Cause Of Pulmonary Embolism Research Articles

Shear wave elastography values of thrombus in patients with lower extremity deep vein thrombosis for pulmonary embolism detection: the ROC analysis

Rationale: Thrombosis of the iliac (IV) and femoral veins (FV) is one of the most common causes of pulmonary embolism (PE). Modern ultrasound scanners are equipped with the technology of shear wave elastography, which gives a quantitative assessment of thrombus stiffness by Young's modulus reconstruction. However, the lack of convincing data on the role of thrombus stiffness for clinical manifestations of PE hinders the active use of shear wave elastography to diagnose the risk of embolism.
 Aim: To determine the threshold values of the venous thrombus Young’s modulus for deep venous thrombosis (DVT) of the lower extremities complicated by massive PE and/or PE with acute cor pulmonale (ACP).
 Materials and methods: This was a single center cross-sectional study in 101 patients who were hospitalized with the diagnosis of acute (duration of less than 2 weeks) or subacute (from 2 weeks to 3 months) IV and FV thrombosis. Doppler ultrasound of the lower extremity veins and echocardiography were done in all patients. Forty eight patients with clinical signs of PE had chest computed tomography. The venous thrombus stiffness was assessed by shear wave elastography with the Young's modulus reconstruction. We performed the ROC analysis for mean values of the Young's modulus for proximal segments of IV and FV thrombi in patients with DVT and massive PE and ACP.
 Results: PE was diagnosed in 40.6% (26/64) of the patients hospitalized with acute DVT and in 54.1% (20/37) of those with subacute DVT. Echocardiographic signs of ACP in massive PE were found in 47.4% (9/19) of the patients, in submassive and minor PE in 55.6% (15/27). In DVT complicated with PE, the ROC analysis of the shear wave elastography results gave the following threshold values of the mean Young’s modulus for the proximal thrombus segment: for acute IV thrombosis + PE and ACP, ≤ 16.7 kPa (AUC 0.714, sensitivity 100%, specificity 42.1%), in subacute IV thrombosis + PE and APC, ≤ 23.7 kPa (0.939, 100 and 90.9%, respectively), in acute FV thrombosis + massive PE, ≥ 9.5 kPa (0.706, 100 and 50%, respectively), in subacute FV thrombosis + massive PE, ≥ 24.4 kPa (0.550, 60.0 and 68.8%, respectively).
 Conclusion: Shear wave elastography of deep vein thrombi of the lower extremities makes it possible to identify patients with PE and ACP during acute and subacute IV thrombosis and to determine massive PE in acute FV thrombosis.

Pulmonary tumor embolism secondary to urothelial carcinoma of urinary bladder: case report and literature review

BackgroundTumor embolism is the least well-described cause of pulmonary embolism, taking into account the non-specificity of radiographic and nuclear imaging results, the necessity of anatomopathological evidence and the frequency of deep venous thrombosis in the course of solid tumors, suggesting thus thromboembolism.Case presentationWe report a rare case of urothelial carcinoma of the urinary bladder associated with persistent pulmonary embolism despite being on different anticoagulation regimens, the patient was ultimately found to have tumor thrombus in the pulmonary trunk secondary to tumoral extension. We provide a literature review as well about the diagnosis, evaluation and prognosis and of this rare clinical entity.ConclusionsOur case highlights the importance of keeping this unusual etiology in mind, particularly when faced with pulmonary embolism occurring in the context of a solid tumor and the ineffectiveness of various anticoagulation protocols. Furthermore, it emphasizes the pivotal role of cytology in confirming diagnosis and guiding therapy.

Predicting in-hospital mortality in patients admitted from the emergency department for pulmonary embolism: Incidence and prognostic value of deep vein thrombosis. A retrospective study.

Pulmonary embolism (PE) is one of the most common causes of death from cardiovascular disease. Although deep vein thrombosis (DVT) is the leading cause of PE, its prognostic role is unclear. This study investigated the incidence and prognostic value of DVT in predicting in-hospital mortality (IHM) in patients admitted from the emergency department (ED) for PE. This retrospective cohort study was conducted in the ED of a third-level university hospital. Patients over 18 years admitted for PE between 1 January 2018 and 31 December 2022 were included. Five hundred and thirty patients (mean age 73.13 years, 6% IHM) were included. 69.1% of cases had DVT (36.4% unilateral femoral vein, 3.6% bilateral, 39.1% unilateral popliteal vein, 2.8% bilateral, 45.7% distal vein thrombosis and 7.4% iliocaval involvement). Patients who died in hospital had a higher Pulmonary Embolism Severity Index (PESI) (138.6 vs. 99.65, p < 0.001), European Society of Cardiology risk class (15.6% vs. 1%, intermediate-high in 50% vs. 6.4%, p < 0.001) and more DVT involving the iliac-caval vein axis (18.8% vs. 6.6%, p = 0.011). PESI class >II, right ventricular dysfunction, increased blood markers of myocardial damage and involvement of the iliocaval venous axis were independent predictors of IHM on multivariate analysis. Although further studies are needed to confirm the prognostic role of DVT at PE, involvement of the iliocaval venous axis should considered to be a sign of a higher risk of IHM and may be a key factor in prognostic stratification.

Multiple Pulmonary Emboli as a Primary Presentation of Renal Cell Carcinoma

A 57-year-old housewife presented with complaints of sudden onset of chest pain and dyspnea. Computed tomography angiography revealed saddle-shaped pulmonary emboli in the main pulmonary artery and its branches. Evaluation for the cause of pulmonary embolism revealed a heterogeneously enhancing lesion arising from the anterior aspect of the lower pole of the left kidney. She had no hematuria, flank pain, or any palpable abdominal mass. She underwent a left open radical nephrectomy with inferior vena cava thrombectomy. Given that only 10% of patients present with the classic triad, it is often difficult to diagnose renal cell carcinoma in the early stages. Therefore, a high index of suspicion in patients with atypical presentations can lead to an early diagnosis.

Nephrotic syndrome: delays in diagnosis and a cause of pulmonary embolism not to miss

British Journal of Hospital MedicineEarly view Case ReportNephrotic syndrome: delays in diagnosis and a cause of pulmonary embolism not to missFrancesca Wright, Mark GilchristFrancesca WrightCorrespondence to: Francesca Wright; E-mail Address: [email protected]Department of Nephrology, Torbay Hospital, Torbay and South Devon NHS Foundation Trust, Torquay, UKSearch for more papers by this author, Mark GilchristDepartment of Respiratory Medicine, Torbay Hospital, Torbay and South Devon NHS Foundation Trust, Torquay, UKUniversity of Exeter Medical School, Exeter, UKSearch for more papers by this authorFrancesca Wright; Mark GilchristPublished Online:22 May 2023https://doi.org/10.12968/hmed.2023.0011AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Hull RP, Goldsmith DJA. Nephrotic syndrome in adults. BMJ. 2008;336(7654):1185–1189. https://doi.org/10.1136/bmj.39576.709711.80 Crossref, Medline, Google ScholarKerlin BA, Ayoob R, Smoyer WE. Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic disease. Clin J Am Soc Nephrol. 2012;7(3):513–520. https://doi.org/10.2215/CJN.10131011 Crossref, Medline, Google ScholarKidney Disease Improving Global Outcomes Guidelines. Clinical practice guideline for the management of glomerular diseases. Kidney Int. 2021;100(4S):S1–S276. https://doi.org/10.1016/j.kint.2021.05.021 Medline, Google ScholarKodner C. Diagnosis and management of nephrotic syndrome in adults. Am Fam Physician. 2016;93(6):479–485 Medline, Google ScholarLeeaphorn N, Kue-A-Pai P, Thamcharoen N et al.. Prevalence of cancer in membranous nephropathy: a systematic review and meta-analysis of observational studies. Am J Nephrol. 2014;40(1):29–35. https://doi.org/10.1159/000364782 Crossref, Medline, Google ScholarMahmoodi BK, ten Kate MK, Waanders F et al.. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome. Circulation. 2008;117(2):224–230. https://doi.org/10.1161/CIRCULATIONAHA.107.716951 Crossref, Medline, Google ScholarNational Institute for Health and Care Excellence. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. 2020. https://www.nice.org.uk/guidance/ng158 (accessed 24 April 2023) Google Scholar FiguresReferencesRelatedDetails Ahead of PrintISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 22 May 2023 Information© MA Healthcare LimitedPDF download

Chymase Inhibition Resolves and Prevents Deep Vein Thrombosis Without Increasing Bleeding Time in the Mouse Model.

Background Deep vein thrombosis (DVT) is the primary cause of pulmonary embolism and the third most life-threatening cardiovascular disease in North America. Post-DVT anticoagulants, such as warfarin, heparin, and direct oral anticoagulants, reduce the incidence of subsequent venous thrombi. However, all currently used anticoagulants affect bleeding time at various degrees, and there is therefore a need for improved therapeutic regimens in DVT. It has recently been shown that mast cells play a crucial role in a DVT murine model. The underlying mechanism involved in the prothrombotic properties of mast cells, however, has yet to be identified. Methods and Results C57BL/6 mice and mouse mast cell protease-4 (mMCP-4) genetically depleted mice (mMCP-4 knockout) were used in 2 mouse models of DVT, partial ligation (stenosis) and ferric chloride-endothelial injury model of the inferior vena cava. Thrombus formation and impact of genetically repressed or pharmacologically (specific inhibitor TY-51469) inhibited mMCP-4 were evaluated by morphometric measurements of thrombi immunochemistry (mouse and human DVT), color Doppler ultrasound, bleeding times, and enzymatic activity assays ex vivo. Recombinant chymases, mMCP-4 (mouse) and CMA-1 (human), were used to characterize the interaction with murine and human plasmin, respectively, by mass spectrometry and enzymatic activity assays. Inhibiting mast cell-generated mMCP-4, genetically or pharmacologically, resolves and prevents venous thrombus formation in both DVT models. Inferior vena cava blood flow obstruction was observed in the stenosis model after 6 hours of ligation, in control- but not in TY-51469-treated mice. In addition, chymase inhibition had no impact on bleeding times of healthy or DVT mice. Furthermore, endogenous chymase limits plasmin activity in thrombi ex vivo. Recombinant mouse or human chymase degrades/inactivates purified plasmin in vitro. Finally, mast cell-containing immunoreactive chymase was identified in human DVT. Conclusions This study identified a major role for mMCP-4, a granule-localized protease of chymase type, in DVT formation. These findings support a novel pharmacological strategy to resolve or prevent DVT without affecting the coagulation cascade through the inhibition of chymase activity.

1033 A STRANGE CASE OF PULMONARY EMBOLISM IN A YOUNG PATIENT WITH CARDIAC RESYNCHRONIZATION THERAPY

Abstract Introduction Clinically relevant pulmonary embolism (PE) related to pacemaker leads is reported in up to 3.5% of cases of implantations. We reported a particular case of acute massive PE in a patient bearer of a Cardiac Resynchronization Therapy-Defibrillator (CRT-D). Case presentation A 49-year-old man presented to our ER reporting dyspnea and localized pain to the left hemithorax. Past medical history included HFrEF due to idiopathic dilated cardiomyopathy complicated by apical thrombosis, CRT-D, Charcot-Marie-Tooth syndrome, dyslipidemia, and a hepatic nodule undergoing diagnosis. Recently, he reported COVID-19 and successive pleuropneumonia requiring hospitalization. At home, he was taking Acenocoumarin, Sacubitril/Valsartan 97/103mg bid, Carvedilol 6.25mg bid, Digoxin 0.0625mg, and Canrenon 50mg with questionable adherence. On physical examination, he was pyretic, mildly hypotensive and hypoxemic. An ECG showed atrio-guided biventricular stimulation at 110 bpm. A transthoracic echocardiogram (TTE) revealed biventricular disfunction and dilation, mitral and tricuspid regurgitation, PAPs 60 mmHg, and a thrombotic formation in the left ventricle apex. Blood tests found elevated D-Dimer and infection markers, INR 1.1. A CT angiography confirmed a bilateral acute massive PE associated with lung consolidations and left pleural effusion. We excluded deep vein thrombosis in the lower limbs. Patient was admitted to CCU and treated with intravenous heparin, antibiotics, and support therapy. After one week, we performed a transesophageal echocardiogram that confirmed the previous TTE except for a minor PAPs and unknown thrombotic formations on the atrial side of the tricuspid valve, adhering to CRT-D leads, pedunculated, highly mobile, the largest with an area of 1.9cm2. Cardiac surgery wasn't indicated; we excluded thrombophilia and thoracic cancer. Patient is still hospitalized, asymptomatic and with a precarious cardiovascular status. Discussion The incidence of asymptomatic clot adhering to cardiac device's leads found by echocardiography is 1.4%, and thromboembolic complications are even rarer, especially after years from the implant. In our patient, the right atrium thrombosis is probably the cause of PE, and possible precipitating factors were pneumonia or unknown hepatic neoplasm. In the diagnostic workup, TTE probably wasn't sensitive enough to detect those thrombi. Conclusions We presented a particular case of PE in a relatively young patient affected with HFrEF. Even if thrombosis related to pacemaker leads is rare, it should be considered as a possible cause of PE in a patient bearer of a cardiac stimulating device.

Pulmonary Embolism With Underlying Family History Presenting as Syncope: A Case Report

An artery blockage by a foreign body, such as a blood clot/fat/air/cholesterol/amniotic fluid, is called an embolism. The most serious conditions caused by an embolism are stroke and pulmonary embolism. Pulmonary embolism (PE) occurs when a foreign body blocks the vessel that carries blood from the heart to the lungs. Deep vein thrombosis (DVT) has the potential to embolize and travel through the right side of the heart and become lodged in the blood-supplying artery of the lungs: the pulmonary artery. DVT is one of the major causes of pulmonary embolism. Pulmonary embolism is a life-threatening disease that can sometimes be problematic to point at, especially when the patient has no obvious symptoms. The risk factors may not be strikingly palpable, and there may also be an intersection between the symptoms and signs of pulmonary embolism and other diseases. Syncope is a comparatively easy clinical symptom to detect but has varied etiologies that lead to a standard cause in only 58% of syncopal events. It is a difficult correlation to make when syncope is the presenting symptom of pulmonary embolism. Family history in the case of undiagnosed pulmonary embolism presenting with symptoms that point in no particular direction becomes crucial in determining the disease.

Pulmonary embolism and 529 human blood metabolites: genetic correlation and two-sample Mendelian randomization study

BackgroundThe incidence of pulmonary embolism complications in the literature ranges from 10 to 50%, with a 0.5–10% risk of fatal pulmonary embolism. However, the biological cause of pulmonary embolism is unknown.MethodsThis study used data from the Genome-Wide Association Study (GWAS) of Pulmonary Embolism and Human Blood Metabolites from the UK Biobank, and the data from subjects of European ancestry were analyzed. We explored the relationship between pulmonary embolism and blood metabolites in three ways. We first analyzed the genetic correlation between pulmonary embolism and human blood metabolites using the linkage disequilibrium score regression (LDSC) and then analyzed the causal relationship between pulmonary embolism and meaningful blood metabolites obtained from the LDSC, a procedure for which we used Mendelian randomization analysis. Finally, we obtained transcriptome sequencing data for patients with a pulmonary embolism from the GEO database, analyzed differentially expressed genes (DEGs) in patients with pulmonary embolism versus healthy populations, and compared the DEGs with the resulting blood metabolite genes to further validate the relationship between pulmonary embolism and blood metabolites.ResultWe found six human blood metabolites genetically associated with pulmonary embolism, stearic acid glycerol phosphate ethanolamine (correlation coefficient = 0.2582, P = 0.0493), hydroxytryptophan (correlation coefficient = 0.2894, P = 0.0435), and N1-methyladenosine (correlation coefficient = 0.0439, P = 0.3728), and a significant causal relationship was discovered between hydroxytryptophan and pulmonary embolism. After screening microarray data from the GEO database, we performed differential gene analysis on the GSE19151 dataset and screened a total of 22,216 genes with P values less than 0.05, including 17,361 upregulated genes and 4854 downregulated genes. By comparing the resulting differentially expressed genes with six genes encoding blood metabolites, LIPC and NAT2 were found to be differentially expressed in association with pulmonary embolism.

Assessment of right ventricular function by 2D transthoracic echocardiography in COVID-19 hospitalized patient in correlation with CT pulmonary angiographic findings

Background:. The Egyptian protocol in COVID-19 patients includes doing a non- contrast CT chest for patients with suspicious respiratory symptoms. However, many patients with worsened symptoms especially during the second week of disease showed symptoms of thrombotic events of pulmonary arteries, and that is why CT pulmonary angiography (CTPA) became recommended by multiple reports. Aim of the Work: Evaluation of RV Function by Echocardiography in COVID-19 hospitalized patients in correlation with CT pulmonary angiographic findings. Patients and Methods: This study is a prospective study which included 100 consecutive adult patients (≥18 years of age). Results: Our study showed that there was non statistically significant difference found between two groups regarding Basal right ventricular diameter , FAC , PASP ,TAPSE (except for sever pulmonary embolism ) Conclusion: Our study revealed the variable presentation of COVID-19 as a cause of pulmonary embolism. And no statistically significant difference found between pulmonary embolism group and no pulmonary embolism group regarding right ventricular dysfunction .

An Integrated Approach to the Treatment of Pulmonary Embolism: Current State of the Problem

&#x0D; The aim. Treatment of venous thromboembolism remains perhaps the most challenging problem of modern phlebology. The aim of our study was to analyze current data and guidelines on the use of surgical and minimally invasive approaches in the treatment of pulmonary embolism (PE) and to compare these with our own results.&#x0D; Materials and methods. The results of treatment of 168 patients with PE, who underwent inpatient treatment at the clinic from 2009 to 2021, were analyzed. Among them, 162 (96%) patients had deep vein thrombosis, in 6 patients the cause of PE could not be identified. Recurrent PE was observed in 2 patients. PE with a high risk of death was observed in 51 (30.3%) patients, with a medium and low risk of death in 117 patients (69.6%).&#x0D; Systemic thrombolysis was performed in 44 (26%) cases. In 5 (2.9%) cases, vena cava filters were implanted. One (0.6%) patient underwent aspiration thrombectomy of the pulmonary artery using an Aspirex catheter. Two (1.1%) patients underwent pulmonary artery thrombectomy using an artificial circulation device.&#x0D; Results. Significant improvement in patients treated with thrombolytic therapy was observed in 40 (92.8%) cases. After surgical treatment of PE, significant improvement was observed in 100% of cases, 2 patients after PE showed complete de-obstruction of the pulmonary artery. No hemorrhagic complications were observed during the study period. No fatalities were reported. No recurrent PE was observed during the study period.&#x0D; Conclusions. The choice of treatment for PE is determined by the degree of the impact on the pulmonary tract, the stability of the patient’s condition, indicators of dysfunction of the right heart, the period from the onset of the disease, the risk of death.&#x0D; The use of aspiration thrombectomy using an Aspirex catheter (Straub, USA) and pulmonary artery embolectomy in the absence of thrombolytic therapy allows to obtain satisfactory results in patients with PE.

Accuracy of point-of-care tele-ultrasonography for assisting ultrasound-naive resident doctors in detecting lower-limb deep venous thrombosis: A prospective controlled trial

ObjectivesThis study aimed to explore the accuracy of point-of-care tele-ultrasonography (POC-TUS) in detecting lower-limb deep venous thrombosis (DVT). MethodsWe conducted a prospective study in the intensive care unit (ICU). Each patient underwent three sessions of POC-US by one US-naive resident doctor (Group 1), one resident doctor supervised by a remote experienced radiologist through real-time POC-TUS (Group 2), and one on-site experienced radiologist (Group 3). The presence and location (if any) of lower limb DVT and the duration of examination of each patient were recorded. Diagnostic accuracy was determined by the consensus of two independent observers. ResultsFinally, 71 patients (39.4%, 71/180) with lower limb DVT were identified. The accuracy of Group 2 was similar to that of Group 3 (91.7% vs. 92.8%, P = 0.694) but significantly higher than that of Group 1 (91.7% vs. 72.8%, P < 0.001). The median duration of examination of Group 2 (7 min) was shorter than that of Group 1 (11 min) (P < 0.001) and longer than that of Group 3 (4 min) (P < 0.001). ConclusionResident doctors can promptly and accurately detect lower-limb DVT in patients in the ICU with real-time POC-TUS guidance. SignificanceLower-limb DVT is the most common cause of pulmonary embolism and may result in substantial morbidity and mortality, and its early and accurate detection is crucial. This study is among the few to provide evidence for the usefulness of real-time POC-TUS early and accurate detection of lower-limb DVT.

Concurrent pulmonary arteriovenous malformation and pulmonary embolism causing stroke: a therapeutic dilemma

BackgroundAs pulmonary arteriovenous malformation (PAVM) include a right-to-left shunt, it can be accompanied by fatal complications such as stroke and brain abscess due to paradoxical embolism. A concurrent PAVM and pulmonary embolism (PE) is a rare condition. Therefore, the sequence of management has not been established.Case presentationA 62-year-old female patient was transferred to our hospital with a sporadic simple PAVM and concurrent bilateral PE. On chest computed tomography (CT), the acute PE was extended to the segmental pulmonary artery where the feeding artery of PAVM originated. Despite the anticoagulation, the patient complained of left sided weakness on the fifth day of admission, and magnetic resonance imaging revealed an acute infarction in the right lateral thalamus, which was thought to be caused by paradoxical embolism. This situation could lead to a dilemma between the risk of thrombus migration during PAVM embolization and another embolic event due to delayed shunt occlusion during anticoagulation. After a multidisciplinary discussion, a delayed endovascular embolization was performed for PAVM after confirming the complete resolution of PE with 4 months of anticoagulation. The cause of PE in this patient was eventually diagnosed as antiphospholipid syndrome.ConclusionThe authors reported a rare case of concurrent PAVM and PE that led to an embolic stroke during hospitalization. This patient was managed with delayed endovascular embolization for PAVM after an anticoagulation for PE and stroke. It is thought to be valuable in deciding for a treatment plan for this rare condition.

Clinical and echocardiographic characteristics of patients with pathology proven right-sided papillary fibroelastomas

BackgroundPapillary fibroelastoma (PFE) are one of the most common primary cardiac neoplasms. They are most commonly found on cardiac valves especially on the left side of the heart and have been associated with an increased risk of embolization. To date, no large studies looked at the clinical significance of right-sided PFE (R-PFE). Therefore, we sought to better characterize patients with R-PFE and its clinical sequelae. MethodsWe retrospectively identified patients with pathology-proven PFEs at a single center between January 1995 and December 2018 (n = 279). Patients with R-PFE were analyzed. Medical records and echocardiograms were reviewed for clinical and PFE characteristics. ResultsTwenty-nine patients with R-PFE (mean age 70 ± 11 years; 62% women) were included in the analysis. PFEs were located on the right atrial (RA) wall in 31%, tricuspid valve in 34%, right ventricular (RV) wall in 7%, RV outflow tract in 4%, and pulmonary valve in 10% of patients. The remaining patients (14%) had multifocal PFEs. Around 38% of patients had cancer diagnosed before PFE diagnosis, and 34% had associated congenital heart disease. Seventeen (59%) patients had angina or dyspnea at the time of the presentation, and 3 (10%) had embolic symptoms. One patient with PFE located on the RA with associated patent foramen ovale had a stroke at time of presentation. Two patients, one with PFE on the RA wall and another patient with PFE at the tricuspid valve, had pulmonary embolism at the time of presentation. Median maximal length for PFE varied by location, ranging from a media of 8 mm to 16 mm. Of the 12 patients with follow up echocardiogram 1 year after PFE removal; 3/12 (25%) had documented PFE recurrence. ConclusionR-PFE can be present in patients thromboembolic events when there is a right-to-left shunt. They can be a rare cause of pulmonary embolism, and at least in those that had follow-up echocardiograms, had a significant recurrence rate.

Incidence of venous thromboembolism in children with primary lymphomas

Cancer increases the risk of venous thromboembolism (VTE) in adults and children. The aim of our study was to evaluate the incidence of VTE in children and adolescents with lymphomas. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. A retrospective analysis based on medical data of 262 children and adolescents (0–18 years) with primary lymphomas (n = 262) who were treated in Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology since 01.01.2013 to 31.12.2019 had been performed. Such parameters as age and sex distribution of patients, the frequency, as well as the cumulative incidence of detection (CI) and differences in localization, the median time of detection of symptomatic (sVTE) and asymptomatic episodes of VT (aVTE), their relationship with central venous catheters (CVC) were analyzed. Statistical processing of the obtained data was carried out using the XLSTAT 2020 program (Addinsoft, France). The median age was 11,1 years (interquartile range (IQR) 6.5–15 years), the ratio of males to females was 2.2:1. There were 71 episodes of VTE in 65 patients (24.8%, 95% confidence interval (CI): 19.6–30). Among all episodes of VTE 31% were defined as sVTE at 400 day CI for sVTE was found to be 8.1% (95% CI: 5.4–12.2) and CI for aVTE – 18.7% (95% CI: 14.4–24.2). The median time to VTE episode was 38 days (IQR 16.5–91.5 days). There was a trend towards an earlier diagnosis of sVTE (median 23.5 days, IQR – 17–42 days) than aVTE (median 62 days, IQR 14–80 days), p = 0.075. VTE was CVC-related in 67.7 of all VTE cases. In one case, asymptomatic thrombosis of right atrium led to pulmonary embolism (PE). VTE is a frequent complication in children and adolescents with lymphomas. Most episodes of VTE were asymptomatic, one of which was the most likely cause of PE in the child. Further research is needed to find risk factors for VTE.

A young woman presented with massive pulmonary embolism with inferior vena cava thrombus as a complication of nephrotic syndrome: a case report

Nephrotic syndrome (NS) was first described in 1827 as the presence of proteinuria of ≥ 3.5 g/24 h, hypoalbuminemia < 3.0 g/dl, peripheral edema, hyperlipidemia, lipiduria, and increased thrombotic risk. Nephrotic syndrome has an incidence of three cases per 100,000 each year in adults. Nephrotic syndrome also has serious complications due to hypercoagulable state in both various venous and arteries which could lead thromboembolic events. The pathophysiology of hypercoagulability in the nephrotic syndrome is due to an imbalance of prothrombotic and antithrombotic factors, as well as impaired thrombolytic activities.Here, we will present a 19-year-old woman who presented to the emergency department complaining of chest pain and shortness of breath for 3 days. The patient was quickly diagnosed with pulmonary embolism and inferior vena cava thrombosis as a complication of nephrotic syndrome, allowing prompt initiation of anticoagulant therapy. After 2 weeks of admission, the patient’s condition resolved, her laboratory results returned to almost normal and the patient was discharged with oral prednisolone, coumadin, atorvastatin, and ramipril. We aim to determine which is the likely cause of pulmonary embolism in patients with nephrotic syndrome.

Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review.

Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

Ovarian vein thrombosis, a rare cause of pulmonary embolism: a case report

Ovarian vein thrombosis, a rare cause of pulmonary embolism: a case report

Rivaroxaban treatment for young patients with pulmonary embolism (Review).

Pulmonary embolism (PE) is a serious, life-threatening condition that affects young populations (>18 and <50 years old, according to most literature reviews) with improved recognition of its clinical manifestations and the widespread use of sensitive imaging techniques, PE is increasingly diagnosed in younger patients. At present, there is limited understanding of the clinical features and adequate anticoagulant treatment options for this population. Most studies to date have yet to demonstrate significant differences in PE pathophysiology or symptoms between young and elderly patients. Although the overall incidence of PE is lower in young populations compared with elderly patients, important risk factors also apply for young patients. Hereditary thrombophilia is common and is a major cause of PE in younger patients. Immobilization, trauma, obesity, smoking and infection are also becoming increasingly frequent in young patients with PE. Among female patients, oral contraceptive use, pregnancy and postpartum status are predominant risk factors underlying PE. Rivaroxaban is a direct oral anticoagulant with a rapid onset of action that is associated with less drug-drug interactions compared with other therapies. Because the drug is administered at fixed doses with no requirement for routine coagulation monitoring, it is becoming an attractive option for anticoagulation treatment in young patients with PE. Therefore, the present literature review focuses on the clinical characteristics of PE and rivaroxaban therapy in younger patients.

Romatolojik Hastalıkların ve Mean Platelet Volume Düzeylerinin Pulmoner Emboli ile İlişkisi

INTRODUCTION: Pulmonary Embolism (PE) is shown as an important health problem all over the world. Many predisposed conditions are known, which are the cause of PE. There are an acquired and genetic risk factors for PE, but in 30% of patients the cause cannot be determined. There are so many and genetic risk factors for PE. However, in %30 of patients the cause aren’t determined. New risk factors are being investigated in recent years. In this study, the relationship between PE and the value of mid platelet volume (MPV) and rheumatological diseases (RH) was studied. METHODS: The records in the hospital database were used in the study. Patients diagnosed with PE between January 2008 and July 2012 were determined retrospectively and 64 patients were included in the study. Among patients diagnosed with PE, those diagnosed with RH and average MPV values of patients were determined. A control group was formed by selecting 64 patients who were not diagnosed with PE and RH from the patients who applied at the same time interval with the case group.Among the patients with PE and who are diagnosed with the RD and whose values of MPV were determined. PE patiends and Rheumatologic patients who are diagnosed with PE and whose values of MPV were compared. RESULTS: As a result of the analyzes, it was determined that there was no significant difference between the case and control groups.