Presentation Of Pulmonary Embolism Research Articles

New Diagnostic Tools for Pulmonary Embolism Detection.

The presentation of pulmonary embolism (PE) varies from asymptomatic to life-threatening, and management involves multiple specialists. Timely diagnosis of PE is based on clinical presentation, D-dimer testing, and computed tomography pulmonary angiogram (CTPA), and assessment by a Pulmonary Embolism Response Team (PERT) is critical to management. Artificial intelligence (AI) technology plays a key role in the PE workflow with automated detection and flagging of suspected PE in CTPA imaging. HIPAA-compliant communication features of mobile and web-based applications may facilitate PERT workflow with immediate access to imaging, team activation, and real-time information sharing and collaboration. In this review, we describe contemporary diagnostic tools, specifically AI, that are important in the triage and diagnosis of PE.

Clinical Presentation and Risk Stratification of Pulmonary Embolism

AbstractPulmonary embolism (PE) presents with a spectrum of symptoms, ranging from asymptomatic cases to life-threatening events. Common symptoms include sudden dyspnea, chest pain, limb swelling, syncope, and hemoptysis. Clinical presentation varies based on thrombus burden, demographics, and time to presentation. Diagnostic evaluation involves assessing symptoms, physical examination findings, and utilizing laboratory tests, including D-dimer. Risk stratification using tools like Wells score, Pulmonary Embolism Severity Index, and Hestia criteria aids in determining the severity of PE. PE is categorized based on hemodynamic status, temporal patterns, and anatomic locations of emboli to guide in making treatment decisions. Risk stratification plays a crucial role in directing management strategies, with elderly and comorbid individuals at higher risk. Early identification and appropriate risk stratification are essential for effective management of PE. As we delve into this review article, we aim to enhance the knowledge base surrounding PE, contributing to improved patient outcomes through informed decision-making in clinical practice.

Atypical presentation of pulmonary embolism masquerading as abdominal pain

This case report highlights a rare presentation of Pulmonary Embolism (PE) with atypical abdominal pain, emphasizing the challenges in timely diagnosis. A female patient in her early eighties presented with left abdomen pain, initially treated for Urinary Tract Infection (UTI), and later accurately diagnosed with PE through Computed Tomography Pulmonary Angiography (CTPA). The mechanisms of abdominal pain encompass many hypotheses such as right-sided heart failure-induced hepatic congestion, diaphragmatic irritation from the pulmonary lobe infraction, increased blood viscosity, and pulmonary hypertension-associated abdominal lymphedema. PE is a prominent cause of unexpected deaths in hospitalized patients, with misdiagnosis occurring in up to 70% of cases, often only discovered postmortem. The condition manifests through various symptoms, with dyspnoea and chest pain being the most common. Abdominal pain, though less frequent, has been documented with an incidence of 6.7% in previous studies.

Atypical Presentation of Pneumonia Mimicking Pulmonary Embolism

This case report highlights the diagnostic challenge arises from the varied clinical presentation, complicating the differentiation between infarction pneumonia, community-acquired pneumonia (CAP), and pulmonary embolism (PE). The author reports a female patient in her late seventies who presents with worsening right-sided pleuritic chest pain, exertional dyspnoea, and productive cough. She was initially treated for CAP with oral amoxicillin 500 mg QDS and clarithromycin 500 mg twice daily for 5 days. She denied any night sweats or weight loss. On lung auscultation, she had right lower lobe crepitations. Subsequently, she underwent a computed tomography pulmonary angiography (CTPA) to rule out PE which demonstrated filling defects in the right pulmonary artery and right lower lobe patchy consolidation. The patient was treated with rivaroxaban 15 mg BD for 21 days followed by 20 mg OD for 4 months, and also treated for CAP with ceftriaxone 2 g OD for 7 days.

Not All That Wheezes Are Asthma

Wheeze as a respiratory symptom is commonly described in obstructive airway diseases. However, wheeze can occur in many other diseases apart from airway obstruction. Pulmonary embolism presenting as wheeze is not uncommon and clinician treating diseases with wheezing should be aware of the rarer conditions such as pulmonary embolism. Here, we present the case of a wheezing disorder treated as asthma initially and diagnosed with pulmonary embolism on a detailed workup due to poor clinical response.

Late Presentation of Acute Pulmonary Embolism following Outpatient-treated Mild COVID-19

Late Presentation of Acute Pulmonary Embolism following Outpatient-treated Mild COVID-19

FRI221 A Case Of Pulmonary Embolism Presenting As Adrenal Crisis

Abstract Disclosure: S. Guntaka: None. C. Barron: None. P. Zhou: None. Introduction: Adrenal crisis is not a typical presentation for iatrogenic adrenal insufficiency. We present a case of pulmonary embolism (PE) with a history of steroid use, to show the complexity of diagnosing adrenal crisis caused by iatrogenic adrenal insufficiency. Case Presentation: A 19-year-old woman with a history of severe atopic dermatitis, was treated with high dose prednisone for three weeks. One month after completing the course, she presented to the ED with rash, mid-sternal chest pain, dizziness and shortness of breath. Vitals were significant for tachycardia and hypotension. BMP showed Na 129 mEq/L (135-145), K 6.1 mEq/L (3.5-5), glucose 140 mg/dl, BUN 22mg/dL (5-20), and Creatinine 1.25 mg/dl (&lt 1.2). EKG showed peaked T waves and chest X-ray was normal. Adrenal crisis was the initial impression due to the history of steroid use and electrolyte abnormalities. She received hydrocortisone 100 mg IV for 2 doses. Hyperkalemia was treated with a calcium gluconate bolus, albuterol, insulin and glucose. She continued to endorse difficulty breathing, and chest pain, and so other etiologies were considered. A V/Q scan demonstrated multiple v/q mismatched defects in bilateral lung fields, suggestive of PE. She was admitted for anti-coagulation therapy and showed clinical improvement, without additional steroid use. An ACTH stimulation test demonstrated adequate function of the hypothalamic-pituitary-adrenal axis with normal cortisol response. Baseline and post-stimulation androstenedione and 17OHP, aldosterone, plasma renin activity, DHEAS and TFTs were also normal. Extensive work-up for coagulative and autoimmune disorders was unremarkable. The patient was subsequently restarted on oral prednisone for worsening skin disease. Conclusion: Steroid use has been associated with the development of PE. Hyponatremia can be seen among patients with PE, occurring at rates of 21 to 26%.1 In contrast, secondary adrenal insufficiency presents with euvolemic hyponatremia, and uncommonly hypoglycemia. Hyperkalemia is not typically seen. Salt craving, postural dizziness, dehydration are also not common in secondary adrenal insufficiency as mineralocorticoid function is preserved. This case demonstrates the importance of evaluating for additional etiologies in the setting of hyponatremia with electrolyte abnormalities that are not usually seen with secondary adrenal insufficiency. This patient’s initial presentation is more consistent with PE and acute renal insufficiency. Understanding the presentation of iatrogenic adrenal insufficiency is necessary to make the correct diagnosis, and to ensure patients receive appropriate care.

Sex-Based Differences in the Presentation and Outcomes of Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis.

The study aimed to review differences in the presentation and outcomes of acute pulmonary embolism (PE) between men and women. PubMed, CENTRAL, Web of Science, and Embase were searched for studies comparing clinical features or outcomes of PE between men and women. Baseline comorbidities, risk factors, clinical features, and mortality rates were also compared between men and women. Fourteen studies were included. It was noted that men presented with PE at a statistically significantly younger age than women (P < .001). Smoking history (P < .001), lung disease (P = .004), malignancy (P = .02), and unprovoked PE (P = .004) were significantly more frequent among men than among women. There was no difference between the sexes for hypertension, diabetes, and a history of recent immobilization. A significantly higher proportion of men presented with chest pain (P = .02) and hemoptysis (P < .001), whereas syncope (P = .005) was more frequent in women. Compared with men, women had a higher proportion of high-risk PE (P = .003). There was no difference in the use of thrombolytic therapy or inferior vena cava filter. Neither crude nor adjusted mortality rates were significantly different between men and women. This review found that the age at presentation, comorbidities, and symptoms of PE differed between men and women. Limited data also suggest that women more frequently had high-risk PE compared with men, but the use of thrombolytic therapy did not differ between the 2 sexes. Importantly, both crude and adjusted data show that the mortality rate did not differ between men and women.

Clinical presentations of acute pulmonary embolism: A retrospective cohort study.

We aimed to investigate whether the unusual clinical presentation of pulmonary embolism (PE) varies by the type of provocation. In this retrospective cohort study, we examined the electronic health records (EHR) records of all patients diagnosed with PE (upon presentation or during hospitalization) presented to our tertiary hospital during 2014 to 2019. Inclusion criteria were the diagnosis of acute PE and age above 18 years. Excluded were all patients to whom complete EHR were not available. The primary outcome was the main presenting symptom, categorized by a multidisciplinary consensus expert committee as either typical or atypical of PE. Comorbidities, vital signs, medications and laboratory results on presentations were recorded. 591 patients were included in the final analysis. Dyspnea was significantly less common and hemoptysis and chest pain more common in the unprovoked PE group (35%, 5%, and 25%, respectively) compared with nonmalignant (42.6%, 0%, and 16.3%) and malignancy-associated (47.7%, 0.9%, and 8.2%) PE (Pv = 0.02, 0.002 and 0.001, respectively). No recorded symptoms were the third most common presentation overall, accounting for a significantly (Pv < 0.001) higher proportion of PE patients with malignancy (19%) whereas atypical presentation was the hallmark of patients with nonmalignant provokation (19.7%) (Pv = 0.005). Accounting for multiple potential confounders, the risk of atypical or asymptomatic presentation was higher with lower heart rates (RR = 0.974 95%C.I. [0.957-0.990]) and higher pulse oximetry saturation (RR = 1.114 95%CI [1.034-1.201]). The clinical presentation of PE varies with different types of provoking factors, with atypical presentation most common in nonmalignant provocation and asymptomatic presentation most prevalent in patients with underlying malignancy. Further studies are needed to determine the effect of said variance on long term clinical outcomes.

Gender Disparities in Presentation, Management, and Outcomes of Acute Pulmonary Embolism

Pulmonary embolism (PE) is the third most common cause of cardiovascular death; however, gender disparities in PE remain understudied. All PE cases at a single institution between January 2013 and June 2019 were retrospectively reviewed. The clinical presentation, treatment modalities, and outcomes were compared between men and women using univariate and multivariate analyses adjusting for differences in baseline characteristics. A total of 1,345 patients were diagnosed with acute PE, of whom 56.3% were women (n=757). Women had a significantly higher mean body mass index (29.4 vs 28.4) and a higher frequency of hypertension (53% vs 46%) and hormone use (6.6% vs 0%; all p <0.02). Men had a higher frequency of smoking (45% vs 33%, p <0.0001). Women had significantly lower PE severity index classifications (p=0.0009). The rates of intensive care unit admission, vasopressor requirements, extracorporeal membrane oxygenation cannulation, and mechanical ventilation were similar between the genders. There was no significant difference in the treatment modality used between the genders. Although the risk factors and PE severity index class differed between the genders, there was no significant difference in resource utilization or treatment modality. Gender was also not a significant predictor of in-hospital mortality, moderate or severe bleeding, increased length of stay, or readmission in the study population.

Pulmonary Embolism Presenting as a Complete Heart Block

Pulmonary Embolism Presenting as a Complete Heart Block

31 Serum Lactate at Presentation and Acute Kidney Injury in Intermediate and High Risk Pulmonary Embolism Presenting at an Academic Tertiary Care Center

31 Serum Lactate at Presentation and Acute Kidney Injury in Intermediate and High Risk Pulmonary Embolism Presenting at an Academic Tertiary Care Center

Sex-Related Differences in Patients Characteristics, Risk Factors, and Symptomatology in Older Adults with Pulmonary Embolism: Findings from the SERIOUS-PE Study.

Sex-specific factors are implicated in pulmonary embolism (PE) presentation in young patients, as indicated by increased risk in pregnancy. Whether sex differences exist in PE presentation, comorbidities, and symptomatology in older adults, the age group in which most PEs occur, remains unknown. We identified older adults (aged ≥65 years) with PE in a large international PE registry replete with information about relevant clinical characteristics (RIETE registry, 2001-2021). To provide national data from the United States, we assessed sex differences in clinical characteristics and risk factors of Medicare beneficiaries with PE (2001-2019). The majority of older adults with PE in RIETE (19,294/33,462, 57.7%) and in the Medicare database (551,492/948,823, 58.7%) were women. Compared with men, women with PE less frequently had atherosclerotic diseases, lung disease, cancer, or unprovoked PE, but more frequently had varicose veins, depression, prolonged immobility, or history of hormonal therapy (p < 0.001 for all). Women less often presented with chest pain (37.3 vs. 40.6%) or hemoptysis (2.4 vs. 5.6%) but more often with dyspnea (84.6 vs. 80.9%) (p < 0.001 for all). Measures of clot burden, PE risk stratification, and use of imaging modalities were comparable between women and men. PE is more common in elderly women than in men. Cancer and cardiovascular disease are more common in men, whereas transient provoking factors including trauma, immobility, or hormone therapy are more common in elderly women with PE. Whether such differences correlate with disparities in treatment or differences in short- or long-term clinical outcomes warrants further investigation.

Be aware of non-specific presentation of pulmonary embolism: a case report

BackgroundThe early diagnosis of non-specific presentation of pulmonary embolism (PE) is difficult because the symptoms are non-specific and varied.Case presentationA 69-year-old female patient had syncope accompanied by gait disturbance, without obvious inducement. The patient was initially suspected to have cerebral infarction, but the symptoms did not improve and myocardial markers increased after two days of symptomatic treatment for myocardial infarction. Hence, PE was suspected and computed tomography pulmonary angiography (CTPA) examination confirmed the diagnosis. CTPA showed multiple emboli in pulmonary artery and its branches, so high-risk PE was diagnosed. Intravenous thrombolysis was administered, and pulmonary CTA showed a significant reduction of emboli in pulmonary artery and its left and right branches.ConclusionThis case report highlights the importance of improving the clinical awareness about non-specific presentation of PE and avoiding misdiagnosis or missed diagnosis.

Pulmonary embolism presenting as delirium: an acute confusional state in an elderly patient—a case report

BackgroundLarge numbers of elderly patients are admitted to hospitals in acute confusional states. In many, the underlying causes are easily found; in some, correct diagnosis is difficult. Pulmonary embolism (PE), the most serious clinical presentation of venous thromboembolism, is often misdiagnosed because of its non-specific features including delirium.Case presentationA 73-year-old woman was admitted to our hospital in a confused state with no obvious risk factors of PE. D-dimer levels were elevated and contrast-enhanced high-resolution computed tomography (HRCT) of the chest confirmed the diagnosis of PE. She was treated with enoxaparin and discharged on dabigatran. Her symptoms had resolved at the time of discharge, and she has been stable for over three month’s follow-up visit.ConclusionPE should be regarded as a differential in elderly patients with an acute confusional state despite the absence of obvious risk factors. Investigating for and treating when confirmed may save a life.

Presentations of pulmonary embolism in COVID-19: An Indian case series

The prevalence of pulmonary embolism (PE) among COVID-19 infections is significantly high. However, in resource-limited settings, appropriate computed tomography (CT) imaging is not possible for all COVID-19 patients. Very sick patients suspected of a PE may not be fit to be shifted to the CT room. Hence, it is likely that PE is underdiagnosed in Indian COVID-19 patients. Coexisting PE should be considered in all patients with influenza-like illnesses who have a Type 1 respiratory failure out of proportion to the severity of COVID- 19 radiology. In this case series, we discuss the different presentations of PE in patients with COVID-19.

Hydropneumothorax – Rare presentation of pulmonary embolism with methylenetetrahydrofolate reductase mutation with hyperhomocysteinemia

Pulmonary embolism (PE) is a relatively common cardiovascular event with high early mortality rates. Many risk factors play a role in the causation of PE including acquired as well as inherited. Methylenetetrahydrofolate reductase (MTHFR) gene mutation is one of the inherited etiologies for PE which cause hyperhomocysteinemia which can lead to PE. This in turn can result in secondary complications such as pneumothorax or hydropneumothorax, which are rare presentations of PE. Hereby, we present this unique case of a 17-year-old boy who presented with a hydropneumothorax which on further evaluation was found to be a complication of bilateral PE which was due to hyperhomocysteinemia with MTHFR A1298C mutation. Hence, we present this unique case with rare presentation as well as rare etiology for PE. This shows the significance for considering PE as one of the differentials in situations such as cavitations, pneumo or hydropneumothoraces, and hyperhomocysteinemias.

Simultaneous presentation of pulmonary embolism and pericardial effusion as complications of cancer: a case report

Summary We report the case of a 62-year-old woman who was admitted to Vilnius University Hospital Santaros klinikos suffering from week-long shortness of breath during minimal physical activity. Computed tomography angiography and echocardiogram findings led to a diagnosis of pulmonary embolism and large pericardial effusion. The patient was previously diagnosed with a base of tongue cancer with lung metastasis. The patient received low-molecular-weight-heparin, and pericardiocentesis was performed. As a result, the patient’s general condition improved, and she was discharged from the hospital. In this case, pulmonary embolism and pericardial effusion coincided as complications of malignancy. The concurrent presentation of these conditions is rare and poses a clinical dilemma regarding the treatment, including anticoagulant therapy.

Surgical Management of Massive Pulmonary Embolism Presenting with Cardiopulmonary Arrest: How Far Is Too Far?

The incidence of diagnosed massive pulmonary embolism presenting to the Emergency Department is between 3% and 4.5% and it is associated with high mortality if not intervened timely. Cardiopulmonary arrest in this subset of patients carries a very poor prognosis, and various treating pathways have been applied with modest rate of success. Systemic thrombolysis is an established first line of treatment, but surgeons are often involved in the decision-making because of the improving surgical pulmonary embolectomy outcomes.

Massive Pulmonary Embolism Presenting as Obstructive Shock in a Nigerian Woman: A Case Report

Massive Pulmonary Embolism Presenting as Obstructive Shock in a Nigerian Woman: A Case Report