Subsequent Pulmonary Thromboembolism Research Articles

Diagnosis and management of acute pulmonary thromboembolism: case report

Background: Pulmonary Thromboembolism (PTE) is an important cause of hospitalization, morbidity and mortality. At the present time it represents one of the most frequent cardiovascular diseases.Case report: a 73-year-old female patient with various comorbidities, who was admitted due to severe respiratory distress and hemodynamic instability, was diagnosed with pneumonia, pulmonary hypertension, and a Computed Axial Tomography revealed a tumor mass with alveolar hemorrhage.Evolution: during the hospital stay, the patient maintained high oxygen needs and hemodynamic instability despite support maneuvers. The alveolar hemorrhage that she presents determines the prophylactic thrombus treatment. The imaging study indicates a tumor mass associated with alveolar hemorrhage and a very high probability of developing deep vein thrombosis (DVT) and subsequent pulmonary thromboembolism (PTE). Reason for which FAST echo was performed, which evidenced deep vein thrombosis in the right common femoral vein, total occlusion of the superficial femoral artery with preserved flow in the deep femoral artery. Absent distal pulses with arterial flow in monophasic anterior tibial with high diastole IR: 0,6, and Ankle arm index 0,5, posterior echocardiogram with dilation of the right cavities, PSAP of 54 mmHg and McConnel's sign. Patient intervenes with a massive pulmonary thromboembolism that results in death.Conclusions: pulmonary embolism is a pathology that occurs in 1 per 1000 cases. Individualizing each case can be decisive to safeguard the life of a patient

Deep Venous Thrombosis and Pulmonary Thromboembolism in a Physically Nonprepared Trekker in the Himalayas: An Autopsy Report

Deep Venous Thrombosis (DVT) and Subsequent Pulmonary Thromboembolism (PTE) in high altitude climbers is a well-known concept. The acclimatization process at high altitude is itself a thrombogenic event. Accordingly, when a physically nonprepared individual with preexisting thrombogenic risk factors attempts trekking at high altitude, they may end up with fatal thromboembolic events. Here, we report a case of a low-lander with multiple thrombogenic risk factors who developed DVT and PTE when he went for a trekking trip in the Himalayas. The risk factors, autopsy findings, and possible mechanism of developing fatal pulmonary embolism, in this case, are discussed here.

Deep Venous Thrombosis And Pulmonary Thromboembolism In A Physically Nonprepared Trekker In The Himalayas – An Autopsy Report.

Deep venous thrombosis (DVT) and subsequent pulmonary thromboembolism (PTE) in high altitude climbers is a well-known concept. The acclimatization process at high altitude is itself a thrombogenic event. Having said that, when a physically nonprepared individual with preexisting thrombogenic risk factors attempts trekking at high altitude, he may end up with fatal thromboembolic events. Here we report a case of a low lander with multiple thrombogenic risk factors who developed DVT and PTE when he went for a trekking trip in the Himalayas. The risk factors, autopsy findings and possible mechanism of developing fatal pulmonary embolism, in this case, are discussed here.

Noninvasive Imaging of Early Venous Thrombosis by 19F Magnetic Resonance Imaging With Targeted Perfluorocarbon Nanoemulsions.

Noninvasive detection of deep venous thrombi and subsequent pulmonary thromboembolism is a serious medical challenge, since both incidences are difficult to identify by conventional ultrasound techniques. Here, we report a novel technique for the sensitive and specific identification of developing thrombi using background-free 19F magnetic resonance imaging, together with α2-antiplasmin peptide (α2AP)-targeted perfluorocarbon nanoemulsions (PFCs) as contrast agent, which is cross-linked to fibrin by active factor XIII. Ligand functionality was ensured by mild coupling conditions using the sterol-based postinsertion technique. Developing thrombi with a diameter<0.8 mm could be visualized unequivocally in the murine inferior vena cava as hot spots in vivo by simultaneous acquisition of anatomic matching 1H and 19F magnetic resonance images at 9.4 T with both excellent signal-to-noise and contrast-to-noise ratios (71±22 and 17±5, respectively). Furthermore, α2AP-PFCs could be successfully applied for the diagnosis of experimentally induced pulmonary thromboembolism. In line with the reported half-life of factor XIIIa, application of α2AP-PFCs>60 minutes after thrombus induction no longer resulted in detectable 19F magnetic resonance imaging signals. Corresponding results were obtained in ex vivo generated human clots. Thus, α2AP-PFCs can visualize freshly developed thrombi that might still be susceptible to pharmacological intervention. Our results demonstrate that 1H/19F magnetic resonance imaging, together with α2AP-PFCs, is a sensitive, noninvasive technique for the diagnosis of acute deep venous thrombi and pulmonary thromboemboli. Furthermore, ligand coupling by the sterol-based postinsertion technique represents a unique platform for the specific targeting of PFCs for in vivo 19F magnetic resonance imaging.

Spinal Epidural Hematoma After Thrombolysis for Deep Vein Thrombosis with Subsequent Pulmonary Thromboembolism: A Case Report

A 38-year-old male was initially admitted for left leg swelling. He was diagnosed as having deep vein thrombosis (DVT) in the left leg and a pulmonary thromboembolism by contrast-enhanced chest computed tomography (CT) with delayed lower extremity CT. The DVT was treated by thrombolysis and a venous stent. Four hours later, he complained of severe back pain and a sensation of separation of his body and lower extremities; he experienced paraplegia early in the morning of the following day. Magnetic resonance imaging showed a spinal epidural hematoma between T11 and L2, which decompressed following surgery. We, therefore, report a case of a spinal epidural hematoma after thrombolysis in a case of DVT with a pulmonary thromboembolism.

Significance of Ligature Technique on the Formation of Pulmonary Artery Stump Thrombosis in a Canine Model

Background: Thrombo-embolism following pulmonary resection is a serious complication with a fatal outcome. We have tried to clarify the role of ligature techniques used in pulmonary resection on the formation of pulmonary artery stump thrombosis, which may lead to a subsequent pulmonary thrombo-embolism.Material and methods: Two groups of 10 mongrel dogs underwent a standard left pneumonectomy under anesthesia. The transfixation, or the continuous ligature technique, was applied to close the pulmonary artery stump in each group. Morphological evaluation of the ligated pulmonary artery was carried out, including the macroscopic thrombus formation and microscopic findings.Results: The transfixation ligature technique showed a significantly greater incidence of macroscopic thrombosis in the pulmonary artery stump when compared with the continuous ligature technique (p = 0.033). This was confirmed by microscopic changes (p = 0.020).Conclusion: Thrombus formation in the pulmonary artery stump is more likely to occur following the closure of the stump with the transfixation ligature technique compared with the continuous ligature technique.

航空機利用後に肺血栓塞栓症を発症した３症例 いわゆるエコノミークラス症候群について

Pulmonary thromboembolism (PTE) after air travel, firstly reported by Symington in 1977, is also called “economy class syndrome.” We recently treated 3 such cases after patients took long-haul flights. All 3 were Japanese women arriving in Japan after 11.7 to 13.5 hours of flight in economy class. Their major symptoms were dyspnea, convulsion, and loss of consciousness. All had risk factors such as obesity, age greater than 40 years, and immobilization in a cramped seat. One took oral contraceptives and another had antiphospholipid syndrome. All 3 were immediately diagnosed with PTE, thanks to findings of ultrasonic echocardiography and computed tomography (CT). They were treated with heparin and immediately transferred to a university medical center. All were eventually discharged with no apparent adverse sequelae. The number of passengers who travel overseas is rapidly increasing. Although the occurrence of deep vein thrombosis and subsequent PTE is very rare, it is serious and may be life-threatening, so the possibility of its occurrence must be kept in mind.

Upper Extremity Deep Venous Thrombosis: Underdiagnosed and Potentially Lethal

The significance of upper extremity deep venous thrombosis (DVT) has been minimized in comparison to iliofemoral thrombosis, likely due to the erroneous belief that subsequent pulmonary thromboembolism is rare. The possibility of pulmonary thromboembolism originating in the upper extremity veins must now be seriously considered with catheters and medical instrumentation being performed more commonly in accessing the central venous system. It has been incorrectly assumed that the risk of pulmonary embolism was low due to the abundant collateral flow, and thus lack of stasis around an upper extremity even with venous occlusion. However, several studies, including a recent prospective trial, concluded that pulmonary embolism is not a rare complication in upper extremity DVT. Significantly, when comparing all sources of secondary upper extremity DVT, catheter-related upper extremity DVT is at greatest risk of subsequent pulmonary thromboembolism. We present an illustrative case documenting extensive pulmonary embolization that occurred following insertion of a central venous catheter and subsequent thrombosis of the right subclavian and innominate veins. With absolute contraindications to thrombolytic and anticoagulation therapy, prevention of further embolization was achieved by percutaneous insertion of a superior vena cava filter.