Massive Pulmonary Artery Research Articles

Successful Resuscitation of Maternal Cardiac Arrest With Disseminated Intravascular Coagulation Guided by Rotational Thromboelastometry and Transesophageal Echocardiography: A Case Report.

We present a case of maternal cardiac arrest during an elective cesarean delivery. Transesophageal echocardiography identified a large pulmonary artery mass, and guided resuscitation efforts. After return of spontaneous circulation, the patient developed disseminated intravascular coagulation with massive hemorrhage. Blood product selection and volume replacement were guided by rotational thromboelastometry and transesophageal echocardiography, respectively. Correction of coagulopathy was observed clinically and confirmed by rotational thromboelastometry. The patient fully recovered without neurological deficit.

Hepatocellular carcinoma with inferior vena caval and right atrial tumor thrombi and massive pulmonary artery embolism: A case report.

The aim of the present study was to report the case of a 55-year-old female patient with a sizeable (7.1×6.2 cm) hepatocellular carcinoma (HCC), who succumbed to massive pulmonary artery embolism. The main symptoms included sudden thoracodynia, dyspnea and transient coma. The initial diagnosis was HCC according to the typical abdominal ultrasound and triple-phase abdominal computed tomography (CT) findings, chronic hepatitis B infection and elevated α-fetoprotein levels (1,036 µg/l; normal, 0-20 µg/l). Two days following admission, the patient developed recurrent chest pain and shortness of breath. The electrocardiogram and myocardial enzyme levels were normal, but the D-dimer level was elevated to 7,210 µg/l (normal, 0-550 µg/l). Magnetic resonance angiography and a contrast-enhanced chest CT confirmed that the inferior vena cava and right atrium were invaded by tumor thrombi; the bilateral pulmonary embolism was also suspected to be formed by tumor thrombi. The final diagnosis was HCC with inferior vena caval and right atrial tumor thrombi, as well as massive pulmonary embolism. Anticoagulation therapy with low-molecular weight heparin calcium was administered; however, the patient succumbed to pulmonary embolism in <2 months.

Massive Pulmonary and Coronary Artery Thromboembolism in the Setting of Undetected Patent Foramen Ovale

Invasive surgery brings with it a unique set of post-surgical risks that are directly dependent on various factors including the specific surgical approach used, pre-existing comorbidities and features such as gender and age. Pulmonary thromboembolism is one of the most feared complications following surgery, and diagnosis and treatment of this entity is a challenging task for the clinician. Here we describe a case of massive pulmonary thromboembolism and associated coronary artery thromboemboli status post spinal fusion surgery in a 68 year-old man with an undetected patent foramen ovale (PFO). Although the decedent was managed clinically with proper deep venous thrombosis prophylaxis protocols and physical rehabilitation, he went into cardiorespiratory arrest after experiencing acute oxygen desaturation and newly detected right bundle branch block. PFO can be incidentally found in 25% of the adult population. Several clinical syndromes including stroke, migraine headaches and obstructive sleep apnea have been associated in patients with PFO, the last two from which the decedent suffered. The pathology of this unique case of massive pulmonary thromboembolism resulting in coronary artery thromboemboli in the setting of an undetected PFO is discussed. The discovery of PFO in patients prior to surgery, if detected early, may improve post-surgical outcomes. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Ezrin Regulating the Cytoskeleton Remodeling is Required for Hypoxia-Induced Myofibroblast Proliferation and Migration

Background: Hypoxia pulmonary arterial hypertension (HPAH) is a disease of the small vessels characterized by sustained vasoconstriction, thickening of arterial walls, vascular remodeling, and progressive increase in pulmonary vascular resistance, thus leading to right heart failure and finally death. Recent evidence demonstrated that massive pulmonary artery smooth muscle-like cells (PASMLCs) accumulating in the intima might also be developed from the differentiation of pulmonary myofibroblast (PMF) of tunica media. And PMF appeared the phenomenon of the cytoskeleton remodeling. So, it would be important in the clarification of the pivotal factors controlling this cytoskeleton structure change.Methods: PMFs were cultured from the normal rats and then divided into three groups and incubated by normal or hypoxic conditions respectively. mRNA level was evaluated by real-time reverse transcription polymerase chain reaction, and protein expression was detected by western blot. Cell proliferation was determined by the MTT and thymidine incorporation assay.Results: Here, we report that the hypoxia increased the expression levels of ezrin mRNA and protein in PMFs, which might explain that the expression of cytoskeletal proteins (destrin, a1-actin, and a1-tubulin) in PMFs was significantly induced by hypoxia. After inhibiting ezrin in PMFs by siRNA transfection, we found the over-expression of cytoskeletal proteins induced by hypoxia was significantly suppressed at all time-points. Additionally, we found that hypoxia or over-expression of ezrin through adenovirus-mediated ezrin gene transfection significantly increases the proliferation and migration of PMFs, and which could be inverted by the transfection of siRNA.Conclusion: These findings suggest that ezrin regulating of aberrant dysregulation of cytoskeletal proteins may be the major cause of PMFs’ proliferation and migration under the condition of hypoxia and may, therefore, play a fundamental role in the accumulation of PASMLCs of HPAH.

Fulminant intraoperative right heart and pulmonary artery thrombosis following prothrombin complex concentrate infusion after complex open heart surgery with cardiopulmonary bypass.

Prothrombin complex concentrates are increasingly used during complex cardiac surgery with cardiopulmonary bypass. Reports describing massive thromboembolism after administration of prothrombin complex concentrates are rare. We report a case of a patient developing massive intracardiac and pulmonary artery thrombus formations during infusion of a moderate dose of prothrombin complex concentrate after separation from cardiopulmonary bypass for complex open heart surgery.

Doppler parameters of fetal lung hypoplasia and impact of sildenafil

Congenital diaphragmatic hernia (CDH) is clinically challenging because of associated lung hypoplasia (LH). There have been no validated parameters to evaluate fetal LH severity. Sildenafil has been shown to improve LH mass in nitrofen-induced pulmonary artery (PA) models, but the pulmonary vascular tone has not been evaluated invivo. The aim of this study was to identify the PA Doppler parameter that best predicts LH severity and to investigate the efficacy of antenatal sildenafil treatment in experimental CDH. Nitrofen (50-60% CDH in offspring) or vehicle on E9.5 and sildenafil or vehicle on E11.5-20.5 were administrated to pregnant rats. On E20.5, PA Doppler indices were investigated with and without maternal hyperoxia. The presence/absence of CDH, lung/body weight ratio and radial saccular count were assessed at E20.5. At baseline, CDH rats had lower PA Doppler acceleration/ejection time ratios and pulsatility index (PI). Maternal hyperoxia resulted ina significant decrease in the PA/PI suggesting pulmonary vasodilation. Incontrast, in CDH fetuses, the ipsilateral PA/PI showed little or no response to hyperoxia (P > .05), and in those with LH, PI response to maternal hyperoxia correlated positively with hernia, lung/body weight ratio (r= 0.70, P= .01). Maternal sildenafil therapy significantly improved PA response to hyperoxia and lung growth in CDH fetuses (P < .01). Pulmonary vasodilation that occurs in E20.5 fetal rats in response to maternal hyperoxia is blunted in CDH. Change in PA/PI with hyperoxia is a useful predictor of LH severity. Sildenafil improves pulmonary vascular response and lung growth in fetal CDH.

Massive Postoperative Pulmonary Artery Tumor Embolism from Renal Cell Carcinoma

A 54-YR-OLD man with renal cell carcinoma underwent radi cal nephrectomy and inferior vena cava (IVC) thrombectomy. The tumor thrombus in the IVC had a length of 8.8 cm and extended 2.6 cm from the right atrium. Surgery was completed smoothly with suprahepatic IVC cross-clamping. Transesophageal echocardiographic examination was conducted, which did not reveal any embolism in the heart or pulmonary artery.On postoperative day 2, the patient complained of dyspnea, accompanied by hypoxemia and tachycardia. Enhanced computed tomography revealed defects in both pulmonary arteries. The arrow in the image indicates an embolus in the left pulmonary artery. An emergency operation was performed under cardiopulmonary bypass. The patient’s blood pressure remained normal before anesthesia induction; however, it decreased dramatically after induction, and the administration of inotropic or vasopressor agents was not very effective. Hypotension (systolic blood pressure, approximately 70 mmHg; mean blood pressure, approximately 50 mmHg) was not corrected until extracorporeal circulation was established. However, the hypoxemia was improved after tracheal intubation. The cancer thrombus and clots were removed from the pulmonary artery. Because of the probability that clots were formed in the IVC as the result of the residual thrombus, anticoagulation therapy—involving subcutaneous injection of low-molecular-weight heparin for 10 days, followed by oral administration of aspirin—was initiated following the operation for pulmonary embolism removal. The patient was discharged without further complications 2 weeks later.Radical nephrectomy with IVC thrombectomy is the most effective therapeutic option for renal cell carcinoma patients with tumor thrombus of the IVC.1 Thrombus embolization is rare, but is associated with an extremely high mortality rate.2 Use of transesophageal echocardiography for this operation helps in the diagnosis of thrombus migration.3 However, in the present case, transesophageal echocardiography did not detect residual thrombus in the IVC.The authors declare no competing interests.

Multi-modality imaging of severe pulmonary artery stenosis leading to massive pulmonary artery aneurysm treated with percutaneous valvuloplasty

Multi-modality imaging of severe pulmonary artery stenosis leading to massive pulmonary artery aneurysm treated with percutaneous valvuloplasty

Acute massive pulmonary embolism mimicking non-ST-elevation acute coronary syndrome

Non-ST-elevation acute coronary syndrome frequently presents with negative T-wave inversion. In acute pulmonary embolism precordial T-wave inversion occurs due to right ventricular strain. We herein report a case of a 48-year-old woman presenting with syncope secondary to massive main pulmonary artery embolism which was initially diagnosed as acute coronary syndrome due to negative anterior T-wave inversion and raised troponin. In addition, her room air saturation was normal and electrocardiogram showed T-wave inversion in inferior wall leads as well. We present this case of massive pulmonary embolism with varied presentation which was initially misdiagnosed as acute coronary syndrome.

实时三维超声心动图在心脏占位诊断中的价值

目的：探讨实时三维超声心动图(real-time three-dimensional echocardiography, RT3DE)在心脏占位诊断中的应用价值。方法：采用Philips sonos 7500和iE33型彩色多普勒超声诊断仪，对65例心脏占位患者(中位年龄42.0岁)行RT3DE检查，结合临床资料进行回顾性分析。结果：RT3DE诊断心脏占位65例，其中左房占位24例，右房占位13例，左室占位9例，右室占位11例，右房及右室占位1例，右房及心包占位1例，心包占位5例，肺动脉主干占位1例。其中39例接受手术治疗。结论：RT3DE能够直观地显示肿瘤的空间位置、整体形态、大小、表面特征及其与周围结构的关系，为心脏肿瘤的诊断提供了可靠的新方法。 Objective: To study the value of real-time three-dimensional echocardiography (RT3DE) in diagnosis of cardiac tumor. Methods: Sixty-five patients with primary cardiac mass were retrospective studied. All cases were di-agnosed using two-dimensional and RT3DE by Philips Sonos 7500 and iE33. The operative and pathological findings were collected. Results: Of these patients, 24 cases were left atrial mass, 13 cases were right atrial mass, 9 cases were left ventricular mass, 11 cases were right ventricular mass, 1 case was right ventricular and atrial mass, 1 case was right atrial and pericardial mass, 5 cases were pericardial mass, 1 case was pulmonary artery mass. Thirty-nine patients un-dertook the surgery. Conclusion: Echocardiography is a preferred method in the diagnosis of cardiac mass. Real-time dimensional echocardiography appeared advantages in showing the whole modality and adjacent tissue.

Predictive value of syncope in pulmonary embolism

Aim. To assess the predictive value of syncope in the clinical course of pulmonary thromboembolism (PTE). Material and methods. The study included 117 PTE patients (62 men and 55 women; mean age 51,86±13,4 years). High and intermediate risk of fatal outcome was observed in 37 and 80 patients, respectively. In all participants, PTE diagnosis was verified by pulmonary artery (PA) computed tomography. All patients were divided into two groups: Group I (n=35) with syncope registered 1-30 days ago (median time 1 day) and Group II (n=82) without syncope. The groups were comparable by age, gender, time of the clinical onset, clinical risk of PTE, and PA pressure levels. However, in Group I patients, the prevalence of high risk of fatal outcome was twice as high as in Group II participants (45,7% vs. 25,6%; p=0,032). To compare the thrombolysis therapy (TLT) independent levels of in-hospital mortality, the two TLT-free subgroups – 1 (14 patients with syncope) and 2 (58 patients without syncope) – were identified. Results. Syncope was associated with massive PA embolism (60% in Group I vs. 39% in Group II; p=0,036), often accompanied by shock/ hypotension (49% vs. 28%, respectively; p=0,032). Group I patients required TLT twice as often as Group II subjects (p=0,001), which resulted in reduced in-hospital mortality levels among individuals with syncope (p=0,048). Overall, both groups did not differ significantly by the levels of in-hospital mortality, while syncope patients demonstrated a tendency towards increased mortality (14,2% and 8,5%; p=0,35). However, in the absence of TLT, mortality levels reached 28,5% (4/14) in Subgroup 1 and 8,6% (8/58) in Subgroup 2 (p=0,042). Conclusion. Syncope in patients with possible PTE should be regarded as a marker of high risk of in-hospital death, due to a high prevalence of embolism in the PA trunk and main branches. TLT could improve the inhospital prognosis. To clarify the issue of prognostic value of syncope in PTE, further studies are necessary.

Pulmonary valve stenosis causing massive pulmonary artery aneurysm

Islam, Sameer; Cevik, Cihan; Islam, Ebtesam A.; Singhatiraj, Ekachai; Jones, Jason; Rodriguez, Sandra; Nugent, Kenneth Author Information

Liver hydatid cyst leading to bilateral pulmonary artery embolism and bilateral multiple pulmonar echinococcosis via inferior vena cava: report of a case

Hydatid disease (HD) is a worldwide parasitic disease. Echinococcosis may involve many organs but affect most commonly liver and lungs. The location of echinococcal cysts inside pulmonary artery is extremely rare. Radiologic findings range from purely cystic lesions to a completely solid appearance. Hydatid cysts (HC) can be solitary or multiple and varies size. Pulmonary artery embolism of HC can be symptomatic or asymptomatic. When symptomatic, we see the chest pain, dyspnea, cough, hemoptysis and sometimes acute cor pulmonale or sudden death secondary to massive giant pulmonary artery embolism of HC.

Surgical treatment of a pulmonary artery vascular hamartoma in a dog

A 6-year-old Siberian Husky-mix dog was examined for episodes of collapse. Physical examination, echocardiography, abdominal ultrasonography, ECG, and thoracic computed tomography with contrast were performed and revealed a 2.5 × 2.3 × 2.0-cm mass over the pulmonic valve leaflets, resulting in moderate pulmonic stenosis. Other abnormal findings included systemic hypertension, right bundle branch block, proteinuria, and a urinary bladder mass. Pulmonary arteriotomy was performed under inflow occlusion, and the mass was resected with transesophageal echocardiographic guidance and direct visualization. Results of histologic examination of the mass revealed a vascular hamartoma. Sequential follow-up examinations and telephone contacts (at 0.5, 5, and 15 months after surgery) revealed that the patient had been free from episodes of collapse since surgery. No regrowth of the mass was noted on follow-up echocardiograms, and the pulmonic stenosis had resolved, although mild to moderate pulmonary insufficiency later developed. The bladder mass was excised 15 months after the first surgery when hematuria developed, and results of histologic examination of this mass revealed a vascular hamartoma. The dog was eventually euthanized 31 months after the initial surgery for reasons that could not be directly linked to any recurrence of the pulmonary artery mass. Hamartomas are benign tumors that can be located in various tissues, including large arteries. Computed tomography was helpful in predicting the resectability of the intracardiac mass in this dog. Treatment with arteriotomy under inflow occlusion and mild hypothermia resulted in a favorable outcome.

Lung adenocarcinoma with peculiar growth to the pulmonary artery and thrombus formation: report of a case

BackgroundCases of pulmonary artery masses have only rarely been reported, and the optimal type of the diagnosis and treatment is controversial.Case PresentationAn 81-year-old woman was found to have an abnormal shadow on chest X-ray film. Computed tomography showed an irregularly bordered tumor centered in the hilar region extending from segment 6 to the middle lobe of the right lung. Pulmonary angiography showed complete occlusion of the trunk at the periphery proximal to the bifurcation of the posterior ascending branch. Based on bronchoscopic biopsy of the tumor, an adenocarcinoma was diagnosed. Middle and lower lobectomy was performed. Histopathologically, the adenocarcinoma had invaded the tunica intima of the pulmonary artery and also replaced the endothelium in the same region. Although a large thrombus was found at the vessel invasion site of the adenocarcinoma in the pulmonary artery, there were no malignant findings in the thrombus itself.ConclusionsThis is the first reported case of radical resection of a lung cancer with invasion along the pulmonary artery wherein a benign thrombus had formed. In general, surgery would be the treatment of choice for a pulmonary artery mass.

Pulmonary artery sarcoma mimicking pulmonary thromboembolism

A 30 years old male patient was referred to our hospital with a diagnosis of pulmonary thromboembolism due to thorax-computerized tomography (CT) angiography, revealing a thrombus totally occluding left main pulmonary artery. The lesion was evaluated as tumoural mass. Positron emission tomography (PET)-CT revealed pathologic uptake at pulmonary artery mass. Due to localization of tumour, left pneumonectomy was performed. The pathological diagnosis revealed to be pulmonary artery sarcoma. The patient was presented because pulmonary artery sarcomas are very rare tumors and can mimick pulmonary thromboembolism. The true prevalence is underestimated as many pulmonary artery sarcomas are misdiagnosed as pulmonary thromboembolism. PET-CT may help to make a differential diagnosis.

Pulmonary Artery Intimal Sarcoma Masquerading as Pulmonary Embolism

A 33-year-old man noted increasing dyspnea over a period of 6 weeks. Initial evaluation with transthoracic echocardiography demonstrated severe right ventricular dilation and systolic contractile dysfunction along with moderately severe tricuspid valve regurgitation on color Doppler with an estimated right ventricular systolic pressure of 108 mm Hg based on continuous wave Doppler assessment of the tricuspid regurgitant jet (Figure 1 and online-only Data Supplement Movies I and II). Subsequent evaluation for the cause of pulmonary hypertension included contrast-enhanced computed tomography of the chest that demonstrated a …

Pulmonary Artery Embolization of Intravenous Leiomyomatosis Extending into the Right Atrium

A 43-year-old woman was diagnosed with an intravenous leiomyomatosis at a previous hospital and transferred to our hospital to undergo surgical treatment. Emergency one-stage operation for coincidental removal of intra-abdominal, right atrial, and intravenous masses were planned. Upon arriving at the operating room, she suffered a sudden onset of severe dyspnea and showed hemodynamic instability. Intraoperative TEE showed pulmonary embolization of a right atrial mass. Removal of the pulmonary artery mass and the intra-abdominal mass, and the cardiopulmonary bypass were performed without any complications.

Incidence and Outcome of Pulmonary Embolism following Popliteal Venous Repair in Trauma Cases

Objectives and design Popliteal vein repair and ligation are the two main approaches to the treatment of the venous component of major, complex, knee injuries with vascular involvement. We have studied the incidence of pulmonary embolism following popliteal vein repair in trauma cases using computed tomography (CT) angiography and report the outcome. Material and methods From June 2006 to December 2009, 45 patients with popliteal vein injury were operated on in our vascular unit using lateral venorrhaphy, end-to-end anastomosis, a saphenous vein interposition graft and venous patch repair. All the patients were operated on using a medial approach to the knee. On the third postoperative day, all patients underwent a colour Doppler scan of the repaired popliteal vein to study patency, and pulmonary artery CT angiography using a 64-slice multidetector CT scan unit to establish the incidence of pulmonary embolism. Results The number of patients treated by each method were: lateral venorrhaphy 20 (44%), end-to-end anastomosis 13 (29%), saphenous vein interposition graft 9 (20%) and venous patch repair three (7%). Two patients (4%) died because of sudden cardio-respiratory arrest the day after surgery with massive bilateral pulmonary artery embolism at autopsy. Popliteal colour duplex ultrasound imaging showed seven (16%) cases of complete vein thrombosis and seven (16%) cases of partial vein thrombosis. CT angiography showed pulmonary embolism in 11 (26%) patients. From seven patients with complete thrombosis three patients, and from seven patients with incomplete thrombosis five patients showed pulmonary embolism on CT angiography. Other than two cases of early mortality, five (12%) patients developed clinical manifestations of pulmonary embolism and 11 (26%) patients had pulmonary embolism detected by CT angiography. Seven (16%) of our patients had mild-to-severe pulmonary embolism and 13 patients (29%) had proven pulmonary embolism. The total mortality rate was 7%. Conclusion A surprisingly high incidence of pulmonary embolism was observed after popliteal vein repair in civil trauma patients. Additional prophylactic methods such as using higher doses of heparin and using inferior vena cava (IVC) filters might be needed to prevent this potentially fatal complication.

Calcified Right Atrial and Pulmonary Artery Mass After Ventriculoatrial Shunt Insertion

Insertion of ventriculoatrial (VA) shunts is an effective method of draining cerebrospinal fluid from the cerebral ventricle to the right atrium and significantly improves the survival of patients with hydrocephalus. Some patients who received a VA shunt subsequently developed complications, including thrombus formation around the intracardiac end of the catheter and thromboembolism. The relative rarity of complications and the long latency between shunt insertion and the development of symptoms in VA shunt recipients may result in misdiagnosis or delayed diagnosis. The case presented suggests that such patients may require routine echocardiography at regular intervals. Otherwise, the indwelling foreign body may become the source of a life-threatening thrombotic mass, if not recognised and treated appropriately.