Differential Diagnosis Of Pulmonary Embolism Research Articles

Cardiac leiomyomatosis misdiagnosed initially as submissive pulmonary embolism: a rare case report

This case report presents a rare case of cardiac leiomyomatosis misdiagnosed initially as submassive pulmonary embolism in a 39-year-old woman. The patient presented with syncope and hypotension, leading to an initial diagnosis of submassive pulmonary embolism. However, further investigations revealed a right-sided heart mass on echocardiogram. Surgical intervention was carried out, and the patient’s condition was successfully managed. This case emphasizes the importance of considering rare cardiac tumours in the differential diagnosis of pulmonary embolism.

Recurrent syncope presenting as an initial symptom of pulmonary embolism

Acute pulmonary embolism (PE) is a life-threatening disease that manifests with cardiorespiratory symptoms. Syncope can be a rare, but warning sign of PE. We report a case of a 49-year-old male diagnosed with PE who presented with recurrent syncope prior to typical cardiorespiratory symptoms. His computed tomography pulmonary angiogram revealed bilateral PE. Syncope can be a rare clinical symptom of PE, but considering lethality of the disease, a differential diagnosis of PE should be considered in patients with recurrent syncope.

Thromboprophylaxis decreases the risk of pulmonary embolism in COVID-19

Aim: Pulmonary embolism caused by micromboli and microthrombuses might be associated with increased mortality and morbidity in Covid-19. Routine thromboprophylaxis application might contribute to clinical recovery by reducing the risk of pulmonary embolism. In this study, the effects of thromboprophylaxis on clinical outcomes were investigated by examining the rates of computed tomographic angiography requests for the differential diagnosis of pulmonary embolism in the patients with Covid-19. 
 Materials and Methods: Patients who underwent computed tomography (CT) between 10 March and 25 May 2020 in our hospital were retrospectively analysed. Patients who received simultaneous PCR tests during CT examination were included in the study. In the follow-up of these patients, rates of pulmonary CT angiography request with the suspicion of pulmonary embolism and it’s were investigated. 
 Results: During the study period, thorax CT was performed in 11142 patients and pulmonary CT angiography was performed in 161 (1.4%) of them. Ninety-nine patients who were performed CT angiography and PCR test during the hospitalization period were included in the study. PCR test was positive in 22% (n = 21) of the patients (22%) and pulmonary embolism was detected in 6 of them (6.3%). PCR test was negative in 74 patients (78%) and 17 (17.9%) had pulmonary embolism.
 Conclusion: Routine thromboprophylaxis contributes to the treatment of Covid-19 by preventing the development of microthrombosis and thrombotic complications in the respiratory system.

Pulmonary arteriovenous malformations with deep vein thrombosis and hypoxemia after delivery as a differential diagnosis of pulmonary embolism: A case report

Pulmonary arteriovenous malformations with deep vein thrombosis and hypoxemia after delivery as a differential diagnosis of pulmonary embolism: A case report

Infrared Spectroscopy in Differential Diagnosis of Pulmonary Embolism

The aim of the study was to assess the effectiveness of infrared spectroscopy for verification of pulmonary embolism (PE) and a number of similar diseases.Materials and Methods.Infrared spectroscopy was used to investigate blood serum of 19 healthy volunteers and 30 patients with intraoperatively confirmed PE as well as with chronic obstructive pulmonary disease (COPD) (n=10), pneumonia (n=10), tuberculosis (n=10), lung abscess (n=10) and lung cancer (n=10), acute disorder of cerebral circulation (ADCC) (n=10), ischemic heart disease (IHD) (n=10). Peak height ratios of absorption band were taken as diagnostic parameters (cm–1/сm–1): P1 — 1160/1165; P2 — 1165/1070; P3 — 1165/1150; P4 — 1165/1050; P5 — 1100/1050; P6 — 1025/1165. These parameters of IR spectrum are significant for the given nosology.Results.The calculated indicators have demonstrated statistically significant difference of IR spectra parameters for the studied nosologies (p<0.001) even on the small samples supplementing each other and enabling step-by-step exclusion of lung abscess and pulmonary tuberculosis, COPD and pneumonia, cancer, IHD, ADCC, and PE.The presented radar charts, built with consideration of the values of all peak height ratios of the absorption bands with diagnostically significant maxima, provided the possibility to visualize the IR profiles making the differentiation of PE and its clinical analogs not only more objective and reliable but also more explicit and compelling.Conclusion.Infrared spectroscopy is a potentially effective method of PE differential diagnosis. Sample expansion will allow researchers to evaluate the sensitivity and specificity of this technique compared to the existing standard schemes of PE verification.

An autopsy case of massive pulmonary tumor embolism due to undiagnosed prostatic adenocarcinoma

Adenocarcinoma of the prostate is occasionally associated with pulmonary embolism, occurring as a result of secondary hypercoagulable states or cancer-associated emboli. The objective of this study was to provide a review of clinical, histopathological and immunohistochemical features of poorly differentiated prostatic adenocarcinoma, emphasizing the relevance of undiagnosed malignancy as a cause of pulmonary embolism. The current study describes the case of a 78-year-old male who experienced remarkable clinical symptoms suggestive of pulmonary embolism. Following several diagnostic examinations, the patient was diagnosed with pulmonary embolism, which led to the detection of prostatic adenocarcinoma. Poorly differentiated adenocarcinoma with a Gleason's score of nine was set as a definite diagnosis. Multiple tumor emboli within small and medium-sized pulmonary blood vessels were found in all specimens taken from lung tissue. Immunohistochemical analysis showed diffuse and strong positivity of tumor cells within pulmonary arteries. Hidden malignancy is a diagnostic challenge that should be considered in the differential diagnosis of pulmonary embolism. Laboratory and radiological findings with additional histopathological evaluation are needed for the definite diagnosis.

Monocyte to large platelet ratio as a diagnostic tool for pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease.

INTRODUCTION A higher prevalence of pulmonary embolism (PE) has been noted among patients with chronic obstructive pulmonary disease (COPD), particularly in those with acute exacerbations of COPD (AECOPD). Due to a similar clinical presentation and the lack of highly specific laboratory tests, there is a common overuse of computed tomography pulmonary angiography (CTPA). The introduction of an additional, simple, and inexpensive diagnostic tool to help in the diagnosis of PE in patients with AECOPD would be of special interest for everyday clinical practice. OBJECTIVES The aim of the study was to assess the usefulness of the monocyte to large platelet ratio (MLPR) as a diagnostic tool for PE in patients with AECOPD. PATIENTS AND METHODS We performed a retrospective evaluation of patients with AECOPD and suspicion of PE who underwent CTPA. The MLPR was investigated as a marker of thrombosis. Receiver operating characteristics (ROC) curve analyses were preformed to measure the accuracy of the MLPR in comparison with CTPA results and to identify the cutoff value for the MLPR. RESULTS A total of 101 patients (56 men and 45 women; median age, 72 years; range, 37-94 years) were included in the study. The MLPR showed an excellent accuracy in comparison with CTPA results: the area under the ROC curve was 0.945 (95% confidence interval [CI], 0.904-0.986). The MLPR was characterized by a good accuracy of qualitative test parameters, with high sensitivity (100%; 95% CI, 79.6-100) and specificity (85.7%; 95% CI, 75.9-92.6). CONCLUSIONS The MLPR measurement appears to be a reliable, simple, inexpensive, and widely available test that may help in the differential diagnosis of PE in patients with AECOPD.

What is the most reliable marker in the differential diagnosis of pulmonary embolism and community-acquired pneumonia?

Because of similar clinical manifestations and laboratory findings, differential diagnosis of pulmonary embolism and community-acquired pneumonia (CAP) is generally difficult. Therefore, this study was conducted to find good markers for the easy, cheap, and fast differential diagnosis of pulmonary embolism and CAP. Thirty-four patients diagnosed with pulmonary embolism and 38 patients with CAP who were admitted to either emergency department or chest diseases outpatient clinic were included in this study. On admission and third day, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate, procalcitonin (PCT), and D-dimer levels of each patient were measured. Neutrophil-to-lymphocyte ratio (NLR) was calculated using the formula NLR = neutrophil count/lymphocyte count. NLR/D-dimer and PCT/D-dimer ratios were also calculated. First day neutrophil count (P = 0.005), NLR (P = 0.002), CRP (P < 0.001), erythrocyte sedimentation rate (P < 0.001), PCT (P < 0.001), NLR/D-dimer (P < 0.001), and PCT/D-dimer (P < 0.001) levels were higher in patients with CAP compared with patients with pulmonary embolism. In stepwise logistic regression analysis done with all the parameters used for the differential diagnosis of pulmonary embolism and CAP, CRP, PCT/D-dimer, and NLR/D-dimer were found to be independent predictive factors for the presence of CAP. Among these factors, NLR/D-dimer ratio was found to be the most sensitive (97.4%) to have the highest negative predictive value 96.7% and to be the most accurate (area under curve = 0.921) (91.7%) parameter for the differential diagnosis of pulmonary embolism and CAP. In this study, NLR/D-dimer ratio was found to be more sensitive and more selective with negative predictive value and area under curve for the differential diagnosis of pulmonary embolism and CAP compared with other laboratory tests.

The Value of Cardiac Troponins in Diagnosis and Differential Diagnosis of Pulmonary Embolism

The Value of Cardiac Troponins in Diagnosis and Differential Diagnosis of Pulmonary Embolism

Erratum to: Differential diagnosis of pulmonary embolism in outpatients with non-specific cardiopulmonary symptoms

Erratum to: Differential diagnosis of pulmonary embolism in outpatients with non-specific cardiopulmonary symptoms

Differential diagnosis of pulmonary embolism in outpatients with non-specific cardiopulmonary symptoms

Most cardiopulmonary diseases share at least one symptom with pulmonary embolism (PE). The aim of this study was to identify the most common acute causes of dyspnea, chest pain, fainting or palpitations, which diagnostic procedures were performed and whether clinicians investigate them appropriately. An Italian multicenter collaboration gathered 17,497 Emergency Department (ED) records of patients admitted from January 2007 to June 2007 in six hospitals. A block random sampling procedure was applied to select 800 hospitalised patients. Results of the overall 17,497 patients were obtained by weighting sampled cases according to the probability of the randomisation block variables in the whole population. The case-mix of enrolled patients was assessed in terms of cardiopulmonary symptoms, and the prevalence of acute disorders. The actual performance of procedures was compared with a measure of their accuracy as expected in the most common clinical presentations. PE occurred in less than 4% of patients with cardiopulmonary symptoms. Acute heart failure, pneumonia and chronic obstructive pulmonary disease exacerbation were the most likely diagnoses in patients with dyspnea. Acute myocardial infarction was present in roughly 10% of patients with chest pain. Atrial fibrillation was the prevalent diagnosis in patients with palpitations. Echocardiography, computed tomographic pulmonary angiography, perfusion lung scan, D-dimer test and B-type natriuretic peptide were performed less than expected from their accuracy. Diagnostic strategies, starting from non-specific symptoms and coping with the eventuality of PE, are likely to benefit from an increased awareness of the examination's accuracy in discriminating among several competing hypotheses, rather than in testing the single PE suspicion.

The Value of Serum Procalcitonin in Differential Diagnosis of Pulmonary Embolism and Community-Acquired Pneumonia

Presence of high fever may cause confusion in differential diagnosis of pulmonary embolism (PE) versus pneumonia. The aim of this study is to investigate the diagnostic value of serum procalcitonin (PCT) in differential diagnosis of PE and community-acquired pneumonia (CAP). A total of 24 patients with proven PE and 22 patients with CAP were included in the study. The study population was subdivided as PE patients with fever (group 1, n = 8) and without fever (group 2, n = 16); and CAP (group 3, n = 22). Serum PCT and systemic inflammatory markers were measured at the initial diagnosis and the third day of the treatment. The relation of PCT level with the other systemic inflammatory markers was investigated in each measurement point. The initial mean serum PCT level in group 3 (2.24 ± 0.99 ng/mL) was statistically higher than group 1 (0.48 ± 0.77 ng/mL) and group 2 (0.14 ± 0.17 ng/mL; P = .000, .000, respectively). Procalcitonin level at the initial (2.24 ± 0.99 ng/mL) and the third day of treatment (0.92 ± 0.62 ng/mL) in group 3 showed a statistically significant reduction (P = .000). There were no statistically significant reduction in PCT levels by anticoagulation in groups 1 and 2 (P = .262, .119, respectively). Other systemic inflammatory markers including interleukin 6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor α (TNF-α) levels statistically significantly decreased with anticoagulant and antimicrobial therapy. This study suggested that serum PCT level may be valuable for differentiating PE patients with or without fever from patients with CAP.

Acute Pulmonary Embolism Mimics Acute Coronary Syndrome in Older Patient

Acute pulmonary embolism is a fatal disease and an often missed diagnosis. There are no specific symptoms or signs. Accurate diagnosis followed by effective therapy can reduce mortality. We report on a 67-year-old man who underwent lumbar laminectomy and developed an acute anterior compressive-like chest pain and jaw numbness rather than dyspnea on the fifth postoperative day. Owing to refractory chest pain with suspicious posterior myocardial infarction or unstable angina on surface electrocardiogram, the patient received emergency coronary catheterization, which demonstrated normal coronary arteries. Further investigation provided a final diagnosis of acute pulmonary embolism. Acute pulmonary embolism with simultaneous recent neuro-surgery was a therapeutic dilemma because of the risk of postoperative hemorrhage threatening neurologic function. After treatment with enoxaparin and close monitoring of his neurologic condition, his symptoms were eliminated. Clinicians must keep in mind a differential diagnosis of pulmonary embolism in a postoperative high-risk patient.

Pulmonary Artery Sarcoma Masquerading as Saddle Pulmonary Embolism

Pulmonary artery sarcoma is a highly malignant tumour. Therefore, making the diagnosis is very important. We describe a case which presented with dyspnea on exertion and was initially diagnosed as saddle pulmonary embolism per CT thorax with contrast. Despite adequate anticoagulation, symptoms still progressed. Follow-up CT thorax showed an extension of the presumed filling defect or clots into the left main pulmonary artery with new lung nodules. This prompted suspicion that this may not be a pulmonary embolism. Biopsy of the lung nodule revealed high grade soft tissue sarcoma with primary source from the pulmonary artery. Our case highlights that pulmonary artery sarcoma should always be included in the differential diagnosis of pulmonary embolism especially, if symptoms still progress while on adequate anticoagulation, or any pulmonary nodules develop on follow-up exam.

The value of pulmonary angiography for the differential diagnosis of pulmonary embolism.

The aim this study was to evaluate potential additional information of pulmonary angiography in patients with suspected pulmonary embolism and non-diagnostic lung scan findings. In a series of 150 patients who underwent pulmonary angiography for suspected venous thromboembolism, the images for potential alternative diagnoses other than pulmonary embolism were evaluated. All patients had non-diagnostic lung scan findings. Angiography was performed both by conventional and by digital subtraction angiography techniques. Images were evaluated by at least two experienced readers. Angiograms were scored for both presence or absence of pulmonary embolism, as well as other diagnoses. Pulmonary embolism was proven in 40 patients (27 %) and excluded in 105 patients (70 %), whereas non-interpretable images were obtained in 5 patients (3 %). A range of alternative diagnoses were detected by angiography: atelectasis (n = 24), pleural effusion (n = 15), pneumonia (n = 11), emphysematous bullae (n = 8), neoplasm (n = 3), atrial septum defect (n = 2), chronic thromboembolism (n = 1), and other diagnoses (n = 3). Overall, only 54 patients (36 %) had completely normal angiograms. Although pulmonary angiography remains the reference method for the diagnosis of pulmonary embolism, one has to be aware of other, often unexpected, but equally important findings which could influence the management of the patient. This aspect of pulmonary angiography has been insufficiently emphasized in the literature.

Angioscopic detection of residual pulmonary thrombi in the differential diagnosis of pulmonary embolism

Definite diagnosis of pulmonary embolism (PE) by conventional methods such as angiography is frequently difficult. If residual thromboemboli incorporated into the pulmonary arterial wall or in the distal small segments are visible, differential diagnosis of PE versus primary pulmonary hypertension (PPH) can be made without open-chest pulmonary biopsy. Six patients suspected of having acute PE, 6 suspected of having chronic PE, and 4 with PPH diagnosed by pulmonary biopsy underwent percutaneous pulmonary angioscopy. In patients suspected of having PE, globular and mural thromboemboli were detected by both angioscopy and angiography in 4 and 1 patients, respectively. By angioscopy, emboli incorporated into the arterial wall were detected in 7 and microemboli obstructing the distal small segments were detected in 6. However, these emboli were detected by angiography in none. In patients with PPH, no embolus was detected by angioscopy and angiography. Angioscopically, however, stenoses were observed in the distal small segments in all patients. The results indicate that residual pulmonary thromboemboli in PE and stenoses of distal pulmonary arteries in PPH are detectable by percutaneous angioscopy, and therefore this method is feasible for differential diagnosis of PE.

Diagnostic Aerosols: Current Status and Future Prospects

The inhalation of diagnostic aerosols directly into the respiratory tract (RT) can mimic the entry of air, inhaled allergens, and toxins. Such inhalation has also the advantage for diagnosis of diseases of the RT in that the active ingredient has, at least initially, a high ratio of local/systemic concentration. Nonradioactive aerosols have been used in the bronchial reactivity testing and as contrast media in bronchography. More recent developments include the assessment of airway dimensions and presence of airway diseases by means of the aerosol bolus technique. Radiolabeled aerosols have been used for anatomical (static) imaging of RT and in the kinetic mode to follow the clearance processes. Gamma scintigraphy has been used extensively in the differential diagnosis of pulmonary embolism and ventilation defects. Detection and localization of airway obstruction are also possible using radioaerosols. Transport processes in the RT can be followed by delivering radiolabeled soluble probes by inhalation to ...

Symptoms, Diagnosis, and Therapy of Primary Sarcomas of the Pulmonary Artery

Primary sarcoma of the pulmonary artery is a rare tumor which must be considered in differential diagnosis of pulmonary embolism. The data of the 93 cases published up to now is evaluated synoptically after a report on a primary sarcoma of the pulmonary artery. Modern diagnostic imaging methods (pulmonary DSA, perfusion scintigraphy, echocardiography, computer tomography, nuclear magnetic resonance tomography) may corroborate the suspicion of a sarcoma of the pulmonary artery. With a median survival time of 1.5 months, the prognosis of patients with primary sarcomas of the pulmonary artery must be regarded extremely poor. After tumor excision, the median survival time of the patients could be prolonged (statistically significant; p less than 0.01) to ten months. The significance of adjuvant chemotherapy and/or radiotherapy cannot be appraised at present.

A combined procedure for 99mTc aerosol ventilation and perfusion imaging.

For several years, radioaerosols have been successfully used to provide detailed images of regional ventilation to aid in the differential diagnosis of pulmonary embolism. It has been widely advocated that the ventilation images should follow the perfusion scan and that the amount of aerosol deposited in the patient's lungs should be three times greater than the perfusion dose. We employed an alternative approach which avoided the deposition of an unpredictable amount of aerosol in individual patients. The aerosol study was performed first, and the activity of the microspheres used for the perfusion images was then tailored to the actual amount of aerosol which the patient had retained. This allowed a microsphere/aerosol activity ratio of 10:1 to be readily achieved, thus successfully masking the ventilation pattern by the perfusion activity. The faster biological clearance of 99mTc-DTPA aerosol from the lung fields, as compared to 99mTc-sulphur-colloid aerosol, allowed higher initial activities to be deposited in the lungs, thus enabling a high-resolution collimator to be used. When the perfusion study was delayed by 1 h (one effective half-life for the 99mTc-DTPA aerosol), it was not necessary to increase the perfusion activity required to mask the ventilation image.

Positive Gallium-67 Scintigraphy Associated with Pulmonary Embolism

A 54-year-old man presenting with symptoms and signs of pulmonary embolism demonstrated gallium-67 accumulation within the right lower lung field in the region of a pulmonary embolism with effusion. An associated infectious process was ruled out. This is contrary to the usual clinical experience and identifies a potential pitfall in the use of gallium-67 as an aid in the differential diagnosis of pulmonary embolism and pneumonitis.