Non-thrombotic Pulmonary Embolism Research Articles

Case report: temporal hollowness augmentation with PEGylated fillers

The use of fillers based on hyaluronic acid in correcting deficits in the upper part of the face, especially in the temporal area, can significantly improve the balance and appearance of the face. Such a procedure, apart from unquestionable aesthetic advantages, carries significant risks, including contour irregularities, vascular occlusion, skin necrosis, hair loss, blindness, stroke, and non-thrombotic pulmonary embolism. To increase the safety and precision of the volumization of the temple area, the technique of administration of the preparation, as well as the product itself, should be carefully selected.

Nodule pulmonaire suspect chez un grand tabagique : faut-il faire une biopsie ?

Sclerotherapy is a widely used as a lifesaving therapeutic option in cases of upper gastrointestinal bleeding (UGB) due to ruptured gastro-esophageal varices (GOV) in cirrhotic patients, especially when there exists a portosystemic shunt. This endoscopic technique can entail many complications, including systemic and non-thrombotic pulmonary embolism (PE). While multiple pulmonary parenchymal manifestations have been described following sclerotherapy of GOV, to our knowledge no solitary suspicious pulmonary nodule has been described. We report the case of 55-year-old man with heavy smoking history who was referred to our pulmonary clinic for work-up of a solitary pulmonary nodule. He was known to have liver cirrhosis with history of massive UGB due to rupture of GOV two months before. He was treated with sclerotherapy by injecting a 3 cc of Histoacryl/lipiodole solution. The post- endoscopic phase was unremarkable. An enhanced CT scan of chest and abdomen performed two months later showed a right upper lobe nodule, even though at that point, the patient was completely asymptomatic. This was ascribed to non-thrombotic PE secondary to sclerotherapy due to complete resolution of the nodule on a CT scan carried out at 2-month follow-up. At that point, his condition did not require any further treatment. Solitary pulmonary nodule is one of the radiologic manifestations of PE subsequent to sclerotherapy of GOV. Awareness and radiologic follow-up of this unusual radiologic presentation may prevent unnecessary biopsies.

A rare combination: thrombotic and non-thrombotic pulmonary embolism.

A rare combination: thrombotic and non-thrombotic pulmonary embolism.

Nonthrombotic pulmonary embolism secondary to cyanoacrylate embolization of gastric varices.

A 51-year-old woman with esophageal varices secondary to decompensated cirrhosis presented to the emergency department with hematemesis. Her heart rate was 123 beats/min and her blood pressure was 86/43 mm Hg. Her initial hemoglobin was 33 (normal 120–160) g/L, her platelet count was 245 (normal

Non-thrombotic pulmonary embolism of brain, liver, or bone marrow tissues associated with traumatic injuries in free-ranging neotropical primates.

From 2016 to 2019, Southeastern Brazil faced an outbreak of yellow fever (YF) affecting both humans and New World primates (NWP). The outbreak was associated with a marked increase in traumatic lesions in NWP in the affected regions. Non-thrombotic pulmonary embolization (NTPE) can be a consequence of massive traumatic events, and it is rarely reported in human and veterinary medicine. Here, we describe NTPE of the brain, liver, and bone marrow in free-ranging NWP, highlighting the epidemiological aspects of these findings and the lesions associated with this condition, including data on traumatic injuries in wild NWP populations during the course of a recent YF outbreak. A total of 1078 NWP were necropsied from January 2017 to July 2019. Gross traumatic injuries were observed in 444 marmosets (44.3%), 10 howler monkeys (23.2%), 9 capuchins (31.0%), 1 titi-monkey (50.0%), and 1 golden lion tamarin (33.3%). NTPE was observed in 10 animals, including 9 marmosets (2.0%) and 1 howler monkey (10.0%). NTPE was identified in the lung and comprised hepatic tissue in 1 case, brain tissue in 1 case, and bone marrow tissue in 8 cases. Although uncommon, it is important to consider NTPE with pulmonary vascular occlusion during the critical care of traumatized NWP. In addition, this study highlights the importance of conservational strategies and environmental education focusing on One Health, not only to protect these free-ranging NWP populations but also to maintain the efficacy of epidemiological surveillance programs.

Het is niet altijd Covid-19!

It is not always Covid-19! Nonthrombotic pulmonary embolism (NTPE) is defined as a partial or total occlusion of the pulmonary circulation. Different causal agents exist. The prevalence is much lower compared to pulmonary thromboembolism. Due to the low specificity of the signs and symptoms, NTPE tends to be underestimated. The diagnosis is a real challenge as there is no standardised diagnostic tool. The imaging findings are heterogeneous, but usually present as diffuse ground-glass abnormalities. In this article, the medical history of two different cases of fat embolism after an orthopaedic trauma is reported. The importance of a good differential diagnosis must be emphasized.

AN UNEXPECTED COMPLICATION FROM IV CONTRAST

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The presence of gas bubbles into blood vessels can be associated with lethal consequences. Air embolism is an under-recognized complication associated with any procedure that involves vascular manipulation. Particular importance should be given to intravascular catheters insertion and intravenous contrast injections due to their frequency in every-day practice. We present a case of a pulmonary arterial embolism after a contrasted CT. CASE PRESENTATION: A 40-year-old male with a history of sigmoid diverticulitis presented to the ED complaining of sharp left lower abdominal pain. Vitals and physical examination were unremarkable except for moderate tenderness on the left lower quadrant of the abdomen. Abdominal CT scan with contrast revealed obstructing lithiasis in the distal left ureter; laboratory workup was unremarkable. Pain control was achieved and he was discharged with tamsulosin and Urology follow up. However, CT over-read disclosed gas bubbles in the main pulmonary artery, suspected to be iatrogenic from IV contrast power injection. He was prompted to return and admitted to the MICU. He denied chest pain or difficulty breathing but mentioned mild shortness of breath while the contrast was administered. EKG and chest x-ray were unremarkable. He was placed on Trendelenburg - left lateral decubitus position and supplemental oxygen was delivered through a non-rebreather mask with subsequent air resorption and no long term sequelae. DISCUSSION: Air embolism is an under-estimated risk from intravascular catheters and contrast injection. A breach in the vasculature plus a pressure gradient that favors the passage of air into the circulation allows bubbles to enter the circulation (arterial or venous). Arterial emboli causes end-organ ischemia. The air in the pulmonary microcirculation impedes blood flow and induces vasoconstriction leading to increased pulmonary arterial and right ventricular pressure. Inflammatory mediators and free radicals are released as well causing endothelial damage. Cases often present with dyspnea, chest pain, crepitus over superficial vessels, livedo reticularis; bubbles within retinal arteries are seldom seen. Diagnosis is made clinically when a patient with risk factors develops acute pulmonary, cardiovascular or neurological decompensation. Imaging tends to be normal because air is quickly absorbed. Patients are treated with repositioning (to avoid further embolization) and supplement oxygen with high FIO2 (to increase the air resorption rate). In cases of hemodynamic instability, neurologic deficits or end-organ damage: hyperbaric oxygen is indicated. CONCLUSIONS: Air embolism is a potential complication of any procedure that involves vascular intervention; keeping this in mind will help with early recognition of cases and timely therapeutic intervention. Reference #1: Jorens PG, Van Marck E, Snoeckx A, Parizel PM. Nonthrombotic pulmonary embolism. Eur Respir J. 2009;34(2):452-474. doi:10.1183/09031936.00141708 DISCLOSURES: No relevant relationships by Hung-I Liao, source=Web Response No relevant relationships by Valeria Trelles Garcia, source=Web Response No relevant relationships by Daniela Trelles Garcia, source=Web Response

A Systematic Literature Review of the Middle Temporal Vein Anatomy: 'Venous Danger Zone' in Temporal Fossa for Filler Injections.

Treatment of a sunken appearance of the temporal region using injectable fillers is a popular procedure. The temporal fossa has very complex anatomy due to multiple vessels running in the different tissue layers. A severe complication in the form of non-thrombotic pulmonary embolism (NTPE) can occur as a result of an inadvertent injection in the middle temporal vein (MTV) while performing temporal fossa filler procedures. Therefore, in-depth knowledge and understanding of the MTV anatomy are essential for successful and safer injectable procedures of the temporal fossa. While there have been many studies to describe the arteries in this region, there is limited information about the location and course of the middle temporal vein. This literature review is aimed at providing detailed information about the course, depth, and size of the MTV to help aesthetic practitioners in performing safer temporal fossa filler injections. This information is imperative to delineate the 'venous danger zone' in the temple region. The preferred reporting items for systematic reviews and meta-analyses guidelines were used for this review. A literature search was performed to find the articles providing details about the MTV anatomy and the measurements related to its course and size. A review of the literature showed that the MTV displays a consistent course and depth in the temporal region, with high variability in its diameter. The middle temporal vein width varied between 0.5 and 9.1mm in various studies. The middle temporal vein receives many subfascial tributaries from the surface of the temporalis muscle, and for most of its course runs in the fat pad enclosed between superficial and deep layers of the deep temporal fascia. A 'venous danger zone,' in the interfascial planes of the temporal fossa, which contain the main part of the MTV and its tributaries, has been proposed in this paper. The temporal fossa filler procedures need great caution, and knowledge of the depth and course of the MTV is essential for avoiding NTPE. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Non-thrombotic pulmonary embolism in emergency CT.

Non-thrombotic pulmonary embolism (NTPE) results from the embolization of non-thrombotic materials. It can often be a challenging diagnosis due to non-specific (similar to thrombotic pulmonary embolism) or uncommon clinical and imaging findings. Patients with NTPE often present to the emergency department with acute respiratory distress, and contrast-enhanced computed tomography (CT) of the chest and CT pulmonary angiography are the imaging modalities of choice for respiratory distress. Since the treatment of NTPE is entirely different from thromboembolism, its distinction is essential. Moreover, early diagnosis of NTPE is necessary. Radiologists must be familiar with the diagnostic findings of NTPE, and this article aims to review the imaging features of various causes of NTPE.

Pulmonary embolism by foreign bodies: a case report

The problem of pulmonary thromboembolism (PTE) continues to be highly relevant, as it remains a complex clinical problem today, in spite of modern diagnostic and treatment methods. According to WHO, PTE is recognized as one of the most common cardiovascular diseases in the world and ranks third after coronary heart disease and brain stroke. Embolism to the pulmonary artery is not always caused by thrombotic masses. There is also a non-thrombotic pulmonary embolism (NTPE), which is defined as embolization to the pulmonary arteries by different types of cells (adipocytes, amniotic, trophoblastic or tumor), fungi, septic and foreign material or air / gases. In our article, the clinical case of embolism to the pulmonary artery by foreign bodies – coils placed in the left spermatic vein for varicocele correction is presented. Despite the significant lesion area, signs of pulmonary hypertension were not revealed. Thus, the rapidly evolving potential of modern interventional medicine requires a doctor to be aware and alert as for a NTPE development. Computed tomographic angiopulmonography with the aid of intravenous contrast enhancement is the main diagnostic method for pulmonary thromboembolism as well as for non-thrombotic pulmonary embolism.

Jak rozpoznajemy ostrą zatorowość płucną na Oddziałach Intensywnego Nadzoru Kardiologicznego?

Żylna choroba zakrzepowo-zatorowa obejmuje dwie jednostki chorobowe: zakrzepicę żył głębokich oraz zatorowość płucną. Jest trzecią co do częstości występowania chorobą układu krążenia — według najnowszych statystyk roczna zapadalność na nią wynosi 100–200 na 100 000 osób. W większości przypadków ZP jest następstwem zakrzepicy żył głębokich kończyn dolnych, natomiast niezakrzepowa ZP występuje dość rzadko. Czynnikami predysponującymi do żylnej choroby zakrzepowo-zatorowej są czynniki osobnicze czyli stałe — związane z chorym oraz czynniki czasowe — powiązane z różnymi sytuacjami klinicznymi. Zatorowość płucna może być również idiopatyczna i wystąpić przy braku jakiegokolwiek znanego czynnika ryzyka. W niniejszej pracy zaprezentowano etiopatogenezę, patofizjologię oraz objawy ZP. Praca będzie użyteczna dla lekarzy dyżurujących w oddziałach ratunkowych oraz oddziałach kardiologii i chorób wewnętrznych Przyczyni się do bardziej trafnego rozpoznawania tej ważnej jednostki chorobowej.

Nichtthrombotische Lungenembolien

The term nonthrombotic pulmonary embolism (NTPE) is defined as embolization of pulmonary arteries caused by foreign bodies (e. g. detached catheter fragments), biological substances (e. g. septic thrombus) or exogenous substances (e. g. gas). The frequency of NTPE is underestimated. Symptoms can cover the spectrum from undetectable to sudden death. In addition to mechanical obstruction of the pulmonary arteries, some NTPEs trigger an inflammatory cascade that causes deterioration of vascular, pulmonary and cardiac function. Radiological imaging in combination with the medical history of patients is sufficient to identify most NTPEs with certainty. The aim of this article is to make readers aware of the symptoms, frequency, relevance, classification, pathophysiology, laboratory findings and radiological findings of the most frequent forms of NTPE. The spectrum of forms presented here includes pulmonary embolisms due to foreign bodies (intravascular, intracorporeal and extracorporeal), amniotic fluid, endogenous tissue, fat, tumors, septic thrombi, hydatids, cement, metallic mercury, gas, silicone and particles.

Non-Thrombotic Pulmonary Embolism

Non-Thrombotic Pulmonary Embolism

Nonthrombotic Pulmonary Artery Embolism: Imaging Findings and Review of the Literature

The purpose of this article is to emphasize the imaging findings encountered in the setting of nonthrombotic pulmonary embolism. Nonthrombotic pulmonary embolism refers to a spectrum of clinical and radiologic disorders caused by embolization of the pulmonary artery vasculature by various cell types, microorganism, and foreign bodies. Awareness of the imaging and clinical features of the nonthrombotic pulmonary embolism may facilitate prompt diagnosis.

Nonthrombotic Pulmonary Embolism: A Potential Complication of Polyacrylamide Hydrogel Cosmetic Injection.

Context. Polyacrylamide hydrogel (PAAG) has gained importance as a synthetic soft tissue filling agent. It has been commonly employed by physicians in Europe for facial contouring and soft tissue augmentation. Previously, PAAG is considered nontoxic and well tolerated with a few mild procedural complications. Case Presentation. A 26-year-old female was hospitalized for dry cough, worsening dyspnea, and chest discomfort after 3 hours of multiple PAAG injections in buttocks. The patient's condition deteriorated and rapidly advanced to acute respiratory failure. Therein, the diagnosis of nonthrombotic pulmonary embolism (NTPE) was established on standard set of investigations. She was intubated; corticosteroid and empiric antibiotic therapy was initiated resulting in improvement of her condition. Subsequently, extubation was done, and she was discharged from the hospital after an uneventful recovery. On 1-month follow-up, the patient had no previous symptoms. Conclusion. This report implicates clinicians to maintain a high index of suspicion for NTPE in patients presenting with respiratory symptoms following PAAG usage.

An Anatomical Study of the Middle Temporal Vein and the Drainage Vascular Networks to Assess the Potential Complications and the Preventive Maneuver During Temporal Augmentation Using Both Anterograde and Retrograde Injections.

Non-thrombotic pulmonary embolism has recently been reported as a remote complication of filler injections to correct hollowing in the temporal region. The middle temporal vein (MTV) has been identified as being highly susceptible to accidental injection. The anatomy and tributaries of the MTV were investigated in six soft embalmed cadavers. The MTV was cannulated and injected in both anterograde and retrograde directions in ten additional cadavers using saline and black filler, respectively. The course and tributaries of the MTV were described. Regarding the infusion experiment, manual injection of saline was easily infused into the MTV toward the internal jugular vein, resulting in continuous flow of saline drainage. This revealed a direct channel from the MTV to the internal jugular vein. Assessment of a preventive maneuver during filler injections was effectively performed by pressing at the preauricular venous confluent point against the zygomatic process. Sudden retardation of saline flow from the drainage tube situated in the internal jugular vein was observed when the preauricular confluent point was compressed. Injection of black gel filler into the MTV and the tributaries through the cannulated tube directed toward the eye proved difficult. The mechanism of venous filler emboli in a clinical setting occurs when the MTV is accidentally cannulated. The filler emboli follow the anterograde venous blood stream to the pulmonary artery causing non-thrombotic pulmonary embolism. Pressing of the pretragal confluent point is strongly recommended during temporal injection to help prevent filler complications, but does not totally eliminate complication occurrence. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Non-Thrombotic Pulmonary Embolism and Rare Pulmonary Vascular Pathologies

Non-Thrombotic Pulmonary Embolism and Rare Pulmonary Vascular Pathologies

Disseminated Cunninghamella bertholletiae infection with septic pulmonary embolism after allogeneic bone marrow transplantation

Mucormycosis in immunocompromised patients is often reported. We report a patient who developed non-thrombotic pulmonary embolism due to Cunninghamella bertholletiae after allogeneic stem cell transplantation.

The impact of pulmonary bone component embolism: an autopsy study

AimsPulmonary bone marrow embolism (BME) and pulmonary bone fragment embolism (BFE) are two types of non-thrombotic pulmonary embolism (NTPE). While BME can be found consistently in autopsies, BFE is a...

A case of nonthrombotic pulmonary embolism after facial injection of hyaluronic Acid in an illegal cosmetic procedure.

Hyaluronic acid is widely used in medical procedures, particularly in cosmetic procedures administered by physicians or nonmedical personnel. The materials used for cosmetic procedures by physicians as well as illegally by non-medical personnel can cause nonthrombotic pulmonary embolism (NTPE). We report the case of a woman with acute respiratory failure, neurologic symptoms and petechiae after an illegal procedure of hyaluronic acid dermal filler performed by an unlicensed medical practitioner 3 days before symptom onset. Although a few cases of NTPE after injection of hyaluronic acid have been reported yet, this is the first typical case showing a NTPE manifestation after the facial injection of hyaluronic acid.