Diagnosis Of Embolism Research Articles

Reactions to Misoprostol: A Case Report

Background: Most of abortions occur before the 13th week of pregnancy. Nowadays, non-surgical approaches for evacuation of uterine have been replaced with surgical ones due to the reduction in bleeding, fewer complications, ease of management, and cost-effectiveness. Misoprostol is a prostaglandin E1 analog that is used for labor induction. It is known as a safe drug with very few side effects. Case Presentation: A 29-year-old woman with the gestational age of 11 weeks and 6 days with a diagnosis of cystic hygroma introduced herself to the labor ward. At the time of hospitalization, the patient was conscious. The heart sounds were normal. A vaginal exam indicated no pathological findings. Totally, she received 1000 mg of Misoprostol. Approximately, 2 hours after the last placement of Misoprostol, the patient developed bending and mild cyanosis of fingers and showed tachycardia with a pulse rate of 140 beats/min. Her O2 saturation decreased to 78%. At this time, the patient had a successful miscarriage. Echocardiography showed an ejection fraction of 55% and normal right ventricular size. The electrocardiogram showed sinus tachycardia. Therefore, she was sent to CCU with a possible diagnosis of embolism. The cardiologist administered a heparin drip of 5000-unit IV stat, and 1000 unit/h heparin and asked for a D-Dimer test. However, the laboratory reported that the patient’s blood sample was hemolyzed and they could only check her hemoglobin which was 4 g/dl. Immediately, the heparin drip was held and the patient received 3 packed cells. Her Hb was 6.5 g/dl. 12 hours later she showed tachycardia, and her O2 saturation reduced to 70%. She lost her consciousness. Nearly 40 minutes later, she had cardiorespiratory arrest and CPR wasn’t successful and she died. Conclusions: In Conclusion, even a frequently used drug such as Misoprostol can cause life-threatening side effects, leading to emergent situations.

Use of Computed Tomography Pulmonary Angiography in Emergency Departments: A Literature Review.

Computed tomography pulmonary angiography (CTPA) has become the most widely used technique for diagnosis or exclusion of a pulmonary embolism (PE). It has been suggested that overuse of this imaging type may be prevalent, especially in emergency departments (EDs). The purpose of this literature review was to explore the use of CTPAs in EDs worldwide. A review following PRISMA guidelines was completed, with research published between September 2010 and August 2020 included. Five key topics emerged: use of CTPAs; explanations for overuse; use of D-dimer; variability in ordering practices between clinicians; and strategies to reduce overuse. This review found that CTPAs continue to be overused in EDs, leading to superfluous risks to patients. Published studies identify that while clinical practice guidelines (CPGs) have a strong effect on reducing unnecessary CTPAs with no significantly increased risk of missed diagnosis, the adoption of these tools by ED clinicians has remained low. This literature review highlights the need for further research into why CTPAs continue to be overused within EDs and why clinicians are hesitant to use CPGs in the clinical setting. Moreover, investigations into other potential strategies that may combat the overuse of this diagnostic tool are essential to reduce potential harm.

Radiological Investigation of Gas Embolism in the East Asian Finless Porpoise (Neophocaena asiaeorientalis sunameri)

Cetaceans have long been considered biologically adapted to suffer no adverse effects from diving-related tissue gas tension. However, increasing reports of gas embolism in cetaceans inhabiting European, Mediterranean and American waters have challenged the conventional understanding of marine mammal diving physiology. In human hyperbaric medicine, virtopsy techniques such as post-mortem computed tomography (PMCT) facilitate the visualization of gas embolism and could be performed adjunct to conventional autopsy. This research presents the first case of gas embolism identified in an East Asian finless porpoise inhabiting Asian waters. Massive gas embolic lesions were found in the liver, which had been compressing both the lungs and abdominal organs, and signs of pneumonia and parasitic infection were observed in both lungs. It is hypothesized that this porpoise might have been unable to expelin vivogas bubbles from its circulation due to pulmonary dysfunction. Consequently, gas bubbles agglomerated in the liver, resulting in the development of gas embolic lesions. The findings of the present study provide insights into the occurrence of gas embolism in the East Asian finless porpoise, highlighting the potential of PMCT as a promising tool for the diagnosis of gas embolism in stranded cetaceans.

Abdominale pijn als atypische presentatie van een longembool

Abdominal pain as an atypical presentation of a pulmonary embolism The diagnosis of a pulmonary embolism is frequently missed due to its varying and often subtle presentation. Abdominal complaints can be its only symptom, as was the case with a 55-year-old man. He presented to the emergency department with severe right-sided flank pain. He had no thoracic pain or respiratory complaints. Initially, a bile duct pathology or urolithiasis was considered. Technical studies could, however, not confirm these diagnoses. Based on blood results and imaging studies, the working diagnosis of pneumonia was made, for which antibiotic therapy was started. Because of persistent and unbearable pain complaints, further research was done, showing a saddle pulmonary embolism. Thrombolysis was initiated, after which the patient was admitted to the intensive care unit. The man recovered well and a pulmonary function test 2 months after his hospital discharge showed that everything was normal. Despite multiple case reports in which abdominal pain was the only symptom of a pulmonary embolism, most textbooks do not mention abdominal complaints as a symptom of this condition. The authors of this article therefore argue to always keep in mind the diagnosis of a pulmonary embolism. Especially in case of unexplained abdominal complaints, this diagnosis should always be considered.

Echocardiographic diagnosis of amniotic fluid embolism with paradoxical embolism.

Echocardiographic diagnosis of amniotic fluid embolism with paradoxical embolism.

Adherence to the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline on the Use of Oral Anticoagulant Agents in Middle Eastern Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study.

Background There is a scarcity of studies that evaluate adherence to the utilization of guideline-recommended oral anticoagulant agents (OACs) in patients with atrial fibrillation (AF) in the Middle East. The Jordan Atrial Fibrillation (JoFib) Study evaluated baseline clinical profiles and the utilization of OACs, including vitamin K antagonists (VKAs) and direct OACs (DOACs), in patients with valvular AF (VAF) and nonvalvular AF (NVAF) according to the 2019 focused update of the 2014 AHA/ACC/HRS guidelines. Methods Consecutive patients with AF were enrolled in 29 hospitals and outpatient clinics. The use of OACs was evaluated in patients with VAF and NVAF according to the prespecified guideline. Results Of 2000 patients, 177 (8.9%) had VAF and 1823 (91.1%) had NVAF. A VKA was prescribed for 88.1% of the VAF group. In the NVAF group, 1468 (80.5%) of patients had a high CHA2DS2-VASc score, i.e., a score of ≥3 in women and ≥2 in men; 202 (11.1%) patients had an intermediate CHA2DS2-VASc score, i.e., a score of 2 in women and 1 in men; and 153 (8.4%) patients had a low CHA2DS2-VASc score, i.e., a score of 1 in women and 0 in men. Of patients with a high CHA2DS2-VASc score, 1204 (82.0%) received OACs, including DOACs for 784 (53.4%) and VKA for 420 (28.6%) patients. Among patients with an intermediate score, OACs were prescribed for 148 (73.3%) patients, including 107 (53.0%) who received DOACs and 41 (20.3%) patients who received VKA. In patients with a low score, OACs were omitted in 94 (61.4%) patients and prescribed for 59 (38.6%) patients. Multivariate analysis showed that age between 50 and 70 years, CHA2DS2-VASc score of ≥2, a diagnosis of stroke or systemic embolization, and nonparoxysmal AF were significantly associated with increased odds of OAC prescription. Conclusions The current status of the utilization of OACs in Middle Eastern AF patients appears to be promising and is consistent with the 2019 focused update of the 2014 AHA/ACC/HRS guideline. This trial is registered with NCT03917992.

Cerebral Air Embolism After Gastrointestinal Procedure: A Case Report and Literature Review

Esophagogastroduodenoscopy (EGD) is one of the forefronts of minimally invasive modalities with excellent safety records and tremendous capability but despite its accolades and functions, there are still very rare complications including air embolism. It is a life-threatening condition that could lead to a significant increase in morbidity and mortality. However, there are limited data for incidence of air embolism in association with gastrointestinal endoscopy. Diagnosis of air embolism after or during gastrointestinal endoscopy might be a difficult task due to overlapping presentations with anesthesia effects on the cardiopulmonary and the neurological systems, as a result, there should be increased awareness allowing clinicians to quickly rule out air embolism in patient with altered mental status or cardiopulmonary changes after or during gastrointestinal endoscopy. Herein, we report a unique case of cerebral air embolism after EGD in a 79-year-old female patient. In addition, we also performed a systematic review of cases based on PRISMA guideline, with the aim to investigate the demographics and clinical outcomes associated with this complication. This systematic review of cases hopes to increase the awareness about this rare entity. J Med Cases. 2021;12(3):119-125 doi: https://doi.org/10.14740/jmc3639

Bilateral pulmonary embolism while receiving tranexamic acid: a case report

BackgroundWe present a case of a suspected tranexamic acid–related bilateral pulmonary embolism in a healthy and active middle-aged woman who was receiving tranexamic acid for menorrhagia with no other known significant risk factors for thromboembolism.Case presentationA 46-year-old Asian woman who was usually fit and well with no remarkable past medical history except for menorrhagia of 1-year duration for which she was receiving tranexamic acid presented to our accident and emergency department with a 2-week history of intermittent pleuritic central chest pain. She was reviewed and discharged to home with a diagnosis of musculoskeletal pain on two hospital visits because she had no significant risk factors for thromboembolism and her workup investigation results for pulmonary embolism and other differential diagnoses were largely unremarkable. On her third visit to the emergency ambulatory clinic with recurring symptoms of pleuritic chest pain, a pulmonary computed tomographic angiogram confirmed bilateral subsegmental pulmonary embolism.ConclusionThis case report reinforces the possible increased risk of thromboembolism in patients receiving tranexamic acid.

Czy zatorowość płucna w ciąży nadal jest wyzwaniem diagnostycznym?

The case of a woman in the 11th week of pregnancy who was diagnosed with pulmonary embolism without signs of thrombosis in ultrasound of the lower extremities. Despite the use of standard tests in the diagnosis of embolism, it was necessary to extend the diagnosis. This is a big challenge in pregnancy because of many difficulties. Aggressive diagnostic methods and anticoagulant PE treatment can be risky for the fetus and subsequent pregnancies. After angio-CT of the chest, which showed embolic material in the proximal parts of the pulmonary arteries, appropriate treatment was applied until the patient's clinical condition improved.

Interpretation of Chinese expert consensus on diagnosis and management of amniotic fluid embolism.

Interpretation of Chinese expert consensus on diagnosis and management of amniotic fluid embolism.

A young female with double mechanical prosthetic heart valves presenting with coronary embolism-a rare case report

Coronary embolism, though uncommon, can occur in young patients with mechanical prosthetic heart valves. Coronary embolism has been reported in patients with prosthetic heart valves with or without thrombosis in literatures. It can cause acute coronary syndrome and lead to death if threshold of diagnosis of coronary embolism is not low. Here we report a case of coronary embolism in a 26 year old female with history of double mechanical prosthetic valve replacement, presenting to our centre with acute coronary syndrome. She was managed with thrombosuction establishing almost complete revascularization.

Excluding Pulmonary Embolism with End-tidal Carbon Dioxide: Accuracy, Cost, and Harm Avoidance.

A non-randomized single center prospective, descriptive, correlational design was used to determine what end-tidal carbon dioxide (EtCO2) level provided the best sensitivity, specificity, and negative predictive value to exclude pulmonary embolism (PE) diagnosis in hemodynamically stable hospitalized adults (n = 111). The financial impact and harm avoidance of adding EtCO2 to the PE diagnostic process also were examined. PE diagnosis was determined by computed tomography pulmonary angiography (CTPA). PE prevalence was 18.9%. Mean±SD EtCO2 was lower for PE positive than negative participants (28 ± 7.8 to 33 ± 8.1 mmHg respectively 95% CI: 1.22-8.96; P = .01). For PE exclusion, an EtCO2 cutoff ≥42 mmHg yielded 100% sensitivity, 12.2% specificity, and 100% negative predictive value. For every six inpatients assessed with EtCO2, one could be saved from unnecessary CTPA. Eliminating unnecessary CTPA removes the potential harm associated with radiation and intravenous contrast exposure. Additionally, an EtCO2 cutoff ≥42 mmHg could eliminate ~$88,000/year in healthcare waste at this institution.

Wytyczne dotyczące diagnostyki i leczenia ostrej zatorowości płucnej

Wytyczne dotyczące diagnostyki i leczenia ostrej zatorowości płucnej

Pulmonary embolism during pregnancy: a 17-year single-center retrospective MDCT pulmonary angiography study

ObjectivesTo determine the prevalence of pulmonary embolism (PE) and alternative diagnoses detected by computed tomography pulmonary angiography (CTPA) in pregnant women; and to assess changes over time regarding radiation dose, technical quality, and examination frequency.Materials and methodsThis retrospective study included all pregnant women referred for CTPA due to clinically suspected PE over 17 years. Two blinded radiologists reviewed the CTPAs in consensus with regard to PE, alternative diagnoses, and technical quality. We retrieved patient data regarding radiation dose metrics and associated clinical and laboratory parameters. Subgroup comparisons were performed (Wilcoxon and Kruskal-Wallis tests).ResultsOf the 237 identified patients, 8 (3.3%) were excluded due to inadequate technical CTPA quality, and 229 patients were analyzed (mean age, 31.7 years; mean gestational age, 28 ± 7 weeks). The four different CT systems used over the study period had similar technical quality (p = 0.28). Of 229 patients 16 (7%) patients had PE, 144 (62.9%) had no abnormal findings, and 69 (30.1%) had an alternative diagnosis (consolidation, other pulmonary opacities, pleural effusion, and basal atelectasis). Gestational age, symptoms, and D-dimer levels were not significantly different between patients with or without PE (p > 0.05). Over time, radiation dose exposure decreased by 30% (p < 0.001), while the number of annual examinations increased by > 4-folds.ConclusionsIn pregnant women, CTPA rarely indicates PE and more often shows alternative diagnoses. Over 17 years, the use of CTPA in pregnancy has notably increased, while the radiation dose exposure has decreased by one third.Key Points• The use of CTPA in pregnancy has steadily risen over the last 17 years• In pregnant women, CTPA rarely reveals PE and more often shows alternative diagnoses• Recent technical improvements have substantially decreased the radiation dose exposure inherent in CTPA without reducing diagnostic image quality

Prime the Line! A Case Report of Air Embolism from a Peripheral IV Line in the Field

Venous air embolisms are rare but a cause of potentially life-threatening events with associated cardiovascular, pulmonary and neurologic effects. We report the first prehospital case of a venous air embolism in a 31-year-old male who became hemodynamically unstable after a peripheral intravenous catheter with unprimed tubing was placed by paramedics in the prehospital setting and diagnosed in the emergency department. We highlight the clinical presentation, diagnosis and emergency management of venous air embolisms.

A comparison of ventilation perfusion combined with pulmonary perfusion fusion tomography imaging and CT pulmonary angiography for diagnosis of pulmonary embolism

Objective To compare the diagnostic value of ventilation/perfusion (V/Q) combined with pulmonary perfusion single photon emission computed tomography combined with CT (SPECT/CT) fusion tomography imaging and computed tomographic pulmonary angiography (CTPA) in evaluation of pulmonary embolism. Methods We retrospectively analyzed 60 patients with clinically suspected pulmonary embolism diagnosed in Shanxi Dayi Hospital from May 2015 to May 2017. All patients underwent pulmonary V/Q imaging and lung perfusion SPECT/CT fusion tomography, and CTPA inspections were completed within 3 days. The final clinical diagnosis and follow-up confirmed the presence or absence of pulmonary embolism. The diagnostic efficacy of two imaging methods for pulmonary embolism were calculated and compared. Results Of the 60 cases of patients, 33 cases were diagnosed with pulmonary embolism; the sensitivity, specificity, and accuracy of V/Q combined with pulmonary perfusion SPECT/CT fusion tomography were 96.97% (32/33), 92.59% (25/27) and 95% (57/60), respectively; the sensitivity, specificity, and accuracy of CTPA were 81.82% (27/33), 92.59% (25/27) and 86.67% (52/60), respectively; both have no diagnostic uncertainty, there was no significant difference in the qualitative diagnosis of pulmonary embolism between the two examination methods (P>0.05). V/Q combined with pulmonary perfusion SPECT/CT fusion tomography found 253 lung segment and 50 unmatched sub-pulmonary segments, including 15 V/Q mismatch lung segment and 5 sub-segment caused by lung lesions which were confirmed by lung perfusion SPECT/CT fusion image (5 interlobular or pleural effusion, 4 local emphysema and pulmonary bulla, 3 interlobular hypertrophy, 8 pulmonary parenchymal inflammation); CTPA found 3 sub-segmental pulmonary filling defects, 6 cases of false-negative cases were multiple sub-pulmonary segment pulmonary embolism. Conclusions V/Q combined with pulmonary perfusion SPECT/CT fusion tomography is similar to CTPA in diagnosing pulmonary embolism, and both of them have better diagnostic efficacy; the former has advantages in the diagnosis of sub-pulmonary segment pulmonary embolism, and can exclude false-positive diagnoses due to other lung lesions and provide additional diagnostic information for lung disease. Key words: Pulmonary embolism; Tomography, emission-computed, single-photon; Radionuclide imaging; Angiography; Tomography, spiral computed

Mechanism and clinical characteristics in diagnosis and treatment of amniotic fluid embolism

Amniotic fluid embolism(AFE) is a fatal intrapartum complication. Typical AFE is characterized by respiratory and circulatory failure, followed by disseminated intravascular coagulation(DIC), while atypical AFE, which had a higher survival possibility, presents with unexplained DIC only. Recent findings support an anaphylactoid inflammatory mechanism underlying the pathophysiology of AFE. Milrinone is currently the first choice for AFE due to its several functions, such as reducing pulmonary artery pressure, and improving right ventricular function through lowering heart rate and positive inotropic action. A multidisciplinary team is required in the rescue of AFE and medical staff who are skilled in critical medicine (such as anesthesiologists) often play a pivotal role. Key words: Embolism, amniotic fluid; Mastocytosis; Hypersensitivity

Introduction of ultrasound at the bedside in the differential diagnosis of the pulmonary embolism as a cause of syncope

There is currently no emergency congress without a table and/or ultrasonography workshop at the bedside and recently the new guidance on the management of syncope has been published (ESC Guide 2018 on the diagnosis and treatment of syncope [1]). Together with the possibility of cushioning the problem of the excess of requests for complementary tests in the emergency departments, we believe that this article combines both aspects and provides an interesting point of reflection. Keywords: Syncope, Pulmonary embolism, Ultrasound at the bedside, Supplementary tests.

Introduction of ultrasound at the bedside in the differential diagnosis of the pulmonary embolism as a cause of syncope

There is currently no emergency congress without a table and/or ultrasonography workshop at the bedside and recently the new guidance on the management of syncope has been published (ESC Guide 2018 on the diagnosis and treatment of syncope [1]). Together with the possibility of cushioning the problem of the excess of requests for complementary tests in the emergency departments, we believe that this article combines both aspects and provides an interesting point of reflection. Keywords: Syncope, Pulmonary embolism, Ultrasound at the bedside, Supplementary tests.

Gas embolism during endoscopic retrograde cholangiopancreatography: diagnosis and management.

Air embolism is rarely diagnosed and is often fatal. The diagnosis is often not made in a timely manner given the rapid and severe clinical deterioration that often develops, frequently leading to cardiac arrest. Many patients are only diagnosed post-mortem. With the increasing use of endoscopic retrograde cholangiopancreatography, air embolism should be considered in the differential diagnosis in patients who experience sudden clinical deterioration during or immediately after the procedure. Clinical suspicion is key in the diagnosis and management of air embolism. Use of precordial Doppler ultrasound and transesophageal echocardiogram can aid in the diagnosis of air embolism. Once the diagnosis is made, supportive management of airway, breathing and circulation is pivotal. Advanced cardiac life support should be initiated when necessary. Fluid resuscitation and vasopressors can improve cardiac output. Hyperbaric oxygen therapy should be considered when possible in cases of suspected cerebral air embolism cases to improve neurological outcome. A multidisciplinary team approach and effective communication with experts, potentially including an anesthesiologist, cardiologist, intensivist, radiologist and surgeon, can improve the outcome in air embolism.