Presentation Of Pulmonary Embolism Research Articles

Clinical Outcome of Orthopaedic Patients with Negative Lower Limb Venography at Discharge

Pharmacological prophylaxis for postoperative venous thromboembolism is generally restricted to the hospital stay. A high incidence of deep vein thrombosis (DVT) and pulmonary embolism presenting after hospital discharge has been reported and thus it has been claimed that pharmacological prophylaxis should be continued after discharge. The aim of this study was to perform a prospective survey to assess the prevalence of clinically overt thromboembolic events in hip surgery patients discharged with a negative venography without further pharmacological prophylaxis. We followed-up 213 patients with negative venography at discharge (105 elective hip replacement and 108 hip fracture patients). 186 patients (87.3%) were re-examined as outpatients one to two months after discharge. Five patients reported symptoms of DVT but the diagnosis was not confirmed by objective testing. The remaining 27 patients (12.7%) were followed up through their family doctor or by telephone call; in these patients the follow-up period ranged from 60 days to 2 years. Twenty-two patients (10.3%) were still alive and reported no signs or symptoms of venous thromboembolism. Three patients (1.4%) died for reasons not correlated with venous thromboembolism. Two patients could not be traced due to geographical inaccessibility; they were still alive after 1 year according to the records of their health care district. The results of our study suggest that in hip surgery patients with negative venography the prevalence of clinically overt thromboembolic events after hospital discharge ranges from 0 to 2.2% (95% C.I.). It is conceivable that the majority of late presenting postoperative DVT actually develop during the hospital stay and become symptomatic after hospital discharge.

Acute pulmonary embolism

Acute pulmonary embolism

Pulmonary Embolism in Children

Pulmonary embolism is an uncommon diagnosis in the pediatric patient, often discovered on autopsy. The mortality rate of untreated pulmonary embolism approaches 30%, and the best way to prevent death is by swift diagnosis and initiation of therapy. This article reviews the risk factors, clinical presentation, pathophysiology, diagnostic modalities, and treatment of pulmonary embolism in children.

Septic Pulmonary Embolism Due to Periodontal Disease

Three weeks following a toothache, a 56-year-old man developed cough, sputum, fever, and pleuritic chest pain. He had mild periodontal disease and his chest radiographs and chest computed tomographic (CT) scans showed multiple pulmonary nodules. The CT scan strongly suggested septic pulmonary embolism. Aspirated pus from one of the nodules yielded pure growth of Streptococcus intermedius. Lesions resolved with antimicrobial therapy. The usual predisposing factors for septic pulmonary embolism were absent, and, the isolation of S intermedius from the pus, the antecedent toothache, and periodontal disease all suggested the gingiva as the source. We hypothesize that periodontal infection led to bacteremia, seeding of the lungs, and multiple anaerobic pulmonary abscesses, akin to reported instances of infective endocarditis from dental foci without any prior dental procedures. To our knowledge, this presentation of septic pulmonary embolism is unprecedented.

Pulmonary Embolism Presenting as Supraventricular Tachycardia in Paraplegia: A Case Report

Supraventricular tachycardia as a presenting sign of pulmonary embolism is unusual. A 31-year-old man with incomplete T11 paraplegia on the basis of spinal cord ischemia developed supraventricular tachycardia 37 days after surgery to repair an aortic tear. Subsequent work-up revealed evidence of multiple submassive pulmonary emboli, despite thromboembolism prophylaxis. Clinicians should maintain a high index of suspicion for thromboembolic events when faced with cardiac rhythm disturbances in high-risk patients.

Pulmonary Embolism Presenting as Fever in Spinal Cord Injury Patients: Report of Two Cases and Review of the Literature

Pulmonary embolism is a common, sometimes fatal complication of spinal cord injury. We describe two quadriplegic patients who developed unexplained fever as the sole presenting sign of multiple pulmonary emboli during the subacute phase following injury. These cases and a review of the literature suggest that ventilation-perfusion scanning should be considered in the diagnostic evaluation of fever in patients with recent spinal cord injury even in the absence of other clinical signs of thromboembolic disease.

A Prospective Investigation of Pulmonary Embolism in Women and Men

Objective. —The aim of this study was to compare, in women and men suspected of pulmonary embolism, the frequency, risk factors, diagnosis, and presentation of pulmonary embolism as well as the accuracy of the ventilation/ perfusion scan (V/Q scan) as a diagnostic tool. Design. —Data were collected during a prospective study (the Prospective Investigation of Pulmonary Embolism Diagnosis) to establish the accuracy of the V/Q scan compared with pulmonary angiograms. Setting. —Six tertiary medical centers in Massachusetts, Michigan, Connecticut, Pennsylvania, and North Carolina. Participants. —Patients suspected of pulmonary embolism for whom a request was made for a V/Q scan or pulmonary angiogram (496 women and 406 men). Results. —Women 50 years old and under had a decreased frequency of pulmonary embolism compared with men of that age (16% vs 32%), but there was no difference in patients over 50 years old (Breslow-Day test, P P Conclusion. —Women 50 years old and under (even young women using oral contraceptives) who were suspected of having pulmonary emboli and were enrolled in the Prospective Investigation of Pulmonary Embolism Diagnosis study had a smaller frequency of pulmonary embolism than men of that age, The risk factors for pulmonary embolism were the same for women and men, except that women using oral contraceptives had an increased risk of pulmonary embolism following surgery. Although the V/Q scan was a useful tool in the preliminary evaluation for pulmonary embolism in these women, a pulmonary angiogram was often needed for accurate diagnosis. ( JAMA . 1992;268:1689-1696)

Focal Pulmonary Embolism Presenting as Diffuse Pulmonary Edema

We report the unique occurrence of bilateral pulmonary edema in a patient with a small focal pulmonary embolus without evidence of underlying cardiac or pulmonary disease. The most likely mechanism for this involves the release of humoral factors leading to extravasation of fluid across pulmonary capillary membranes. This case illustrates that pulmonary emboli should always be considered in the differential diagnosis of pulmonary edema.

A Prospective Investigation of Pulmonary Embolism in Women and Men

The aim of this study was to compare, in women and men suspected of pulmonary embolism, the frequency, risk factors, diagnosis, and presentation of pulmonary embolism as well as the accuracy of the ventilation/perfusion scan (V/Q scan) as a diagnostic tool. Data were collected during a prospective study (the Prospective Investigation of Pulmonary Embolism Diagnosis) to establish the accuracy of the V/Q scan compared with pulmonary angiograms. Six tertiary medical centers in Massachusetts, Michigan, Connecticut, Pennsylvania, and North Carolina. Patients suspected of pulmonary embolism for whom a request was made for a V/Q scan or pulmonary angiogram (496 women and 406 men). Women 50 years old and under had a decreased frequency of pulmonary embolism compared with men of that age (16% vs 32%), but there was no difference in patients over 50 years old (Breslow-Day test, P less than .01). Risk factors for pulmonary embolism, the usefulness of the V/Q scan, and 1-year mortality were not different for women and men. Estrogen use in women was not associated with an increased frequency of pulmonary embolism, except in women using oral contraceptives who had undergone surgery within 3 months; four of five (80%) had emboli compared with four of 28 (14%) age-matched surgical patients not using estrogens (P less than .01). Women 50 years old and under (even young women using oral contraceptives) who were suspected of having pulmonary emboli and were enrolled in the Prospective Investigation of Pulmonary Embolism Diagnosis study had a smaller frequency of pulmonary embolism than men of that age, The risk factors for pulmonary embolism were the same for women and men, except that women using oral contraceptives had an increased risk of pulmonary embolism following surgery. Although the V/Q scan was a useful tool in the preliminary evaluation for pulmonary embolism in these women, a pulmonary angiogram was often needed for accurate diagnosis.

MATTERS ARISING: Hinse and This reply:

<b>Background:</b> It has been speculated that the atypical clinical presentation of acute pulmonary embolism (PE) in older patients leads to a delay in diagnosis and therefore contributes to the worse prognosis of older patients presenting with acute PE. <b>Methods:</b> In this single-centre study we investigated the delay in diagnosis and its relation with in-hospital mortality in 202 consecutive patients with acute PE in a period of 14 months. The study population was divided in a younger (≤ 65 years) and an older age group (&gt; 65 years). <b>Results:</b> Older patients present more often hypoxic (p = 0.017) and with a history of syncope (p = 0.046) than younger patients. Delay in diagnosis was not statistically different in both age groups (3.1±3.0 days in the younger and 3.5±3.1 days in the older age group, p = 0.450). Age above 65 years was significantly associated with an increased risk for in-hospital mortality (OR 4.36, 95% CI 0.93-20.37, p = 0.043). Delay in diagnosis was not associated with an increase of in-hospital mortality in univariate or multivariate analysis. <b>Conclusions:</b> The atypical clinical presentation of acute PE in patients older than 65 years cannot be considered as a risk factor for late diagnosis. Moreover, delay in diagnosis is not related to the higher in-hospital death rate of older patients suffering from acute PE.

Chronic pulmonary embolism presenting with slowly progressing dyspnea and pulmonary artery dilation: Improvement after pulmonary thromboendarterectomy

Chronic pulmonary embolism presenting with slowly progressing dyspnea and pulmonary artery dilation: Improvement after pulmonary thromboendarterectomy

Extensive pulmonary embolism presenting as severe adult respiratory distress syndrome after surgical resection of a cornual pregnancy

A rare case of severe adult respiratory distress syndrome associated with a Po2 of 9 mm Hg after surgical resection of a cornual pregnancy at 10 weeks' gestation was treated successfully with positive end-expiratory pressure. The underlying cause, extensive pulmonary embolism, was subsequently revealed. The patient survived without residual brain damage. The possible causes of adult respiratory distress syndrome in pregnancy are discussed.

Pulmonary Embolism Presenting as Exercise-Induced Hypotension

A 68-year-old man with remote history of previous myocardial infarction presented with a four-week history of intermittent dyspnea. After developing hypotension during an exercise tolerance test, he underwent cardiac catheterization, revealing significant pulmonary hypertension and two-vessel coronary artery disease. Pulmonary angiography confirmed the presence of pulmonary emboli which partially resolved after thrombolytic therapy. Subsequent treadmill testing confirmed the absence of exercise-induced hypotension two months following treatment. This case underscores the importance of considering pulmonary embolism as a potential cause of exercise-induced hypotension, since it can be successfully treated with thrombolytic agents weeks after the initial onset of symptoms.

Atypical presentation of pulmonary embolism

Today we have discussed an interesting patient with an atypical presentation of pulmonary embolism. We have outlined a suggested algorithm to aid in the diagnosis and management of this disease. References 8 through 24 in the reference section are suggested readings that offer further insight into the diagnosis and management of this entity.

Defecation Syncope Caused by Pulmonary Embolism

Letters and Corrections1 July 1990Defecation Syncope Caused by Pulmonary EmbolismMarin H. Kollef, MD, David T. Schachter, MDMarin H. Kollef, MDSearch for more papers by this author, David T. Schachter, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-113-1-86_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors: Defecation syncope accounts for approximately 5% of all patients who present with syncope (1-4). Pulmonary embolism presenting with syncope is reported in 17% of patients (5). Pulmonary embolism as a cause of defecation syncope has not been well described in the medical literature. We report the cases of four patients with this entity who presented to us over a 12-month period.A 60-year-old man had a brain tumor surgically removed. On the sixteenth postoperative day after the completion of defecation, he lost consciousness, fell from the commode, and died. Autopsy showed a saddle embolus to be the...

Pulmonary fat embolism presenting as chronic respiratory failure

A patient is presented with progressive respiratory failure, caused by pulmonary fat embolism as proved by an open lung biopsy. Four and a half yrs earlier, she underwent a right hip operation. We surmise that a loosening hip prosthesis caused the marrow embolisation.

Autopsy proven pulmonary embolism among the institutionalized elderly.

The presentation of pulmonary embolism is variable in the elderly as in any age group. Common symptoms such as chest pain, dyspnea, and hemoptysis may be absent. Furthermore, precursors such as phlebitis, malignancy, and recent surgery often may be absent as well. Our intent was to examine the occurrence in a long-term care institution of pulmonary embolism at autopsy and the extent of missed antemortem diagnosis of this condition, and to compare patients with and without pulmonary embolism by chart and autopsy review. The incidence of pulmonary embolism in our study of elderly patients during a six-year period in a teaching nursing home was 12.8%. Although our series is small, consisting of 47 autopsies, our results are in accord with reports from other patient sites. Few autopsies are performed on nursing home patients and even fewer have been studied with regard to the occurrence and characteristics of pulmonary embolism in this population. The diagnosis remains difficult and uncertain, especially so in the elderly, because of the variability of presentation and association, the lesser pursuit of aggressive or invasive diagnostic methods, and the paucity of postmortem documentation.

Clinical and Hemodynamic Correlates in Pulmonary Embolism

The clinical presentation of pulmonary embolism may be dominated by manifestations of pulmonary infarction or by the signs and symptoms of an acute hemodynamic disturbance. Most often, some manifestation is present along with hemodynamic abnormalities, which may range from shock or cardiac arrest to tachycardia.

Diagnostic Considerations in Chest Wall Tenderness

To Editor. —In OctoberArchives, Dreyfuss and Weiland 1 described two patients with excruciating chest wall accompanying pulmonary embolism. Several statements in that article deserve comment. The authors said, We were unable to find additional documented cases. Later, they said that severe chest wall dominating clinical presentation of pulmonary embolism is finding not previously reported, to our knowledge. In 1942, however, McMillan 2 mentioned 18 patients who had the most extreme tenderness over areas of suspected pulmonary infarction. Autopsy in one of cases demonstrated an infarct of lung. At least four subsequent reports 3-6 have called attention to striking chest wall as a manifestation of pulmonary infarction. Dreyfuss and Weiland further stated that if no cause for is obvious, pulmonary embolism should be seriously considered. I contend that when cause is not obvious, many diagnostic considerations exist. Apart

Clinical and Hemodynamic Correlates in Pulmonary Embolism

The clinical presentation of pulmonary embolism may be dominated by manifestations of pulmonary infarction or by the signs and symptoms of an acute hemodynamic disturbance. Most often, some manifestation is present along with hemodynamic abnormalities, which may range from shock or cardiac arrest to tachycardia.