior at the left atrium and the left atrial appendage according to different blood velocities based on their anatomic variety (chicken wing 0.14 m/s, windsock 0.10, cactus 0.08, and cauliflower 0.04). Wall shear stress results were demonstrated and correlated with the velocities and the thrombus formation inside the appendage cavity.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Trombose , Apêndice Atrial/diagnóstico por imagem , Ecocardiografia Transesofagiana , Átrios do Coração/diagnóstico por imagem , Humanos , Trombose/diagnóstico por imagem
10.
Medicine (Baltimore) ; 99(42): e22500, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080684

RESUMO

INTRODUCTION: We report the youngest documented patient (38 years old) to develop an acute popliteal artery thrombus following primary total knee arthroplasty (TKA). PATIENT CONCERNS: The patient presented for an elective TKA secondary to posttraumatic arthritis. Past medical history included a tibial plateau fracture, two knee arthroscopies and an elevated body mass index (37.53). A right TKA was performed with no intraoperative complications. Two hours postoperatively, the right foot was poikilothermic and lacking dorsalis pedal pulse. DIAGNOSIS: Popliteal artery thrombus confirmed by angiogram and venous duplex. INTERVENTIONS: Immediate vascular surgery consult and subsequent embolectomy. OUTCOMES: At 1 year postoperatively, the patient is doing well with no further complications. CONCLUSION: Due to the lack of significant past medical history putting this patient at risk, future research should focus on prior trauma, age, and BMI as risk factors, specifically in patients undergoing TKA.


Assuntos
Artroplastia do Joelho , Artéria Poplítea , Complicações Pós-Operatórias/etiologia , Trombose/etiologia , Adulto , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Trombose/diagnóstico por imagem , Trombose/cirurgia
11.
Radiographics ; 40(6): 1574-1599, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33001783

RESUMO

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) results in coronavirus disease 2019 (COVID-19), which was declared an official pandemic by the World Health Organization on March 11, 2020. The infection has been reported in most countries around the world. As of August 2020, there have been over 21 million cases of COVID-19 reported worldwide, with over 800 000 COVID-19-associated deaths. It has become apparent that although COVID-19 predominantly affects the respiratory system, many other organ systems can also be involved. Imaging plays an essential role in the diagnosis of all manifestations of the disease, as well as its related complications, and proper utilization and interpretation of imaging examinations is crucial. With the growing global COVID-19 outbreak, a comprehensive understanding of the diagnostic imaging hallmarks, imaging features, multisystemic involvement, and evolution of imaging findings is essential for effective patient management and treatment. To date, only a few articles have been published that comprehensively describe the multisystemic imaging manifestations of COVID-19. The authors provide an inclusive system-by-system image-based review of this life-threatening and rapidly spreading infection. In part 1 of this article, the authors discuss general aspects of the disease, with an emphasis on virology, the pathophysiology of the virus, and clinical presentation of the disease. The key imaging features of the varied pathologic manifestations of this infection that involve the pulmonary and peripheral and central vascular systems are also described. Part 2 will focus on key imaging features of COVID-19 that involve the cardiac, neurologic, abdominal, dermatologic and ocular, and musculoskeletal systems, as well as pediatric and pregnancy-related manifestations of the virus. Vascular complications pertinent to each system will be also be discussed in part 2. Online supplemental material is available for this article. ©RSNA, 2020.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral/diagnóstico por imagem , Tromboembolia/diagnóstico por imagem , Trombose/diagnóstico por imagem , Angiografia/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Síndrome da Liberação de Citocina/etiologia , Síndrome da Liberação de Citocina/fisiopatologia , Progressão da Doença , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Inflamação , Peptidil Dipeptidase A/fisiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Artéria Pulmonar/diagnóstico por imagem , Receptores Virais/fisiologia , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/etiologia , Avaliação de Sintomas , Tromboembolia/sangue , Tromboembolia/etiologia , Trombose/sangue , Trombose/etiologia , Microangiopatias Trombóticas/diagnóstico por imagem , Microangiopatias Trombóticas/etiologia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos
12.
Clin Nucl Med ; 45(11): 902-904, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32910048

RESUMO

We present a case with a pancreatic neuroendocrine tumor and extensive tumor thrombosis in portal venous system. The tumor was first identified on contrast-enhanced CT and later confirmed using Ga-DOTATATE and Ga-NODAGA-LM3 PET/CT. Both tracers demonstrated similar pattern with higher tumor affinity and tumor-to-background ratio using Ga-NODAGA-LM3.


Assuntos
Acetatos , Compostos Heterocíclicos com 1 Anel , Tumores Neuroendócrinos/complicações , Compostos Organometálicos , Veia Porta/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Trombose/complicações , Trombose/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/patologia , Veia Porta/patologia
13.
Clin Nucl Med ; 45(11): 900-901, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32910051

RESUMO

A 69-year-old man with a history of back pain, urinary obstruction, and deep vein thrombosis of both lower extremities 4 years earlier was diagnosed with rectal neuroendocrine tumor, grade 2, Ki-67 index 3%. Ga-DOTANOC PET/CT images showed a left pelvic mass extended to the lumen of the inferior vena cava with a high affinity for somatostatin receptor. A tubular focus of radiotracer accumulation after the course of inferior vena cava with filling defect was suggestive of tumor thrombus.


Assuntos
Tumores Neuroendócrinos/complicações , Compostos Organometálicos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retais/complicações , Trombose/complicações , Trombose/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Idoso , Humanos , Masculino , Veia Cava Inferior/patologia
14.
Semin Thromb Hemost ; 46(7): 850-852, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32886934
15.
J Vasc Interv Radiol ; 31(11): 1831-1835, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32958378

RESUMO

PURPOSE: To review the immediate flow response and incidence of steal syndrome after taper reduction of tapered dialysis grafts. MATERIAL AND METHODS: This was a retrospective review of a quality assurance database of all hemodialysis access interventions performed between 2005 and 2017. It identified 77 patients who underwent a taper reduction procedure, involving angioplasty of the arterial limb of the graft and the arterial anastomosis for graft thrombosis/poor flow. A subset of patients underwent 5-, 6-, or 7-mm balloon taper reduction angioplasty coupled with intravascular direct flow measurement (n = 15 with 16 dialysis grafts). A two-tailed Wilcoxon matched-pairs signed-rank test was used to compare pre- and post-taper reduction flows. Mean duration of follow-up was 3.5 years (range, 0-12.5 years). RESULTS: Mean access survival after taper reduction was 20.2 months (range, 0.10-94.4 months). Pre- and post-taper reduction access flows (mean Qb ± standard deviation) were 574 ± 315 ml/min and 929 ± 352 ml/min, respectively (P < .0001). The mean ratio of post- to pre-taper reduction flows was 1.6 (range, 1.1-10.2). No patients developed steal syndrome within 6 months after taper reduction. CONCLUSIONS: Dialysis graft arterial anastomotic taper reduction did not result in the development of steal syndrome within 6 months. In the subset of patients who underwent flow measurements, taper reduction was associated with nearly a 2-fold improvement in access flow, which is a key predictor of access function.


Assuntos
Angioplastia com Balão , Derivação Arteriovenosa Cirúrgica/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Oclusão de Enxerto Vascular/terapia , Diálise Renal , Trombose/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Implante de Prótese Vascular/efeitos adversos , Bases de Dados Factuais , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Isquemia/etiologia , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Respir Med ; 172: 106135, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32947171

RESUMO

PURPOSE: Patients hospitalized for infection with SARS-CoV-2 typically present with pneumonia. The respiratory failure is frequently complicated by pulmonary embolism in segmental pulmonary arteries. The distribution of pulmonary embolism in regard to lung parenchymal opacifications has not been investigated yet. METHODS: All patients with COVID-19 treated at a medical intensive care unit between March 8th and April 15th, 2020 undergoing computed tomography pulmonary angiography (CTPA) were included. All CTPA were assessed by two radiologists independently in respect to parenchymal changes and pulmonary embolism on a lung segment basis. RESULTS: Out of 22 patients with severe COVID-19 treated within the observed time period, 16 (age 60.4 ± 10.2 years, 6 female SAPS2 score 49.2 ± 13.9) underwent CT. A total of 288 lung segment were analyzed. Thrombi were detectable in 9/16 (56.3%) patients, with 4.4 ± 2.9 segments occluded per patient and 40/288 (13.9%) segments affected in the whole cohort. Patients with thrombi had significantly worse segmental opacifications in CT (p < 0.05) and all thrombi were located in opacitated segments. There was no correlation between d-dimer level and number of occluded segmental arteries. CONCLUSIONS: Thrombi in segmental pulmonary arteries are common in COVID-19 and are located in opacitated lung segments. This might suggest local clot formation.


Assuntos
Angiografia por Tomografia Computadorizada , Infecções por Coronavirus , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar , Síndrome do Desconforto Respiratório do Adulto , Trombose , Betacoronavirus/isolamento & purificação , Coagulação Sanguínea , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Radiografia Torácica/métodos , Radiografia Torácica/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/virologia , Estudos Retrospectivos , Trombose/diagnóstico por imagem , Trombose/etiologia
18.
Anticancer Res ; 40(10): 5837-5844, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988913

RESUMO

BACKGROUND/AIM: Renal cell carcinoma (RCC) is one of the most common malignancies of the urinary tract. Venous migration, tumor thrombus and metastases are often seen in patients with RCC and are adverse prognostic factors. Intravascular tumor growth along the renal vein into the inferior vena cava occurs in up to 10% of all patients with RCC. Furthermore, extension of the tumor reaching the right atrium is detected in approximately 1% of all patients. Synchronous involvement of pulmonary arteries with tumor emboli is very rare and challenging. Management of metastatic RCC includes surgical resection of renal and metastatic lesions. We present 3 cases of patients with RCC tumor thrombus extending into the inferior vena cava (IVC) and with pulmonary emboli of the tumor thrombus into one of the branches of the main pulmonary artery. All the cases had simultaneous resection of the kidney tumor with the tumor thrombus and pulmonary lobectomy that included the tumor emboli with satisfactory outcome. CASE REPORT: We present a series of cases of RCC with tumor extension into the inferior vena cava (IVC) and with tumor emboli to the pulmonary arteries. Surgical procedure in all cases consisted of radical nephrectomy with IVC tumor thrombus resection, along with a thoracotomy with lung resection including the tumor emboli to one of the branches of the main pulmonary artery. Synchronous metastatic lesions were found on the liver in one case and contiguous extension of renal tumor to the pancreas in another. CONCLUSION: In patients with IVC thrombus with synchronous pulmonary artery tumor embolus, such as the cases presented in this series, a careful multidisciplinary management approach is preferable. Transplant technique used in our open approach minimizes complications, blood loss, and provides excellent visualization for abdominal vascular manipulation of IVC. This provides a potentially curable treatment option with acceptable survival rates.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Pulmonares/cirurgia , Artéria Pulmonar/cirurgia , Veia Cava Inferior/cirurgia , Adulto , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Metástase Neoplásica , Células Neoplásicas Circulantes/metabolismo , Células Neoplásicas Circulantes/patologia , Nefrectomia/métodos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Veias Renais/cirurgia , Trombose/diagnóstico por imagem , Trombose/patologia , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/patologia , Trombose Venosa/cirurgia
19.
Am J Case Rep ; 21: e926915, 2020 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-32963216

RESUMO

BACKGROUND Recent studies demonstrated evidence of coagulation dysfunction in hospitalized patients with severe coronavirus disease 2019 (COVID-19) due to excessive inflammation, hypoxia, platelet activation, endothelial dysfunction, and stasis. Effective anticoagulation therapy may play a dominant role in the management of severe COVID-19 cases. CASE REPORT A 73-year-old man with a 6-day history of fever up to 38.5°C, dyspnea, cough, and fatigue was diagnosed with COVID-19. He had a past medical history significant for hypertension and coronary artery bypass grafting. Two days after hospital admission, the patient developed acute respiratory failure, requiring intubation, mechanical ventilation, and transfer to the intensive care unit (ICU). He received treatment including antibiotics, hydroxychloroquine, tocilizumab, vasopressors, prone positioning, and anticoagulation with enoxaparin at a prophylactic dose. After a 15-day ICU stay, the patient was hemodynamically stable but still hypoxemic; a transthoracic echocardiogram at that time, followed by a transesophageal echocardiogram for better evaluation, revealed the presence of a right atrium thrombus without signs of acute right ventricular dilatation and impaired systolic function. Since the patient was hemodynamically stable, we decided to treat him with conventional anticoagulation under close monitoring for signs of hemodynamic deterioration; thus, the prophylactic dose of enoxaparin was replaced by therapeutic dosing, which was a key component of the patient's successful outcome. Over the next few days he showed significant clinical improvement. The follow-up transesophageal echocardiogram 3 weeks after effective therapeutic anticoagulation revealed no signs of right heart thrombus. CONCLUSIONS The presented COVID-19 case, one of the first reported cases with evidence of right heart thrombus by transesophageal echocardiography, highlights the central role of diagnostic imaging strategies and the importance of adequate anticoagulation therapy in the management of severe COVID-19 cases in the ICU.


Assuntos
Infecções por Coronavirus/complicações , Ecocardiografia Transesofagiana/métodos , Átrios do Coração/diagnóstico por imagem , Cardiopatias/terapia , Pneumonia Viral/complicações , Síndrome Respiratória Aguda Grave/complicações , Trombose/terapia , Idoso , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Tosse/diagnóstico , Tosse/etiologia , Cuidados Críticos/métodos , Progressão da Doença , Serviço Hospitalar de Emergência , Febre/diagnóstico , Febre/etiologia , Seguimentos , Grécia , Átrios do Coração/patologia , Cardiopatias/diagnóstico por imagem , Cardiopatias/etiologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/terapia , Índice de Gravidade de Doença , Trombose/diagnóstico por imagem , Trombose/etiologia , Resultado do Tratamento
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