Pulmonary Embolism In Adults Research Articles

Incidence and Treatment Options for Massive Pulmonary Embolism in Sweden

Swedish Healthcare is organised by relatively independent counties which are responsible for the appropriateness of delivered care. As a consequence, few formal guidelines are issued by national authorities or professional societies, which is the case for the treatment of pulmonary embolism (PE). The yearly incidence of PE in Swedish adults was 86/100,000 in 2011, corresponding to approximately 6000 cases with an overall mortality of 6.5%. Acute massive PE with circulatory shock carries mortality up to 50% but its true incidence in Sweden is not known. First-line treatment is intravenous thrombolysis but non-pharmacological alternatives for cases where thrombolysis has no effect or is contraindicated have recently undergone technical development. This includes catheter fragmentation, surgical embolectomy and extracorporeal circulatory support, which may be used as a bridge to further treatment in very unstable patients. This article summarises the treatment options for acute massive PE and their rationale as seen from a Swedish perspective.

A Case of Acute Pulmonary Embolism Associated with Dysplasminogenemia

The incidence of pulmonary embolism (PE) rises markedly with age, and only a few cases have been reported in younger adults. Thrombophilia has been reported as one of the predisposing factors for PE in younger adults. Here we report an extraordinary case of PE complicated with dysplasminogenemia, a rare genetic disorder resulting in hypercoagulability, in a young male. An 18-yr-old male visited an emergency room in the United States complaining chest discomfort. He was diagnosed as PE with deep vein thrombosis without apparent risk factors. Anticoagulation therapy with warfarin had been initiated and discontinued after 6 months of treatment. After returning to Korea he was tested for thrombophilia which revealed decreased activity of plasminogen and subsequent analysis of PLG gene showed heterozygous Ala620Thr mutation. He was diagnosed with PE complicated with dysplasminogenemia. Life-long anticoagulation therapy was initiated. He is currently under follow-up without clinical events for 2 yr.

Pulmonary Embolism in Patients with CKD and ESRD

CKD and ESRD are growing burdens. It is unclear whether these conditions affect pulmonary embolism (PE) risk, given that they affect both procoagulant and anticoagulant factors. This study examined the frequency and associated outcomes of PE in CKD and ESRD. The Healthcare Cost and Utilization Project's Nationwide Inpatient Sample was used to estimate the frequency and outcomes of PE in adults with CKD and ESRD. Hospitalizations for the principal diagnosis of PE and presence of CKD or ESRD were identified using International Classification of Diseases, Ninth Revision codes. Data from the annual US Census and US Renal Data System reports were used to calculate the number of adults with CKD, ESRD, and normal kidney function (NKF) as well as the annual incidence of PE in each group. Logistic regression modeling was used to compare in-hospital mortality among persons admitted for PE who had ESRD or CKD to those without these conditions. The annual frequency of PE was 527 per 100,000, 204 per 100,000, and 66 per 100,000 persons with ESRD, CKD, and NKF, respectively. In-hospital mortality was higher for persons with ESRD and CKD (P<0.001) compared with persons with NKF. Median length of stay was longer by 1 day in CKD and 2 days in ESRD than among those with NKF. Persons with CKD and ESRD are more likely to have PE than persons with NKF. Once they have PE, they are more likely to die in the hospital.

The Association of Septic Thrombophlebitis with Septic Pulmonary Embolism in Adults

Background: There have been an increasing number of pediatric reports of septic pulmonary embolism in the setting of septic thrombophlebitis adjacent to a primary infectious source.Methods: Retrospective review at an urban hospital. A total of five adults with a documented primary infectious source, adjacent septic thrombophlebitis and septic pulmonary embolism were identified between 2000 and 2011.Results: The predominant symptoms on presentation were fever and pleuritic chest pain, followed by chills and cough. S. aureus was the pathogen in 4 patients. Only one case had echocardiographic evidence of endocarditis. All patients received IV antibiotics and anticoagulation therapy. No new embolic events or central nervous system complications were noted.Conclusions: The triad of extrapulmonary infection, contiguous septic thrombophlebitis and septic pulmonary embolism is present in adult as well as pediatric populations. The use of systemic anticoagulation with appropriate antibiotics resulted in clinical and radiologic improvement but no significant complications.

Pulmonary Embolism in Children

Pulmonary embolism (PE) has long been described in children. Nevertheless, most of the algorithms applied to patients within this age range, from diagnosis to therapy, have been adapted from adult protocols. This article reviews the progresses that occurred to PE in children placing them in historical perspective with the key events relevant to PE in adults. A brief summary of the initial reports encountered in the pediatric literature followed by key conclusions drawn from national database reports characterizing its epidemiology in children is highlighted. Additionally, a section with the diagnostic tools pertaining to children is included. Closing remarks encompass commentaries related to therapy and outcomes, reflecting on current knowledge gaps related to PE in children.

MDCT evaluation of pulmonary embolism in children and young adults following a lateral tunnel Fontan procedure: optimizing contrast-enhancement techniques

Pulmonary embolism (PE) is a life-threatening thromboembolic complication in patients who have undergone a Fontan procedure for augmenting pulmonary blood flow in the setting of single-ventricle physiology. In patients following a Fontan procedure, lack of proper contrast agent mixing in the right atrium and sluggish, low-velocity blood flow within the Fontan circulation often results in suboptimal contrast enhancement within the pulmonary artery for evaluating PE. Unfortunately, there is a paucity of information describing the optimal contrast-enhancement technique with multidetector CT (MDCT) for evaluating PE in children and young adults following a Fontan procedure. We illustrate the MDCT imaging findings of suboptimal contrast enhancement within the pulmonary artery, which can be mistaken for PE, in patients following a lateral Fontan procedure, and we discuss MDCT techniques to optimize contrast enhancement within the pulmonary artery in these patients for evaluating PE. The MDCT imaging findings in pediatric and young adult patients following a lateral Fontan procedure and with clinically suspected PE are illustrated. We describe intravenous contrast agent injection techniques that can be used to optimize the contrast enhancement in the pulmonary artery in patients following a lateral Fontan procedure. The use of a suboptimal contrast-enhancement technique led to initial misdiagnosis and incomplete evaluation of PE in the three patients following a lateral Fontan procedure. Imaging in two patients showed that optimal evaluation of thrombosis in the Fontan pathway and PE in the pulmonary arteries can be successfully achieved with simultaneous upper- and lower-limb injections of contrast agent. This series demonstrates that suboptimal contrast enhancement can result in misdiagnosis or incomplete evaluation of PE in children and young adults following a lateral Fontan procedure. Careful attention to optimizing contrast enhancement during MDCT examination for evaluation of PE in these patients is essential to prevent misdiagnosis and incomplete evaluation.

Role of Screening Tests for Deep Venous Thrombosis in Asymptomatic Adults With Acute Spinal Cord Injury

Systematic review. To examine the evidence to support practice guidelines for screening for DVT in asymptomatic adults with acute traumatic spinal cord injury (SCI) who undergo pharmacologic thromboprophylaxis. Despite the fact that pharmacologic thromboprophylaxis has been widely used since the 1980s, deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) still account for approximately 10% of deaths during the first year following SCI. MEDLINE and EMBASE were searched from the earliest achievable date to December 2005. We only included clinical studies that used a screening test for DVT and the gold standard diagnostic tests for DVT (i.e., lower limb venography) and for PE (i.e., lung arteriogram) in adults with traumatic SCI who underwent drug thromboprophylaxis during the acute stage after SCI. The search yielded 188 articles, of which 9 articles fulfilled the criteria to be included in our review. Screening for DVT was performed in 3 randomized clinical trials and 6 case series. The protocol of these studies included the use of D-Dimer (1 of 9), I-labeled fibrinogen (2 of 9), ultrasound (1 of 9), impedance plethysmography (1 of 9), impedance plethysmography and Doppler in combination (1 of 9), Duplex (1 of 9) or venography (2 of 9) as screening test for DVT. Based on the pooled data of these studies, asymptomatic DVT was detected in 16.9% of SCI population. Only 4 studies reported the occurrence of PE in 4.4% of cases. There is insufficient evidence to support (or refute) a recommendation for routine screening for DVT in adults with acute traumatic SCI under thromboprophylaxis. However, there is level II-2 evidence that screening could detect asymptomatic DVT in 22.7% of those individuals. Although additional investigation is needed, we hypothesize that weekly screening for DVT during the first 13 weeks post-SCI could detect most of the asymptomatic DVT events in this patient population. D-Dimer, ultrasound, and MR venography could be considered as potentially useful screening tests for DVT in the SCI population in future research studies.

Pulmonary embolism and deep venous thrombosis in hospitalized adults with chronic obstructive pulmonary disease

Hospitalized patients with exacerbations of chronic obstructive pulmonary disease (COPD), when routinely evaluated for pulmonary embolism (PE), show PE in 25-29% of cases. We assessed the rate of diagnosis of PE and deep venous thrombosis (DVT) in hospitalized patients with COPD and the influence of age on relative risk compared with hospitalized patients who do not have COPD. A retrospective evaluation of data in hospitalized adults with and without COPD from the National Hospital Discharge Survey. From 1979 to 2003, 58,392,000 adults 20 years of age and older, were hospitalized with COPD in the United States. Among these patients, PE was diagnosed in 381,000 (0.65%) and DVT in 632,000 (1.08%). The relative risk of PE in adults hospitalized with COPD was 1.92 and for DVT it was 1.30. Relative risks were age dependent. Among those aged 20-39 years with COPD, the relative risk of PE was 5.34. Among patients aged 40-59 years, the relative risk of PE decreased to 2.02, and among patients aged 60-79 years the relative risk of PE was 1.23. These data, when compared with the rate of diagnosis of PE in hospitalized patients with exacerbations of COPD, all of whom were evaluated for PE, indicate that PE in patients with COPD is generally underdiagnosed. In young adults, other risk factors in combination with COPD are uncommon, so the contribution of COPD to the risk of PE becomes more apparent than in older patients.