Chronic Pulmonary Thromboembolism Research Articles

Use of the Spectral Iodine Map in the Assessment of Chronic Pulmonary Thromboembolism

Use of the Spectral Iodine Map in the Assessment of Chronic Pulmonary Thromboembolism

Pulmonary Artery Intimal Sarcoma Treated as Chronic Pulmonary Thromboembolism

Pulmonary Artery Intimal Sarcoma Treated as Chronic Pulmonary Thromboembolism

Massive Bilateral Pulmonary Thromboembolism – A Bolt from the Blue Case Report

Thrombosis originating from the deep veins of the lower limbs can result in recurrent emboli leading to acute on chronic pulmonary thromboembolism. The death in such situations would be sudden and unexpected due to acute right sided heart failure (cor pulmonale). There can be few preceding non-specific symptoms such as cough and/or dyspnoea, especially in non-hospitalised decedents. Many a time pulmonary thromboembolism is only detected in a medicolegal autopsy. The sudden and unexpected death in an apparently healthy individual paves the way for a police inquest procedures, and a medicolegal autopsy would be the only legal and logical alternative to find a closure. However, massive bilateral pulmonary thromboembolism occluding almost more than 80 percentage of the pulmonary artery vasculature is an extremely rare phenomenon in a medicolegal autopsy. This case report has been prepared to discuss on such a rare presentation, discovered during the medicolegal autopsy of an apparently healthy 46-year-old individual who collapsed on the sides of a road, and was brought dead to the hospital.

Detection of pulmonary thrombembolism and postmortem clotting on postmortem magnetic resonance imaging

The purpose of this study was to develop a feasible imaging protocol superior to postmortem computed tomography (PMCT) and to establish diagnostic parameters for diagnosing pulmonary thromboembolism (PE) on postmortem magnetic resonance imaging (PMMR).The study collective of 113 subjects was prospectively investigated by PMMR for the presence of PE and / or postmortem clotting (cruor). PE was detected in 20 cases; the remaining 93 cases were investigated for the morphology of cruor. Age grading was performed by PMMR, autopsy and histology. The postmortem sedimentation effect was used for the applied imaging protocol on PMMR (supine and prone position). Visual distension of the pulmonary arteries in PE was seen in all cases, but not in the controls. Re-positioning of the corpse from supine in prone position proved to be beneficial in 90 %. Postmortem motion artifacts are firstly described in 20.4 %. Hyperacute PE (grade 1) presented with a homogenous and hypointense signal on T2w images, acute PE (grade 2) with slightly heterogeneous, but still homogenous hypointense signal, subacute PE (grade 3) was with heterogeneous and slightly hyperintense signal and chronic PE (grade 4) with predominately homogenous with scarce portions of heterogeneous but hyperintense signal. PMMR allowed for the detection of PE and for in situ depiction of combined age grading.

Retrieval of Chronically Implanted Dual-chamber Leadless Pacemakers in an Ovine Model.

The clinical utilization of leadless pacemakers (LPs) as an alternative to traditional transvenous pacemakers is likely to increase with the advent of dual-chamber LP systems. Since device retrieval to allow LP upgrade or replacement will become an important capability, the first such dual-chamber, helix-fixation LP system (Aveir DR; Abbott, Abbott Park, IL) was specifically designed to allow catheter-based retrieval. In this study, the preclinical performance and safety of retrieving chronically implanted dual-chamber LPs was evaluated. Atrial and ventricular LPs were implanted in the right atrial appendage and right ventricular apex of 9 healthy ovine subjects. After ≈2 years, the LPs were retrieved using a dedicated transvenous retrieval catheter (Aveir Retrieval Catheter; Abbott) by snaring, docking, and unscrewing from the myocardium. Comprehensive necropsy/histopathology studies were conducted to evaluate device- and procedure-related outcomes. At a median of 1.9 years postimplant (range, 1.8-2.6), all 18 of 18 (100%) LPs were retrieved from 9 ovine subjects without complications. The median retrieval procedure duration for both LPs, from first-catheter-in to last-catheter-out, was 13.3 minutes (range, 2.5-36.4). Postretrieval, all right atrial, and right ventricular implant sites demonstrated minimal tissue disruption, with intact fibrous tissue limited to the distal device body. No significant device-related trauma, perforation, pericardial effusion, right heart or tricuspid valve injury, or chronic pulmonary thromboembolism were observed at necropsy. This preclinical study demonstrated the safe and effective retrieval of chronically implanted, helix-fixation, dual-chamber LP systems, paving the way for clinical studies of LP retrieval.

P391 THE DIAGNOSTIC CHALLENGE BETWEEN CHRONIC PULMONARY EMBOLISM AND PULMONARY ARTERY SARCOMA: A CASE REPORT

Abstract We report the case of a 63–year–old obese and hypertensive woman, admitted in hospital with worsening dyspnea for 2 weeks and syncope. A suspected chronic thromboembolism was diagnosed nine months before for a similar clinical picture; hematologic screening excluded thrombophilia and NOACs were prescribed. Two–dimensional transthoracic echocardiography showed enlargement of right chambers, the interventricular septum shifted to the left ventricle, showing “D” sign. Color Doppler flow imaging showed moderate regurgitation in tricuspid valve, with indirect pulmonary pressure estimation 90 mmHg. Left ventricle was normal for dimensions and function. ECG evidenced sinus tachycardia and no specific ST–T alterations. Blood exams evidenced anemia (Hb 9 mg/dl), negative neoplastic markers and absence of occult blood in feces, mildly elevated inflammatory markers, T–Troponin and D–dimer. Naso–pharyngeal swab for SARSCoV2 infection was negative. Chest computed tomography with contrast revealed a large filling defect within bilateral main pulmonary arteries. No lymph nodes or pulmonary pneumonia were detected. Lower extremity venous ultrasound was positive for right popliteal deep vein thrombosis. The global clinical picture suggested an acute pulmonary embolism recurrence, with a severe right ventricle impairment and a concomitant deep vein thrombosis. Some factors were not completely clear: chronic anemia, only mildly increased D–dimer, no specific increase of inflammatory markers. The patient was referred to Cardiac Surgery Unit of IRCCS Foundation Policlinico San Matteo in Pavia, for pulmonary endarterectomy. Unexpectedly the surgical finding was a bilateral pulmonary artery sarcoma, confirmed by histological exam. We thus clarified some uncertain clinical aspects, explainable in the context of a severe neoplastic picture. There were no immediate complications, and a chemotherapy was initiated after a period of cardio–pulmonary rehabilitation. Pulmonary artery intimal sarcoma is a very rare disease, its prevalence is about 0.001–0.003%, it can originate from the left and right pulmonary arteries and intimal layer of pulmonary arteries, forming a tumor growing in the nodular cavity or spreading along the intimal surface. PAS is often misdiagnosed as acute or chronic pulmonary thromboembolism due to its clinical presentation and radiological findings. Thus, early diagnosis is very crucial and may improve patient outcome.

Pulmonary Thromboendarterectomy for Chronic Pulmonary Thromboembolism

Pulmonary embolism in terms of causes of mortality is the third most common cause, when talking about cardiovascular diseases, yet most undiagnosed or misdiagnosed one. Among causes of pulmonary thromboembolism protein C deficiency is a rare one and idiopathic most common entity. In general population the incidence of severe protein C deficiency is about 1 in 500,000-750,000 people. We present a case of chronic pulmonary thromboembolism in young female of 23 years. She presented with history of dyspnea, dry cough and bilateral DVT of legs. On pulmonary CT diagnosis of massive pulmonary thrombus was made and her pulmonary thromboendarterectomy was done in our center. Conclusion: All patients with chronic pulmonary thromboembolic hypertension should be assessed for operability by proper referral to an experienced CTEPH (chronic thromboembolic pulmonary hypertension) team to determine if they are viable candidate for PEA (pulmonary endarterectomy). PEA is standard and recommended operative technique for treatment of CTEPH. Keywords: pulmonary endarterectomy, pulmonary embolism, protein C deviciency

An interesting case of chronic pulmonary thromboembolism caused by a femoral arterial aneurysm

Femoral artery aneurysm (FAA) is an unusual peripheral arterial aneurysm that can result in potential rupture, thrombosis and embolism. FAA can variably present as an asymptomatic mass or acute lower limb-threatening ischemia. We present a rare case of asymptomatic FAA causing proximal deep vein thrombosis, leading to chronic pulmonary thromboembolism. Endovascular intervention was performed to secure FAA. This report signifies FAA as a differential diagnosis of DVT and chronic pulmonary thromboembolism. Although an open surgical approach is generally preferred for FAA repair, minimally invasive endovascular repair can be considered a safe alternative technique.

Comprehensive Review of Pulmonary Hypertension and Treatment Options in the Paediatric Population

Pulmonary hypertension (PH) is a complex condition that can occur as a result of a wide range of disorders, including left heart disease, lung disease, and chronic pulmonary thromboembolism. Multiple improvements have been made in the diagnosis and treatment of pulmonary arterial hypertension (PAH)including a greater understanding of the involvement of extrapulmonary vascular organ systems, validated point of care, clinical assessment tools, and a focus on the initial exposure of numerous pharmacotherapeutics in the appropriate level of care. To achieve a minimal symptom burden, improve the patient's biochemical, hemodynamic, and functional profile, and reduce adverse impact, early diagnosis of PAH is a key objective today. The preferred method of management for thromboembolic PH, which is chronic, is pulmonary endarterectomysince the majority of affected patients are operable. The timing of pulmonary endarterectomy should never be delayed for medical reasons, and risk stratification can enable us to select patients who have a high chance of success. Patients who are not qualified for endarterectomy should be referred for drug trials. Even though there are more effective ways to guarantee a sufficient, long-lasting septostomy, atrial septostomy is promising but undervalued. The procedure's indications remain the sameand needto be taken into account more frequently. Class III or IV patients who are not improving need to be consulted at a transplant centre as soon as possible as they may be candidates for potential recipients of bilateral sequential lung or heart-lung transplants, which is a significant choice for some people. PH is rarely linked to other conditions like connective tissue or thromboembolic disease. It is either idiopathic or linked to congenital heart disease. Infants and children with PH are more frequently recognised in conjunction with a congenital diaphragmatic hernia and developmental lung diseases like bronchopulmonary dysplasia. Although the underlying disease has not yet been treated and advanced structural changes have not yet been reversed, the value of natural life and survival have suggestively increased. Children's haemodynamic and functional outcomes have improved as a result of endothelin receptor antagonists, prostacyclin analogues, and phosphodiesterase type 5 inhibitors, which are examples of targeted pulmonary vasodilator therapies. The health maintenance of paediatric PH is still difficult because treatment decisions are largely based on the findings of adult studies that have been supported by evidence and the clinical expertise of paediatric specialists.

Analysis of family histories suggests shared genetic risk for chronic thromboembolic pulmonary hypertension and venous thromboembolism.

Chronic thromboembolic pulmonary hypertension (CTEPH) and acute pulmonary embolism (PE) are related phenotypes, however, previous reports have suggested that genetic risk factors for CTEPH and PE differ. Here we report that a family history of VTE is equally frequent in individuals with CTEPH and PE, suggesting that shared genetic variants may influence risk of both phenotypes. We also provide the first estimate of the frequency of familial CTEPH, which we identified in 2.2% of CTEPH patients in our cohort.

Clinical and imaging risk factors for the persistence of thromboembolism following acute pulmonary embolism.

BackgroundPredicting the progression of acute pulmonary embolism to chronic pulmonary thromboembolism (CPTE) disease is essential to monitoring and improving the long-term prognosis of pulmonary embolism. We explored the risk factors for chronic persistence of thromboembolism after acute pulmonary embolism.MethodsCases with newly onset acute pulmonary embolism in the China-Japan Friendship Hospital from November 2016 to November 2019 were retrospectively analyzed. The clinical characteristics, serological examination results, and treatment strategies of acute pulmonary embolism patients were obtained through the electronic medical record system (Goodwill E-Health Info Co., Ltd.). Imaging parameters on computed tomography pulmonary angiography (CTPA) images at the onset of the acute pulmonary embolism were measured and counted. Notably, we propose a new parameter based on CTPA images: the ratio of Sd (sum of residual segmental pulmonary artery diameter) to MPAd (the main pulmonary artery diameter) (Sd/MPAd). After 3 months of regular treatment for acute pulmonary embolism, patients were classified into a CPTE group or a non-CPTE group based on the presence of residual embolus. All data were compared between the CPTE group and non-CPTE group. Furthermore, logistic regression analysis was used to investigate risk factors for the progression of acute pulmonary embolism to CPTE.ResultsA total of 77 cases (male:female = 1:1.26) were included in the study. There were 43 cases (55.84%) in the CPTE group and 34 cases in the non-CPTE group (44.16%). The results of univariate analysis showed that there were statistically significant differences between the 2 groups in risk stratification (χ2=8.043; P=0.005), protein S activity (χ2=5.551; P=0.018), the ratio of sum of residual segmental pulmonary artery diameter to the main pulmonary artery diameter (Sd/MPAd; t=–2.103; P=0.039), Mastora score (U=362.500; P<0.001), and embolus location (χ2=16.969; P<0.001). However, there were no statistically significant differences between the 2 groups in treatment options (P=0.381). According to multivariate logistic-regression analysis, protein S activity <55% (P=0.025), Sd/MPAd ≥1.97 (P=0.011), and an embolus being located in the central pulmonary artery (P<0.001) were independent risk factors for chronic persistence of thromboembolism following acute pulmonary embolism.ConclusionsThe protein S activity, location of the embolus, and Sd/MPAd on CTPA at the onset of acute pulmonary embolism may suggest the progression of acute pulmonary embolism to CPTE.

Decreased Pulmonary Artery Bifurcation Angle: A Novel Imaging Criterion for the Diagnosis of Chronic Pulmonary Thromboembolism.

Background: Chronic pulmonary thromboembolism (CTEPH) is an unusual complication of acute pulmonary embolism (PE), which is now considered to be treatable. In modern multi-detector scanners, a detailed evaluation of pulmonary artery geometry is currently possible. This study aimed to evaluate the changes in pulmonary artery bifurcation angle (PABA) in the follow-up computed tomography angiography (CTA) of patients with acute PE.Methods: In this cross-sectional study, the records of two tertiary-level academic hospitals were gathered from 2012 to 2019. Pulmonary artery (PA) bifurcation angle and diameter were measured. Chi square test, independent samples t test, Mann-Whitney, and Pearson’s tests were employed to compare data. To evaluate the cut-off point, we utilized receiver operating characteristic (ROC) curve analysis. The accuracy, sensitivity, and specificity of pulmonary artery bifurcation angle changes were calculated. A P value <0.05 was considered to be significant.Results: Forty-six patients were included in the study. No significant differences were found between patients with and without CTEPH, and PABA in the dimeters of PA trunk, right PA, and left PA in the first CTA images (P values of 0.151, 0.142, 0.891, and 0.483, respectively), while in the secondary CTA, the mean PABA was significantly smaller in patients with CTEPH (P=0.011). In the receiver operating characteristic (ROC) analysis, delta angle revealed an area under the curve of 0.745 and an optimal cutoff of 0, leading to a sensitivity of 64%, specificity of 87%, and accuracy of 76% for diagnosing CTEPH.Conclusion: We showed a significant decrease in PABA in patients developing CTEPH. This parameter can be easily measured in lung CTA.

STAY ALERT ABOUT COAGULATION PARAMETERS - IMPLICATIONS OF THROMBOSIS TREATMENT IN COVID-19

Objective: The case report presents two patients with COVID-19 history. The first patient, treated with enoxaparin, was diagnosed with pulmonary embolism, and later developed heparin-induced thrombocytopenia. The second patient with history of chronic pulmonary thromboembolism and multiple comorbidities, treated with rivaroxaban and acetylsalicylic acid, reported haemorrhagic events. The objective of this case report is to highlight possible complications of anticoagulant treatment and the role of accurate and rapid response of clinicians in COVID-19 patients. Design and method: Case report of two patients with COVID-19 - related thrombotic complications treated respectively with low molecular weight heparin and rivaroxaban. Observation of the treatment process revealed complications in both cases, demanding change of medications within the same group of drugs. Results: Development of thrombotic episodes was noticed and treated in time. Both patients developed complications of treatment. Modifications of anticoagulation drugs (low molecular weight heparin replaced with fondaparinux and rivaroxaban with apixaban respectively) were provided with positive outcomes. Conclusions: SARS-CoV-2 infection is associated with a high risk of thrombotic events whereas anticoagulant treatment can also lead to various complications. The necessity of watchful observation of coagulation parameters in patients with COVID-19, but also potential complications of any anticoagulant treatment is crucial for the positive long-term outcomes.

Bilateral Pulmonary Thromboendarterectomy for a Patient with Chronic Pulmonary Thromboembolism Developing Severe Pulmonary Hypertension – A Case Report

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease with high mortality and few treatment options. Pulmonary thromboendarterectomy (PTE) is the treatment of choice to relieve pulmonary artery obstruction in patients with chronic thromboembolic pulmonary hypertension (CTEPH). This is a challenging procedure in our perspective because of number of regions such as, late diagnosis, scarcity of appropriate instruments, lack of skilled surgeon as it is not familiar to them. Here we are presenting such a case that was also diagnosed incidentally. We successfully operated the patient with chronic pulmonary thromboembolism with severe pulmonary hypertension. Cardiovasc j 2022; 14(2): 176-179

68 Ga-FAPI-04 Versus 18 F-FDG PET/CT in a Case With Intimal Sarcoma of the Pulmonary Artery.

Intimal sarcoma of the pulmonary artery is a rare entity, mimicking acute or chronic pulmonary thromboembolism. We describe 68 Ga-FAPI-04 and 18 F-FDG PET/CT findings in a case with intimal sarcoma of the pulmonary artery. The intrapulmonary artery tumor showed inhomogeneously increased FDG and FAPI uptake. Compared with FDG PET/CT, FAPI PET/CT more clearly delineated the tumor partially because of a very low background FAPI activity in the walls of the main pulmonary artery and right ventricle, which showed diffuse FDG uptake.

Differential diagnosis between pulmonary artery sarcoma and central chronic pulmonary thromboembolism:a preliminary study on CT signs

Objective: To improve the diagnostic accuracy of pulmonary artery sarcoma, and to distinguish it from central chronic pulmonary thromboembolism using CT scans. Methods: In this retrospective study, two groups of pulmonary artery sarcoma (PAS group) and central chronic pulmonary thromboembolism (central CPTE group) confirmed by pathology at our hospital between August 2009 and July 2019 were enrolled, clinical features and pre-operative CT pulmonary artery manifestation were collected, and the key points of differential diagnosis were summarized. Results: The study was composed of 13 cases in the PAS group including 10 males (76.9%), with an average age of (45.4±15.5) years. There were 19 patients in the central CPTE group including 14 males (73.7%), with an average age of (38.6±14.1) years. There were no significant differences in gender and age between the two groups. Deep venous thrombosis in the lower extremities was significantly higher in the central CPTE group than in the PAS group (7/19 vs. 0/13, P=0.025), and the N-terminal pro-brain natriuretic peptide value was higher in the central CPTE group than in the PAS group [674.50(261.70-1 977.70) vs. 66.00(28.10-505.50),P=0.001]. In CT pulmonary angiography, the involvement of the main pulmonary artery, and the proximal lesion showing an acute angle to the pulmonary artery wall were more common in the PAS group [11(84.6%) vs. 5(26.3%), P=0.003; 11(84.6%) vs. 2(10.5%), P<0.001, respectively]. The swelling index of the main pulmonary and the left/right main pulmonary arteries in the PAS group were significantly higher, as well as the dilatation in the lobar and segmental pulmonary arteries [1.19±0.17 vs. 0.99±0.19,P=0.006, 10(76.9%) vs. 2(10.5%), P<0.001, respectively]. The right ventricular transverse diameter/left ventricular transverse diameter (RVd/LVd) and pulmonary artery diameter/ascending aortic diameter ratio (Pad/Aod) were significantly lower in PAS group than those in the central CPTE group (0.97±0.19 vs. 1.23±0.35,P=0.020; 0.98±0.25 vs. 1.15±0.20,P=0.039). Conclusions: In CT pulmonary angiography, filling defects involving the main pulmonary artery and showing expansive growth were highly suggestive of pulmonary artery sarcoma. The history of deep venous thrombosis of the lower extremities was helpful for the diagnosis of chronic pulmonary embolism.

Right ventricular end-systolic remodeling index on cardiac magnetic resonance imaging: comparison with other functional markers in patients with chronic thromboembolic pulmonary hypertension.

Cardiac magnetic resonance imaging (CMR) can provide important metrics of pulmonary hypertension. In the current study, we investigated whether the CMR-derived right ventricular end-systolic remodeling index (RVESRI) could be a metric in assessing the function and hemodynamics of chronic thromboembolic pulmonary hypertension (CTEPH). A total of 64 patients (45±14 years, 37 males), including 46 patients with CTEPH and 18 patients with chronic pulmonary thromboembolism (CTE), were retrospectively enrolled. All patients underwent right heart catheterization and CMR within 7 days. RVESRI, right ventricular eccentricity index, right ventricular end-diastolic and end-systolic volume index, right ventricular ejection fraction, right ventricular cardiac output, and strain were analyzed on cine images of CMR. Hemodynamic parameters including mean pulmonary arterial pressure, pulmonary vascular resistance, and cardiac output were obtained from right heart catheterization. RVESRI of all patients was 1.50 (IQR, 1.26-1.90). Compared with CTE patients, RVESRI in patients with CTEPH was significantly increased (U=27.5, P<0.001). The interclass correlation coefficients of intra-observer reproducibility and inter-observer reproducibility for RVESRI measurement were 0.96 (95% CI, 0.93-0.97) and 0.99 (95% CI, 0.98-0.99), respectively. RVESRI positively correlated with right ventricular end-diastolic and end-systolic volume index and right ventricular global longitudinal strain (r=0.79, 0.83, 0.62, P<0.001), while it was negatively correlated with right ventricular ejection fraction (r=-0.64, P<0.001), right ventricular cardiac output (r=-0.50, P<0.001), and right ventricular eccentricity index (r=-0.81, P<0.001). RVESRI had a positive correlation with mean pulmonary arterial pressure (r=0.65, P<0.001) and pulmonary vascular resistance (r=0.69, P<0.001), while it was negatively correlated with cardiac output (r=-0.64, P<0.001). The receiver operating characteristic curve indicated that RVESRI >1.35 had a sensitivity of 97.8% and specificity of 83.3% in predicting mean pulmonary arterial pressure ≥25 mmHg, and its area under the curve (AUC) was 0.96±0.02. Meanwhile, the AUC of RVESRI was similar to RVEI (Z=1.635, P=0.102) and was more than the diameter of the main pulmonary artery (MPA) (Z=2.26, P=0.02) and the ratio of the MPA and ascending aorta diameter (MPA/AAo) (Z=3.826, P<0.001) in predicting mean pulmonary arterial pressure ≥25 mmHg. RVESRI measured on CMR is a simple and reproducible metric in assessing right ventricular function and hemodynamics in CTEPH patients.

Abstract TP216: Ischemic Stroke In Patients With Cancer Compared To Ischemic Stroke In Patients Without Cancer - A Cohort Study Using Synthetic Data

Background: Patients with cancer are at an increased risk for ischemic stroke (IS) compared to those without cancer. The objectives of this study are 1) to examine risk factors for stroke in cancer and non-cancer patients, and 2) to identify predictive factors for recurrent IS in cancer patients. Methods: We performed a retrospective cohort study using MDClone, a platform that produces synthetic datasets based on real health system data from the Ottawa Hospital Data Warehouse. We analyzed all subjects with a diagnosis of cancer (excluding non-melanoma skin cancer or primary central nervous system malignancies) and IS within a 2-year period preceding and following their cancer diagnosis, and all IS patients without cancer, from the same time period (2000-2019). Patients were followed until May 2019. A forward selection, stepwise multivariate logistic regression model was used to assess the association between recurrent IS (primary outcome) and baseline characteristics. A sensitivity analysis was performed with only survivors in the cancer cohort. Results: We analyzed 10,875 subjects with IS: 1,250 had cancer and 9,625 did not. In cancer subjects, there was a higher prevalence of chronic obstructive pulmonary disease (8.4% vs 4.7%), previous IS (1.9% vs 0.1%), and previous venous thromboembolism (VTE) (8.3% vs 1.5%); the prevalence of atrial fibrillation and vascular risk factors was similar between the two groups. Recurrent IS occurred in 11.0% of cancer subjects and 12.1% of non-cancer subjects. In cancer subjects, the only significant predictor of recurrent IS was previous IS (OR 3.8, 95%CI 2.6 - 5.6). A sensitivity analysis of survivors amongst cancer subjects revealed an even stronger relationship between previous IS and recurrent IS (OR 4.4 95%CI 2.7 - 7.0). In the non-cancer subjects, significant predictors for recurrent IS include older age, while hypertension, dyslipidemia, and history of hemorrhagic stroke were negative predictors of recurrent IS. Conclusion: We found cancer patients with IS have a higher prevalence of COPD, previous IS and VTE, and that previous IS is an important predictor of recurrent IS in cancer patients. These results highlight the importance of identifying optimal secondary prevention treatments in cancer patients.

Circumflex-to-Bronchial Artery Fistulas in Behçet's Disease

A coronary-to-bronchial artery fistula is a rare entity that emerged in the case of chronic pulmonary thromboembolism (cPTE). We present a case of a 50-year-old man with coronary-to-bronchial artery fistula in Behçet's disease that had been hospitalized in consequence of pulmonary thromboembolism attacks and treated with anticoagulation therapy repeatedly. After myocardial infarction was ruled out, coronary computerized tomography angiography was performed, and demonstrated right pulmonary artery occlusion, delay of the contrast passage in the right pulmonary veins, dilated right lung bronchial arteries, and fistulas between the right lung bronchial arteries and the left circumflex artery due to cPTE. Diagnosis of coronary-to bronchial artery fistula and early treatment are very important for the prevention of fatal complications. Radiologist and clinician should be alerted for this entity.

A case report of primary pulmonary artery intimal sarcoma

BackgroundPulmonary artery intimal sarcoma (PAS) is a very rare disease, its prevalence is about 0.001–0.003%. PAS is often misdiagnosed as acute or chronic pulmonary thromboembolism due to its clinical presentation and radiological findings. Thus, early diagnosis is very crucial and may improve patient outcome.Case presentationHere, we report a case in a Chinese male where the symptom presentation was episodes of shortness of breath. Transthoracic echocardiography showed a solid mass in the pulmonary valve orifice, which was demonstrated to be a pulmonary artery intimal sarcoma diagnosed by histopathology. In this case, the initial differential diagnosis included pulmonary embolism. Because the initial symptom of primary pulmonary artery sarcoma is extremely similar to the pulmonary embolism, half of them may be misdiagnosed as pulmonary embolism. Imaging studies are very helpful. Ultrasound and CT are the best due to their resolution and ability to assess the relationship of the mass with the surrounding structures. The final diagnosis is mostly made after surgical excision and this is the most effective treatment. At the same time, radiotherapy and chemotherapy after surgery is also an adjuvant treatment.ConclusionWe report a very rare case of pulmonary artery intimal sarcoma. Due to late diagnosis and delayed treatment in this case, the patient displayed a poor prognostic. Early diagnosis and right treatment can improve the prognosis of PAS and optimize overall health.