Case Of Acute Pulmonary Embolism Research Articles

The reversed halo sign with a reticulonodular pattern as unusual findings of pulmonary infarct in acute pulmonary embolism: case report and literature review

BackgroundThe reversed halo, also known as the atoll sign, is a distinct sign with ring-shaped consolidation and central lucency. The reversed halo sign, initially emerging in cryptogenic organizing pneumonia, has been observed in various pulmonary diseases, including pulmonary embolism. The presence of this sign in the subpleural, posterior basal parts of the lower lobes, predominantly when solitary, should raise the possibility of other causes, such as pulmonary infarction.Case presentationWe present a case of acute pulmonary embolism with pulmonary infarction discovered on a CT pulmonary angiogram in our emergency department, where the pulmonary infarction appears as a reverse halo sign with a reticulonodular pattern. The reticular nodular pattern in the halo sign is not typical of a pulmonary infarct presenting with a reverse halo sign.ConclusionsTo our knowledge, this is the first case of pulmonary infarction in acute pulmonary embolism with the appearance of a reverse halo sign with a reticulonodular pattern.

Disparities in the prevalence of acute pulmonary embolism in patients with ovarian cancer: A nationwide analysis.

e17560 Background: Ovarian cancer is the leading cause of death among gynecological cancers. It is highly thrombogenic and is associated with increased venous thromboembolism events. We conducted a retrospective analysis to study the prevalence and disparities in the association of Acute Pulmonary embolism(PE) with ovarian cancer. Methods: National Inpatient Sample (2017-2020) was used to identify the patients with primary diagnosis of Acute PE and was stratified into those with and without concurrent diagnosis of Ovarian cancer ( regional and advanced metastatic disease). Basic demographic variables were analyzed to identify disparities in the prevalence of Acute PE among ovarian cancer patients.Multivariate logistic regression analysis was conducted to examine the association between Acute PE and Ovarian cancer. Results: A total of 651435 patients were hospitalized with a primary diagnosis of Acute PE, and 2980 (0.46%) had a secondary diagnosis of Ovarian cancer. The ovarian cancer group had a greater percentage of white (73.4% vs.71.93%), Hispanics (7.98% vs. 6.04%), and fewer Black patients (15.78% vs. 19.86), p=0.021. Compared to the white, Black population with ovarian cancer (OR=0.77(0.6-0.9); p=0.04) had a decreased likelihood of developing Acute PE without any difference noted in the Hispanics (OR=1.13 (0.81-1.58); p=0.44) and other races (OR=1.11 (0.67-1.83); p=0.67). Patients in the high income groups were more likely to be admitted due to acute PE ($65,000-$85,999: OR=1.35 (1.05-1.73), p=0.018; >$86,000: OR=1.24 (1.14-1.62), p=0.01). A greater percentage of patients with ovarian cancer had private insurance (35.2% vs. 28.91%), while a greater percentage of patients without ovarian cancer had Medicare (54.38% vs. 50.34%) and Medicaid (11.9% vs. 12.5%), p=0.003. Patients with private insurance were more likely to be admitted due to acute PE (OR=1.73(1.36-2.22); p<0.001). Patients with a Charlson comorbidity index of 3 or more had higher odds of Acute PE (OR=1.3(1.12-3.4); p=0.02). A greater percentage of Acute PE patients with ovarian cancer were admitted to large (54.03% vs. 47.86%; p=0.014), urban (95.3% vs. 90.35%; p<0.001), and teaching hospitals (79.87% vs. 69.15%; p<0.001). Teaching hospitals had higher odds of admissions due to acute PE in ovarian cancer patients (OR=1.37(1.07-1.75); p=0.01). On multivariate regression analysis, Ovarian cancer patients had higher odds of Acute PE (OR=1.88 (1.73-2.05); p<0.001). Conclusions: Ovarian cancer patients with Black race and private insurance showed a significantly increased likelihood of admissions due to acute pulmonary embolism. Additionally, urban and teaching hospitals demonstrated higher odds of encountering cases of acute pulmonary embolism. Further prospective studies are necessary to validate the findings presented in our study.

Prognostic significance of quantitative electrocardiographic parameters in patients with non-high-risk pulmonary embolism

BackgroundElectrocardiogram (ECG) abnormalities indicating right ventricular strain have been reported to have prognostic value in severe cases of acute pulmonary embolism (PE). We aimed to analyze the prognostic significance of other quantitative ECG parameters in non-high-risk acute PE. MethodsConsecutive patients with non-high-risk acute PE were prospectively enrolled. The following baseline ECG parameters were collected: rhythm, heart rate, QRS axis, right bundle branch block (RBBB) pattern, S1Q3T3 pattern, T-wave inversion, ST-segment elevation, Qr in lead V1, PR Interval, QRS complex duration, QT interval, P-wave amplitude and duration, R- and S-wave amplitudes. The primary endpoint was early discharge within three days. Associations between ECG parameters and early discharge were analyzed. ResultsOverall, 383 patients were enrolled (median age: 67 years, 57% female): 277 (72.3%) with low-risk and 106 (27.7%) with intermediate-risk. The two groups of patients differed in several ECG signs of right ventricular strain and many other quantitative parameters like R- and S-wave amplitudes. In the multivariate logistic regression analysis, the S-wave depth in lead V5 (S-V5) was the only independent prognostic factor for early discharge (odds ratio = 0.137, 95% confidence interval = 0.031-0.613, p = 0.009). The optimum cutoff value of S-V5 for predicting early discharge derived from the receiver operative characteristic curve was 0.15 mv (c-statistic = 0.66, p =0.003). ConclusionsSeveral ECG signs of right ventricular strain and many other quantitative parameters were associated with disease severity in non-high-risk acute PE. An S-V5 lesser than 0.15 mv was predictive for early discharge in these patients.

A rare case of acute pulmonary embolism in a postoperative case of dysgerminoma in a young adolescent girl: Lesson learnt

A rare case of acute pulmonary embolism in a postoperative case of dysgerminoma in a young adolescent girl: Lesson learnt

A Case of Acute Pulmonary Embolism after Catheter Radiofrequency Ablation of Paroxysmal Supraventricular Tachycardia

Radiofrequency ablation is an effective method to treat paroxysmal supraventricular tachycardia. In this article, we report a case of pulmonary embolism and death after ablation of paroxysmal supraventricular tachycardia. The patient did not have other diseases, nor did he have any risk factors for embolism. A summary of the literature found that despite the low incidence, radiofrequency ablation for paroxysmal supraventricular tachycardia is still associated with the risk of pulmonary embolism. At present, there is no clear guidance for the perioperative anticoagulation treatment of such patients. It is necessary to investigate this issue in depth in the future.

Acute pulmonary embolism after short term exposure to smoke in an enclosed area

We report a case of acute pulmonary embolism (PE) following short term exposure to smoke in an enclosed area. The patient was obese and had type 2 diabetes mellitus. He developed PE as a consequence of acute systemic inflammatory response to short term exposure to smoke and an underlying chronic inflammatory milieu.

Fatal Case of Acute Pulmonary Embolism due to Venous Thrombosis after COVID-19 Vaccination: Based on Forensic Postmortem Examination

We present an unexpected fatal case of pulmonary embolism due to venous thrombosis after vaccination for coronavirus disease 2019 (ChAdOx1 nCov-19). The deceased was a 64-year-old woman with Alzheimer disease. The deceased had fever shortly after vaccination, and presented sudden dyspnea and died 8 days after vaccination. On postmortem examination, pulmonary embolism and venous thrombosis were noted in deep veins of both lower legs. Even though the psychomotor function of the deceased became fragile due to Alzheimer disease, the deceased was not bed-ridden, and major known risk factors related to venous thrombosis were not explicit in this case. Because there are not enough data related to vaccination and thrombosis, we hope that this case would be helpful in unraveling pathogenesis of venous thrombosis after vaccination and in determining whether there is any association between thrombosis and vaccination. Key Words: COVID-19 vaccines · Pulmonary embolism · Venous thrombosis

Acute provoked pulmonary embolism masquerading as inferior wall myocardial infarction with right ventricular infarction

We present an extreme rare case of acute pulmonary embolism in an 83-year-old male presenting as acute inferior wall ST-elevated myocardial infarction with right ventricular infarction (RVMI) in electrocardiogram (ECG). Acute pulmonary embolism presenting as acute inferior wall ST-elevation myocardial infarction with RVMI has not been described in the world literature so far. Our case is unique and first to describe the presentation of acute pulmonary embolism in the form of inferior wall ST-elevated myocardial infarction with evidence of RVMI in the ECG. It is of utmost important for the treating cardiologist and critical care physician to differentiate the same as treatment modalities of both conditions varies markedly and wrong therapeutic measures can land up in a catastrophe.

Comparison of neutrophil to lymphocyte ratio with other prognostic markers affecting 30 day mortality in acute pulmonary embolism.

Identifying the prognostic factors for patients with acute pulmonary embolism (APE) play a critical role in determining of the treatment strategy and to reduce mortality. The aim of this study is to evaluate the prognostic value of Neutrophil to Lymphocyte Ratio (NLR) and compare NLR with other prognostic factors in APE. We retrospectively examined 550 cases of acute pulmonary embolism diagnosed by spiral computed tomographic angiography. A receiver operating characteristics (ROC) curve was used to determine the sensitivity and specificity of parameters and the optimal cut-off value for predicting mortality. Significance of each prognostic factors selected by univariate analysis confirmed using Cox regression model. Baseline NLR, Platelet to Lymphocyte Ratio (PLR), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP), and D-dimer values respectively were found significantly high in patients who died within 30 days (p< 0.05). Patients with high-risk status and sPESI > 2 points had a significantly higher short-term mortality rate (p< 0.05). Short-time mortality was found significantly higher in patients with NLR > 7.3 (p< 0.05). Cox regression analysis indicated that patient risk status and sPESI score were independent prognostic factors (p< 0.05). However, NLR was not found as a predictor of mortality in APE (p> 0.05). After the subgroup analysis of the study, in patients without comorbid diseases NLR, patient’s risk status, sPESI score were found the predictor of mortality in APE (p< 0.05). NLR maybe a useful prognostic factor for patients without comorbid diseases in short time of mortality in APE.

A Rare Case of Pulmonary Embolism: A Case Report

Pulmonary embolism in an old patient with a history of coagulation disorder, any recent major surgeries or in a chronic heart or lung diseases is widely reported. Also, a recent history of travel by air with flight distance of more than 5000km or BMI greater than 35 kg/m2 increase risk. However, we report here, a suggestive case of acute pulmonary embolism in a previously well male of 38 years, with a BMI of 25.71kg/m2 without any history of chronic illness or acute exacerbations.&#x0D; The patient presented in health facility with sudden onset of radiating chest pain and some other nonspecific symptoms. Neither any other significant personal risk factors except smoking, nor any family history of heart/lung diseases were ruled out during initial assessments. On investigations, other routine examinations were normal but T-wave inversion was noticed in lead V1-4 in ECG, Troponin-I was positive and CPK-MB was slightly elevated (27 U/L). Furthermore, no any remarkable changes were noticed in Chest X-ray. Then, the patient was referred to higher center with cardiac facility with provisional diagnosis of Acute Coronary Syndrome for further evaluation and management.&#x0D; Thereupon, Coronary Angiogram (CAG) was done and the report was normal but echocardiography findings were suggestive of pulmonary Embolism. D-dimer was also elevated (8279.05 ng/ml) but venous doppler study of bilateral lower limb was normal. Finally, CT-PA showed partially occluding thrombus in main pulmonary bifurcation extending into left and right pulmonary artery, its bilateral segmental branches and calcified granuloma was seen in right lobe of liver. Patient was under inj. LMWH and other supportive management during hospitalization. After an uneventful hospital stay for 12 days, general condition was improved and eventually, patient was discharged, with oral warfarin.&#x0D; Keywords: chest pain; Nepal; pulmonary embolism; risk factors.

Sequential nursing of acute pulmonary embolism after operation in a patient with ovarian cancer merger immunoglobulin defects

Objective To investigate the treatment and nursing of patients with pulmonary embolism after ovarian cancer combined with common variant immunoglobulin deficiency. Methods The clinical data of 1 case of acute pulmonary embolism after operation in a patient with ovarian cancer merger immunoglobulin defects were analyzed retrospectively. Results After the rescue patients, close observation of vital signs change, according to nursing bleeding and thrombosis, strengthen psychological support and other measures. The patient was discharged after 56 days of treatment and care. Conclusions The early detection of acute pulmonary embolism, timely diagnosis and treatment, close observation of vital signs, the nursing care of bleeding and thrombosis, in order to improve the success rate of treatment of acute pulmonary embolism. Key words: Acute pulmonary embolism; Immunoglobulin defects; Nursing care

A Case of Acute Pulmonary Embolism With Right Atrial Thrombus Treated With Systemic Thrombolytic Therapy After Surgery

A Case of Acute Pulmonary Embolism With Right Atrial Thrombus Treated With Systemic Thrombolytic Therapy After Surgery

Acute Pulmonary Embolism Leading to Cavitation and Large Pulmonary Abscess: A Rare Complication of Pulmonary Infarction

Pulmonary infarction is an infrequent complication of pulmonary embolism due to the dual blood supply of the lung. Autopsy studies have reported cavitation to occur in only 4–5% of all pulmonary infarctions with an even smaller proportion of these cases becoming secondarily infected. Patients with infected cavitating pulmonary infarction classically present with fever, positive sputum culture, and leukocytosis days to weeks following acute pulmonary embolism. We describe a rare case of acute pulmonary embolism with pulmonary infarction leading to cavitation and subsequent abscess formation requiring left lower lobe resection.

A case of acute pulmonary embolism complicated with influenza B infection treated its hypoxia by non-invasive positive pressure ventilation

A case of acute pulmonary embolism complicated with influenza B infection treated its hypoxia by non-invasive positive pressure ventilation

経皮的心肺補助装置導入により救命し得た緊急帝王切開後急性肺血栓塞栓症の1例

経皮的心肺補助装置導入により救命し得た緊急帝王切開後急性肺血栓塞栓症の1例

A Case of Acute Pulmonary Embolism Treated With Ultrasound-Assisted Catheter-Directed Thrombolysis

A Case of Acute Pulmonary Embolism Treated With Ultrasound-Assisted Catheter-Directed Thrombolysis

Management of Acute Pulmonary Embolism: Anticipating and Responding to Complexity

Abstract Introduction This problem-based learning discussion (PBLD) provides a case-based opportunity for learners to work through a case of acute pulmonary embolism, a frequently encountered poten...

Paradoxical embolism causing acute embolic events in a patient with hereditary thrombophilia

Paradoxical embolism (PDE) is an uncommon but clinically important entity. In clinical practice, PDE involving multiple organs is a rarely reported occurrence. Herein, we present a case of acute pulmonary embolism complicated by PDE through an atrial septal defect (ASD) causing a series of embolic events. Subsequent laboratory screening confirmed the patient to be a heterozygous carrier of the factor V Leiden mutation that increases the risk for deep venous thrombosis (DVT). The patient was treated with warfarin indefinitely and underwent transcatheter ASD closure and implantation of an inferior vena cava filter.

A Rare Case of Acute Pulmonary Embolism after Coronary Angiography due to Sand Bag Compression

Pulmonary embolism (PE) is very rare after coronary angiography. We present here a case of acute PE after coronary angiography due to sand bag compression which has not been reported previously. After the femoral sheath removal, patient was immobilized for 6 hours with a sand bag on his right femoral artery area. After the removal of sand bag, patient stood up with the help of a nurse. Immediately after standing up, patient complained sudden onset of dyspnea, lost his consciousness, and suddenly fell on the ground while hitting left occipital region of his head. Clinical, echocardiographic, laboratory, and tomographic findings were compatible with massive PE and we decided to give thrombolytic agent. On the contrary, because he had cranial trauma during syncope and oozing type hemorrhage in his right inguinal region, we administered a total dose of 50 mg alteplase (tissue plasminogen activator) within 2 hours (normal recommended dose is 100 mg). Just after finishing alteplase, clinical, laboratory, and echocardiographic parameters of the patient returned to normal without any complication. Patient was discharged with warfarin treatment 5 days after the event.

A Case of Acute Pulmonary Embolism Associated with Dysplasminogenemia

The incidence of pulmonary embolism (PE) rises markedly with age, and only a few cases have been reported in younger adults. Thrombophilia has been reported as one of the predisposing factors for PE in younger adults. Here we report an extraordinary case of PE complicated with dysplasminogenemia, a rare genetic disorder resulting in hypercoagulability, in a young male. An 18-yr-old male visited an emergency room in the United States complaining chest discomfort. He was diagnosed as PE with deep vein thrombosis without apparent risk factors. Anticoagulation therapy with warfarin had been initiated and discontinued after 6 months of treatment. After returning to Korea he was tested for thrombophilia which revealed decreased activity of plasminogen and subsequent analysis of PLG gene showed heterozygous Ala620Thr mutation. He was diagnosed with PE complicated with dysplasminogenemia. Life-long anticoagulation therapy was initiated. He is currently under follow-up without clinical events for 2 yr.