Pulmonary Embolism Research Articles

Prognostic performance of the Bova, sPESI, and Qanadli scores in patients with acute pulmonary embolism.

Acute pulmonary embolism (PE) is a disease with a serious prognosis and a high probability of death in the emergency department. To investigate the prediction of PE-related mortality and intensive care admission (ICU) of Qanadli (Qscore), Bova, and simplified Pulmonary Embolism Severity Index (sPESI) scores. This retrospective observational study consisted of all patients diagnosed with acute PE who were imaged under computed tomography pulmonary angiography (CTPA) for a total of 5 years between 1 June 2018 and 1 June 2023. The prediction of radiological and clinical scores for mortality and ICU admission was examined. A total of 95 patients were analyzed. Patients who died and those who were admitted to the ICU had a significantly higher frequency of being found to have a high-risk (≥1) sPESI score (P = 0.04 and P = 0.016, respectively). For mortality, the sPESI score was found to be significant; the sensitivity and specificity were observed as 54% and 66% (area under the curve [AUC]=0.670, 95% confidence interval [CI]=0.527-0.814; P = 0.020). For ICU admission, the sensitivity and specificity of the Qscore, sPESI, and Bova scores were 35%, 77%, and 58%, and 78%, 65%, and 84% respectively (AUC=0.626, 95% CI=0.511-0.740, P = 0.031; AUC=0.769, 95% CI=0.674-0.865, P < 0.001; and AUC=0.767, 95% CI=0.671-0.862, P < 0.001, respectively). It was found that the sPESI score was effective at predicting mortality in patients with acute PE. Qscore, sPESI, and Bova scores have been shown to be useful in predicting ICU admission.

Clinical features, outcomes, and anticoagulant strategies in lung cancer-associated isolated distal deep vein thrombosis

IntroductionThe clinical presentation, outcomes, and anticoagulation strategies in patients with lung cancer-associated isolated distal deep vein thrombosis (LC-iDDVT) are not well-defined. Materials and methodsThe study included 593 patients with LC-iDDVT and 260 patients with lung cancer-associated proximal DVT (LC-Proximal DVT). LC-iDDVT was further classified into axial venous thrombosis (AVT; 112 patients) and muscular venous thrombosis (MVT; 481 patients). Cox proportional risk regression models with Fine-Gray tests and competing risk models were employed to evaluate short-term (90-day) and long-term (1-year) outcomes (hazard ratio [HR]; 95 % confidence interval [CI]). ResultsAt the 90-day follow-up, patients with MVT had lower adjusted risks of pulmonary embolism (PE; HR = 0.20 [0.07–0.55], p = 0.002) and venous thromboembolism (VTE) recurrence (HR = 0.54 [0.34–0.88], p = 0.013) than those with LC-Proximal DVT. Similar results were observed at the 1-year follow-up. However, adjusted risks for PE (HR = 0.74 [0.29–1.92], p = 0.540; HR = 0.87 [0.42–1.78], p = 0.700) and VTE recurrence (HR = 0.96 (0.54–1.71), p = 0.890; HR = 0.99 [0.63–1.56], p = 0.970) at 90-day and 1-year were not significantly different between patients with AVT and those with LC-Proximal DVT. Among patients with LC-iDDVT, those receiving anticoagulation had reduced risks of VTE recurrence (HR = 0.57 [0.35–0.95], p = 0.030) and DVT deterioration (HR = 0.28 [0.13–0.60], p = 0.001) compared to those without anticoagulation. Moreover, AVT patients on >3 months of anticoagulation had a lower VTE recurrence risk (HR = 0.23 [0.03–0.92], p = 0.038) than those on ≤3 months of anticoagulation. ConclusionIn the context of lung cancer, patients with AVT may have a higher tendency for recurrent thrombosis compared to those with MVT, especially if anticoagulation is refused or given briefly.

Real-World Safety of Prostate Cancer Focal Therapy: MAUDE Database Analysis.

Objective: The aim of this study was to assess the real-world safety profile of medical devices used in focal prostate cancer treatment utilizing the Manufacturer and User Facility Device Experience (MAUDE) database. Methods: The MAUDE database was searched for reports on high-intensity focused ultrasound (HIFU), cryoablation, laser ablation, and irreversible electroporation (IRE) devices used in prostate cancer treatment from 1993 to 2023. Adverse events were identified and categorized. Results: We identified 175 reports for HIFU, 1362 for cryoablation, 615 for laser ablation, and 135 for IRE devices, with 28, 284, 126, and 2 respective reports, directly related to prostate cancer treatment. The aggregated data revealed the majority of complications were minor, with 82.5% (n = 363 out of 440 total complications) classified as Clavien-Dindo grade 1 or 2. Common minor complications included erectile dysfunction and urinary retention. Severe complications such as rectal fistulas were noted in HIFU and IRE treatments, along with singular mortality due to pulmonary embolism in cryoablation. Conclusions: Our analyses from MAUDE reveal that devices used in focal therapy for prostate cancer are predominantly associated with minor complications, underscoring their overall real-world safety profile. However, the occurrence of severe adverse events emphasizes the critical importance of rigorous patient selection and meticulous procedural planning. These findings provide valuable insights into the safety profile of focal therapy devices and contribute to the growing body of evidence on their use in prostate cancer treatment.

44 Spotting the clotting: a 3-year national surveillance study of paediatric pulmonary thromboembolism

Abstract Background Pulmonary thromboembolism (PE) is a rare event in the paediatric population but can be acutely life-threatening and result in chronic complications. Awareness of contemporary patterns of clinical presentation, diagnostic modalities, and management may aid clinicians in ensuring that patients are promptly identified and treated. Objectives To describe the risk factors, symptoms, diagnostic modalities, therapeutic interventions, and short-term outcomes in paediatric patients (neonate up to 18 years) with PE through national surveillance. Design/Methods Between January 2020 and December 2022, monthly surveillance was conducted with over 2,800 paediatricians and sub-specialists through the Canadian Paediatric Surveillance Program. Voluntary reporting of cases meeting a standardized definition of PE was followed up with a detailed questionnaire. Results 58 confirmed cases were reported; 33 (57%) were females age 15 to 18 years. Detailed information was available for 31 (53%) of 58 cases. At least 1 risk factor was identified in 28 (90%) cases and 12 (39%) patients had 2 or more risk factors. The most common risk factors were oral contraceptive use (n=10 of 31; 32%) and obesity (n=9 of 31; 29%). Presentation was symptomatic in 28 (90%) cases; 24 (77%) patients presented with 2 or more symptoms. The most common symptoms were chest pain (n=18; 58%), dyspnea (n=13; 42%) and tachycardia (n=13; 42%). The most common diagnostic modality utilized was computed tomography pulmonary angiography (n=25; 81%). Initiation of systemic anticoagulation was reported for 24 (77%) of 31 cases; thrombolysis and surgical interventions were uncommon (&amp;lt; 5 cases). Treatment complications were common (n=8; 29%). Mortality was reported, but in fewer than 5 cases. Conclusion PE in children often presents with non-specific symptoms, but usually occurs in patients with known risk factors. Clinicians should maintain a high index of suspicion in symptomatic patients, particularly those with risk factors and in cases when other diagnoses that may explain symptoms have been excluded. Anticoagulation is the mainstay of treatment; complications can occur. Prompt recognition and management presumably reduce morbidity and mortality, but this cannot be inferred from our data.

Procoagulant platelet activation promotes venous thrombosis.

Platelets are key players in cardiovascular disease and platelet aggregation represents a central pharmacological target, particularly in secondary prevention. However, inhibition of adenosine diphosphate and thromboxane signaling has low efficacy in preventing venous thromboembolism, necessitating the inhibition of the plasmatic coagulation cascade in this disease entity. Anticoagulation carries a significantly higher risk of bleeding complications, highlighting the need of alternative therapeutic approaches. We hypothesized that procoagulant activation (PA) of platelets promotes venous thrombus formation and that targeting PA could alleviate venous thrombosis. Here, we found elevated levels of procoagulant platelets in the circulation and in thrombi of patients with deep vein thrombosis (DVT) and pulmonary embolism, and in mice developing DVT following inferior vena cava stenosis. Further, we detected procoagulant activation of recruited platelets within murine venous thrombi and human pulmonary emboli. Mice with platelet-specific deficiency in central pathways of procoagulant activation – cyclophilin D and transmembrane protein 16F – were more resistant towards low flow-induced venous thrombosis. Finally, we found that a clinically approved carbonic anhydrase inhibitor, methazolamide, reduced platelet procoagulant activity and alleviated murine thrombus formation without affecting trauma-associated hemostasis. These findings identify an essential role of platelet procoagulant function in venous thrombosis and delineate novel pharmacological strategies targeting platelets in the prevention of venous thromboembolism.

The Role of Screening for Venous Thromboembolism in Pelvic Trauma Patients: A Single-Centre Retrospective Study

Background: Venous thromboembolism (VTE) is a severe complication following pelvic trauma. Thromboprophylaxis has reduced the risk of VTE in the pelvic trauma population; nevertheless, the risk remains high. A substantial pulmonary embolism has emerged as the unexpected cause of death among patients presenting with ‘minor pelvic fractures’. The purpose of this study was to analyse the single-centre experience with a surveillance protocol. We hypothesised that DVT surveillance with VUS and CTPA may reduce the perioperative mortality–morbidity rate in the subpopulation of patients with pelvic or acetabular fractures. Methods: This is a retrospective analysis of patients admitted with pelvic or acetabular fractures between January 2001 and December 2021. In April 2013, a screening protocol for VTE was introduced. This protocol included venous ultrasound and CTPA for patients with chest injuries. Patients from two groups—one screened for VTE and one without screening—were compared. Results: Of the 3186 patients with pelvic and/or acetabular fractures who were admitted, 1975 were not screened for VTE and 1211 underwent screening. There were more VTE cases in the screening group (5.62% vs. 0.86%, p &lt; 0.001). Nine (0.46%) cases of sudden death occurred in the non-screening group, and all of them died with symptoms of acute PE. Since the screening was introduced, we have not encountered any deaths in the perioperative period (0.46 vs. 0, p = 0.02). Conclusions: The combined use of VUS and CTPA in chest-injured patients is a trustworthy means of screening for VTE, resulting in decreased mortality rates for those with pelvic and acetabular fractures by accurately diagnosing VTE during the perioperative phase.

Comparison of arthroscopic-assisted mini open and all arthroscopic repair methods in small to large size rotator cuff tears

Aim: This study aimed to compare the functional and clinical results of all arthroscopic (AA) and arthroscopic-assisted mini open (AAMO) rotator cuff tear (RCT) repair methods with a minimum 2 years follow-up. Methods: In this retrospective study, patients who operated with the AA repair method were included in group 1 and patients who operated with AAMO RCT repair method were included in group 2. Between January 2018 and June 2021. All patients were evaluated with shoulder range of motion (ROM), the Disabilities of the Arm, Shoulder and Hand (DASH), Constant Murley Score (CMS) and visual analog scale (VAS) pain score preoperatively and postoperatively. Postoperative evaluation was made on the 3rd, 6th, 12th, and 24th months. In addition, the length of hospital stay, and surgery time were evaluated. Results: Eighty patients (48 female, 32 male) were included in group 1, who were treated with the AA technique. Sixty-seven patients (28 male, 39 female) were included in group 2, who were treated with the AAMO technique. The average follow-up time was 29,36 ±3,48 months for group 1, 28,12±2,87 months for group 2. No significant difference was detected between group 1 and group 2 for length of hospital stay and follow-up time (p&gt;0,05). At the postoperative 3rd-month follow-up measurements, a statistically significant difference was determined between group 1 and group 2 for abduction, flexion measurements, VAS score, and DASH score (p=0,03, p=0,04, p=0,02, p=0,01 respectively). At the 24th month postoperative follow-up, statistically no significant difference was determined between groups 1 and 2 in terms of ROM, VAS, and functional scores. Conclusion: In the early recovery period, AA repair provides better ROM, DASH, and VAS scores. However, in long-term follow-up, no significant difference was detected in AA and AAMO repair in terms of functional results, ROM, and VAS scores.

Contribution of an Artificial Intelligence Tool in the Detection of Incidental Pulmonary Embolism on Oncology Assessment Scans

Introduction: The incidence of venous thromboembolism is estimated to be around 3% of cancer patients. However, a majority of incidental pulmonary embolism (iPE) can be overlooked by radiologists in asymptomatic patients, performing CT scans for disease surveillance, which may significantly impact the patient’s health and management. Routine imaging in oncology is usually reviewed with delayed hours after the acquisition of images. Nevertheless, the advent of AI in radiology could reduce the risk of the diagnostic delay of iPE by an optimal triage immediately at the acquisition console. This study aimed to determine the accuracy rate of an AI algorithm (CINA-iPE) in detecting iPE and the duration until the management of cancer patients in our center, in addition to describing the characteristics of patients with a confirmed pulmonary embolism (PE). Materials and Methods: This is a retrospective analysis of the role of Avicenna’s CE-certified and FDA-cleared CINA-iPE algorithm in oncology patients treated at Gustave Roussy Cancer Campus. The results obtained from the AI algorithm were compared with the attending radiologist’s report and were analyzed by both a radiology resident and a senior radiologist. In case of any discordant results, the reason for this discrepancy was further investigated. The duration between the exact time of the CT scan and analysis was assessed, as well as the duration from the result’s report and the start of active management. Results: Out of 3047 patients, 104 alerts were detected for iPE (prevalence of 1.3%), while 2942 had negative findings. In total, 36 of the 104 patients had confirmed PE, while 68 alerts were false positives. Only one patient reported as negative by the AI tool was deemed to have a PE by the radiologist. The sensitivity and specificity of the AI model were 97.3% and 97.74%, while the PPV and NPV were 34.62% and 99.97%, respectively. Most causes of FP were artifacts (22 cases, 32.3%) and lymph nodes (11 cases, 16.2%). Seven patients experienced delayed diagnosis, requiring them to return to the ER for treatment after being sent home following their scan. The remaining patients received prompt care immediately after their testing, with a mean delay time of 8.13 h. Conclusions: The addition of an AI system for the detection of unsuspected PEs on chest CT scans in routine oncology care demonstrated a promising efficacy in comparison to human performance. Despite a low prevalence, the sensitivity and specificity of the AI tool reached 97.3% and 97.7%, respectively, with detection of all the reported clinical PEs, except one single case. This study describes the potential synergy between AI and radiologists for an optimal diagnosis of iPE in routine clinical cancer care. Clinical relevance statement: In the oncology field, iPEs are common, with an increased risk of morbidity when missed with a delayed diagnosis. With the assistance of a reliable AI tool, the radiologist can focus on the challenging analysis of oncology results while dealing with urgent diagnosis such as PE by sending the patient straight to the ER (Emergency Room) for prompt treatment.

Safety and outcomes with use of FlowTriever for mechanical thrombectomy i n acute pulmonary embolism

Objectives: Mortality in the pulmonary embolism (PE) risk categories has historically been reported between 30% and 40% in high-risk and &lt;15% in intermediate-risk group. In those who survive, there is a high rate of morbidity with dyspnea and exercise intolerance. Advanced therapies with a favorable safety profile have the potential to improve outcomes. We present the largest single-center data set studied to-date for safety, mortality, and outcomes post-mechanical thrombectomy including functional assessment 3 months post-discharge. Material and Methods: We analyzed retrospective database of patients with PE undergoing catheter directed mechanical thrombectomy (CDMT). We report clinical characteristics and outcomes stratified by PE risk categories. Comparison in the groups has been made using analysis of variance method. Results: A total of 365 patients were evaluated in the CDMT group. Among these 81 (22%) presented with high-risk and 261 (71%) with intermediate-risk PE. The average age at diagnosis was 61 ± 17 years with male-to-female distribution ratio of 1.2. Most common risk factors being reduced mobility (18%), malignancy (15%), recent surgery (13%), and hormonal therapy (12%). Mortality within 30 days of PE diagnosis was 8.6% (7/81) in high-risk, 1.7% (4/230) in intermediate-high-risk groups. There were no deaths in intermediate-low and low-risk group post-CDMT. Before thrombectomy, 349 (95%) patients had right heart strain, 307 (84%) had elevated troponin, and 197 (54%) had elevated B-type natriuretic peptide. Post-procedure echocardiogram at 3 month revealed improvement in the right ventricular (RV) fractional area change (27.53 ± 10.38% to 39.73 ± 8.3%, P &lt; 0.01), tricuspid annular plane systolic excursion (10.9 ± 8.3 mm to 21.81 ± 4.75 mm), and RV systolic pressure (43.96 ± 14.48 mmHg to 28.47 ± 7.88 mmHg, P &lt; 0.01). At 3 months post-thrombectomy, the majority (74%) of the patients fell into non-to-negligible functional limitation. Conclusion: We present a descriptive analysis of outcomes including improved mortality, and functional assessment of patients undergoing CDMT.

Case Report: Right Atrial Thrombus with Pulmonary Embolism - Effect of Timely Medical Treatment

Case Report: Right Atrial Thrombus with Pulmonary Embolism - Effect of Timely Medical Treatment

Development of the Pulmonary Embolism Progression (PEP) score for predicting short-term clinical deterioration in intermediate-risk pulmonary embolism: a single-center retrospective study.

Accurate risk stratification in acute intermediate-risk pulmonary embolism (PE) is essential. Current prediction scores lack the ability to forecast impending clinical decline. The Pulmonary Embolism Progression (PEP) score aims to predict short-term clinical deterioration (respiratory failure or hemodynamic instability within 72h) in patients with intermediate-risk PE. This single-center retrospective cohort study analyzed patients with intermediate PE. The outcome of interest was respiratory failure or hemodynamic instability within 72h. A multivariate logistic regression identified five predictive variables for the final PEP score: use of > 4L/min of supplemental oxygen above baseline, lactate > 2.0 mmol/L, high-sensitivity cardiac troponin T (hs-cTnT) > 40 ng/L, tricuspid annular plane systolic excursion (TAPSE) < 13mm, and the combination of central and subsegmental clot. The derivation cohort included 117 patients, and the validation cohort included 70 patients. The area under the receiver operating characteristic (AUROC) curve for the derivation cohort was 0.8671 (95% CI: 0.7946, 0.9292), and for the validation cohort, it was 0.9264 (95% CI: 0.8680, 0.9847). A PEP score of 4 points yielded the highest combination of sensitivity (93%) and specificity (65%). Each incremental point increase in the PEP score raised the probability of clinical deterioration by a factor of 1.933. The PEP score is a reliable tool for predicting the likelihood of clinical deterioration in intermediate-risk PE patients within 72h, potentially aiding in timely clinical decision-making and improving patient outcomes.

Pharmacological Thromboprophylaxis Effectiveness in Low-Risk Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial

Background: There is a paucity of evidence and controversies regarding prophylaxis strategies in low-risk patients undergoing knee arthroscopy. This study aims to evaluate the effectiveness and safety of aspirin and low-molecular-weight heparin (LMWH) in an arthroscopic anterior cruciate ligament (ACL) reconstruction for low-risk patients. Methods: We performed a preoperational evaluation a week before surgery for any sign of pulmonary embolism (PE) and deep vein thrombosis (DVT). For this purpose, we used single limited compression Doppler ultrasonography (CUS) of the lower extremities. Rehabilitation started before the time of the surgery to improve the range of motion (ROM) and quadriceps muscle function. A team of 3 orthopedists performed the procedures. The same surgical technique and graft were used with spinal anesthesia, and operation time was recorded. Results: The mean age of participants was 31.4 ± 5.6 years, with 93 individuals (67%) being men and 23% women. No cases of DVT or PE were observed. Three cases in the LMWH group and one case in the aspirin group experienced minor surgical site bleeding. One case of hemarthrosis with normal ultrasonography occurred in the LMWH group. Regarding safety and effectiveness, there was no statistically significant difference between the parallel arms. Conclusion: The use of LMWH or aspirin after simple arthroscopic ACL reconstruction in low-risk patients showed no difference in effectiveness. Hence, the routine use of thromboprophylaxis in this setting is questionable although adverse events are rare

Association Between White Blood Cell Counts at Diagnosis and Clinical Outcomes in Venous Thromboembolism - From the COMMAND VTE Registry-2.

White blood cell (WBC) counts were reported to be a risk factor for acute adverse events in patients with venous thromboembolism (VTE). However, there are limited data on VTE patients without active cancer. The COMMAND VTE Registry-2 was a multicenter study enrolling 5,197 consecutive patients with acute symptomatic VTE. We divided 3,668 patients without active cancer into 4 groups based on WBC count quartiles (Q1-Q4) at diagnosis: Q1, ≤5,899 cells/μL; Q2, 5,900-7,599 cells/μL, Q3, 7,600-9,829 cells/μL; and Q4, ≥9,830 cells/μL. Patients in Q4 more often presented with pulmonary embolism (PE) than patients in Q1, Q2, and Q3 (68% vs. 37%, 53%, and 61%, respectively; P<0.001). The proportion of massive PEs among all PEs was higher in Q4 than in Q1, Q2, and Q3 (21% vs. 3.4%, 5.8%, and 11%, respectively; P<0.001). Compared with Q1, Q2, and Q3, patients in Q4 had a higher cumulative 5-year incidence of all-cause death (17.0%, 15.2%, 16.1%, and 22.8%, respectively; P<0.001) and major bleeding (10.9%, 11.0%, 10.3%, and 14.4%, respectively; P=0.002). The higher mortality risk of Q4 relative to Q2 was consistent regardless of the presentations of VTEs. An elevated WBC count on VTE diagnosis was associated with a higher risk of mortality and major bleeding regardless of VTE presentation, suggesting the potential usefulness of WBC counts for further risk stratification.

Incidence of Chronic Thromboembolic Pulmonary Hypertension After Pulmonary Embolism in the Era of Direct Oral Anticoagulants: From the COMMAND VTE Registry-2.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening complication post-acute pulmonary embolism (PE). The assessment of CTEPH incidence and risk factors post-acute PE in the era of direct oral anticoagulants remains insufficient. The COMMAND VTE Registry-2 (contemporary management and outcomes in patients with venous thromboembolism registry-2) is a multicenter registry that recruited consecutive patients with acute symptomatic venous thromboembolism from 31 centers across Japan. The primary outcome was to demonstrate the detection rate of CTEPH after acute PE in routine clinical practice. Out of the 5197 patients with venous thromboembolism included in the COMMAND VTE Registry-2, 2787 were diagnosed with acute PE. Following a median follow-up duration of 747 days, 48 cases of CTEPH were detected, and the cumulative diagnosis of CTEPH in routine clinical practice was 2.3% at 3 years. Independent risk factors for the detection of CTEPH by multivariable Cox regression analysis included women (hazard ratio [HR] 2.09 [95% CI, 1.05-4.14]), longer interval from symptom onset to diagnosis of PE (each 1 day, HR 1.04 [95% CI, 1.01-1.07]), hypoxemia at diagnosis (HR 2.52 [95% CI, 1.26-5.04]), right heart load (HR 9.28 [95% CI, 3.19-27.00]), lower D-dimer value (each 1 μg/mL, HR 0.96 [95% CI, 0.92-0.99]), and unprovoked PE (HR 2.77 [95% CI, 1.22-6.30]). In the direct oral anticoagulant era, the cumulative diagnosis of CTEPH after acute PE was 2.3% at 3 years, and several independent risk factors for CTEPH were identified, which could be useful for screening a high-risk population after acute PE.

ELEVATED TROPONIN OF NON-CORONARY ETIOLOGY A REVIEW

Elevated troponin levels are traditionally associated with acute myocardial infarction (AMI) and are widely used as a specific marker for the diagnosis of ischemic myocardial injury. However, recent studies have shown that elevated troponin levels can occur in several non-coronary conditions, requiring a more careful diagnostic approach to avoid misinterpretations and inadequate management. This study aimed to perform a systematic review of the literature on the non-coronary causes of elevated troponin levels, seeking to identify the main associated clinical conditions and discuss their prognostic value in different contexts. To this end, a systematic review of articles published between 2014 and 2024 was conducted using the PubMed, Scopus and Web of Science databases. The results revealed that conditions such as sepsis, pulmonary embolism (PE), chronic renal failure (CRF), chronic obstructive pulmonary disease (COPD) and tachyarrhythmias are the main non-coronary causes of elevated troponin levels. It is concluded that elevated troponin levels of non-coronary etiology are an important marker of severity and poor prognosis in several systemic conditions. Troponin levels should be interpreted carefully, taking into account the clinical context and underlying conditions of each patient.

Paroxysmal sympathetic hyperactivity syndrome after recurrent stroke: A case report

Paroxysmal sympathetic hyperactivity (PSH) is a state of autonomic dysfunction characterized by symptoms such as tachypnea, tachycardia, hypertension, hyperthermia, sweating, and dystonia. It can occur after traumatic brain injury, hypoxic-ischemic encephalopathy, and diseases such as stroke. Hypoxia, extensive axonal damage, and young age are believed to predispose to the development of PSH. These patients may be diagnosed with pulmonary embolism, septicemia, or epileptic seizures. Delays in diagnosis prolong hospital stay. Here, we present an 81-year-old man who developed PSH after a recurrent stroke and our management.

Enhanced complement consumption and histone H3 citrullination predict disease severity and early mortality risk in non-high-risk pulmonary embolism.

Enhanced complement consumption and histone H3 citrullination predict disease severity and early mortality risk in non-high-risk pulmonary embolism.

Pseudomyxoma Peritonei Lesion of the Thoracic Spine: A Case Report and Literature Review

Background: Pseudomyxoma peritonei (PMP) is a rare condition, with no previously described location in the spine. Here is presented a case of PMP extension to the thorax and then the spine, treated with two-level vertebrectomy, laminectomy, and posterior fusion. Case Report: We report here the case of a 64-year-old man presenting pathological fractures of T6 and T7 due to PMP extension to the pleural cavity and thoracic spine. He presented interscapular pain with mild spinal cord compression symptoms. He was treated by achieving T5-T8 laminectomy, T2-T10 pedicle fixation, and T6-T7 vertebrectomy. The postoperative course was uneventful apart from a pulmonary embolism (PE) with favorable evolution under anticoagulants. Conclusion: To achieve spinal cord decompression, kyphosis correction, and spine stabilization, a two-level vertebrectomy, laminectomy, and posterior fusion would be beneficial for a PMP lesion of the thoracic spine.

Eosinophilic granulomatosis with polyangiitis associated with malignant arrhythmias: a case report

Abstract Background Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare vasculitis associated with significant cardiac morbidity and mortality. This case report presents the diagnostic and management challenges of EGPA-related arrhythmias in a remote general hospital setting. Case summary A 64-year-old Caucasian male presented with an indolent prodrome of fatigue, shortness of breath and anorexia, that culminated in an acute presentation with pulmonary embolism. His complicated clinical course included intracranial haemorrhage and refractory ventricular arrhythmias. Eosinophilia and subendocardial hypoattenuation observed on chest computed tomography were key findings that led to the diagnosis of EGPA. Multiple antiarrhythmic therapies were required as temporary measures whilst control of the underlying eosinophilic inflammation was achieved. Once stable, the patient was transferred to a tertiary cardiac centre for further investigation and cardioverter-defibrillator implantation. With EGPA now well controlled, he has experienced no further ventricular arrhythmias and has fully recovered. Conclusion Cardiac complications of EGPA, including ventricular arrhythmias, are difficult to manage without concurrent immunosuppression, which may itself further destabilise cardiac electrophysiology. The role of multiple imaging modalities in the diagnosis and monitoring of EGPA is emphasised, with cardiac magnetic resonance imaging playing a crucial role in detecting subendocardial fibrosis.

Beyond the Heart: The Predictive Role of Coronary Artery Calcium Scoring in Non-Cardiovascular Disease Risk Stratification

Coronary artery calcium scoring (CACS), a non-invasive measure of coronary atherosclerosis, has significantly enhanced cardiovascular (CV) risk assessment and stratification in asymptomatic individuals. More recently, a higher score for CAC has been associated with an increased risk of non-CV diseases and all-cause mortality. This review consolidated evidence supporting the role of CAC in assessing non-CV diseases, emphasizing its potential in early diagnosis and prognosis. We observed a strong association between CACS and non-CV diseases, viz., chronic obstructive pulmonary disease, pulmonary embolism, pneumonia, diabetes, chronic kidney disease, osteoporosis, metabolic dysfunction-associated steatotic liver disease, nephrolithiasis, stroke, dementia, malignancies, and several autoimmune diseases. Also, CAC may aid in evaluating the risk of CV conditions developing secondary to the non-CV diseases mentioned earlier. Further evidence from prospective studies, intervention trials, and population-based behavioral studies is needed to establish CAC cutoff values and explore preventative care applications, facilitating their broader integration into healthcare practices.