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Clinical Imaging Dec 2021
Topics: COVID-19; Humans; Lung; Pulmonary Embolism; Pulmonary Infarction; SARS-CoV-2
PubMed: 34332464
DOI: 10.1016/j.clinimag.2021.07.014 -
Turkish Thoracic Journal Jan 2021The purpose of this study was to determine the prognostic role of C-Reactive Protein (CRP) in acute PE.
OBJECTIVE
The purpose of this study was to determine the prognostic role of C-Reactive Protein (CRP) in acute PE.
MATERIAL AND METHODS
Two hundred and twenty patients with acute PE were consecutively enrolled and followed for 30 days after discharge. Serum CRP and NT-proBNP were determined. Right ventricular function was evaluated by transthoracic echocardiography.
RESULTS
There was a significant difference in age, S-PESI, and CRP levels between the early mortality group and without early mortality group. There was statistically no significant difference between the groups with and without early mortality in terms of gender distribution and whether or not they received thrombolytic therapy for DVT. Pulmonary infarct, pleural fluid, or both have no effect on early mortality. There was no correlation between CRP and pro-BNP, right/left ventricular ratio. The serum CRP levels at diagnosis were significantly higher in patients with PE and with pleural effusion and pulmonary infarct than those in PE patients without pleural effusion and pulmonary infarct (4.75±4.91 ng/mL, 9.67±8.02 ng/mL; p<0.0003).
CONCLUSION
High levels of CRP owing to inflammation in pulmonary embolism associated with effusion and infarction reveals why early mortality is significant in this group. CRP may help in the risk stratification of patients with acute PE, especially those with effusion and pulmonary infarction. CRP is an inexpensive and easily applicable biochemical marker, which can be used to predict early mortality.
PubMed: 33646097
DOI: 10.5152/TurkThoracJ.2020.19048 -
BMJ Case Reports Mar 2022Crohn's disease and ulcerative colitis are inflammatory bowel diseases (IBDs) and they primarily involve the intestines and confer an increased risk of thromboembolism...
Crohn's disease and ulcerative colitis are inflammatory bowel diseases (IBDs) and they primarily involve the intestines and confer an increased risk of thromboembolism (TE). Here we report a case of a young man with active ulcerative colitis (UC) who presented with shortness of breath and syncope. He was found on imaging to have an extensive bilateral pulmonary embolism (PE) and right heart strain with associated pulmonary infarctions. The patient was initially managed with a heparin infusion and subsequently transitioned to a direct acting oral anticoagulant (DOAC) with clinical improvement in his symptoms.
Topics: Colitis, Ulcerative; Crohn Disease; Humans; Male; Pulmonary Embolism; Pulmonary Infarction
PubMed: 35264397
DOI: 10.1136/bcr-2022-249428 -
Clinics (Sao Paulo, Brazil) 2020Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension (PH) that arises from obstruction of the pulmonary vessels by...
OBJECTIVES
Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension (PH) that arises from obstruction of the pulmonary vessels by recanalized thromboembolic material. CTEPH has a wide range of radiologic presentations. Commonly, it presents as main pulmonary artery enlargement, peripheral vascular obstructions, bronchial artery dilations, and mosaic attenuation patterns. Nevertheless, other uncommon presentations have been described, such as lung cavities. These lesions may be solely related to chronic lung parenchyma ischemia but may also be a consequence of concomitant chronic infectious conditions. The objective of this study was to evaluate the different etiologies that cause lung cavities in CTEPH patients.
METHODS
A retrospective data analysis of the medical records of CTEPH patients in a single reference PH center that contained or mentioned lung cavities was conducted between 2013 and 2016.
RESULTS
Seven CTEPH patients with lung cavities were identified. The cavities had different sizes, locations, and wall thicknesses. In two patients, the cavities were attributed to pulmonary infarction; in 5 patients, an infectious etiology was identified.
CONCLUSION
Despite the possibility of being solely associated with chronic lung parenchyma ischemia, most cases of lung cavities in CTEPH patients were associated with chronic granulomatous diseases, reinforcing the need for active investigation of infectious agents in this setting.
Topics: Angiography; Anticoagulants; Chronic Disease; Female; Granulomatous Disease, Chronic; Humans; Hypertension, Pulmonary; Lung; Male; Perfusion Imaging; Pulmonary Embolism; Retrospective Studies; Thromboembolism; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31939560
DOI: 10.6061/clinics/2020/e1373 -
Spine Jul 2023A hospital-wide medication management program was implemented to ensure that high-risk patients would systematically pause antiplatelet and anticoagulant medications. We...
STUDY DESIGN
A hospital-wide medication management program was implemented to ensure that high-risk patients would systematically pause antiplatelet and anticoagulant medications. We analyzed complications before and during the implementation of this program.
OBJECTIVE
The goal of the study was to determine if a medication management support program was effective for reducing perioperative complications, including hemorrhage, myocardial infarction, stroke, pulmonary embolism, and deep vein thrombosis.
DATA AND METHODS
Using data from the National Surgical Quality Improvement Program database, we examined the presence of 5 complications before and during the implementation of a medication management support program. There were 9732 patients in the clinic population who underwent elective spine surgery between 2011 and 2020 and were included in this analysis. Of those 9732 patients, 7205 had surgery before the introduction of the program, whereas 2527 had surgery at some point after the program was introduced. We conducted a series of Pearson's χ 2 tests to determine the relative frequencies of the complications before and during the program.
RESULTS
Results showed that during the implementation of the program, patients were relatively less likely to experience hemorrhage (3.16% vs. 1.11%; P <0.001). The reductions in thrombotic complications were clinically significant: myocardial infarction (0.12% vs. 0.00%), stroke (0.10% vs. 0.04%), pulmonary embolism (0.33% vs. 0.28%), and deep vein thrombosis (0.36% vs. 0.28%). These P values ranged from P =0.08 for myocardial infarction to P =0.67 for pulmonary embolism.
CONCLUSIONS
The use of this medication management support program appears effective for reducing the need for blood transfusions and thrombotic complications. While promising, the results should be interpreted with caution as we do not know whether this type of program will be effective for other hospital systems.
Topics: Humans; Medication Therapy Management; Retrospective Studies; Pulmonary Embolism; Myocardial Infarction; Thrombosis; Stroke; Venous Thrombosis; Postoperative Complications
PubMed: 36607822
DOI: 10.1097/BRS.0000000000004570 -
BMC Cardiovascular Disorders Jan 2023This study aimed to investigate the clinical characteristics and long-term prognosis of mycoplasma pneumoniae pneumonia (MPP)-associated thrombosis and to gain a better...
OBJECTIVE
This study aimed to investigate the clinical characteristics and long-term prognosis of mycoplasma pneumoniae pneumonia (MPP)-associated thrombosis and to gain a better understanding of the diagnosis and treatment of the disease.
METHODS
The medical records of 14 children with MPP-associated thrombosis between January 2016 and April 2020 were retrospectively reviewed at the Tianjin Children's Hospital.
RESULTS
The ages of the patients ranged from 3 to 12 years old. Among the 14 cases, there were five cases of pulmonary embolism, two cases of cerebral infarction, one case of splenic infarction, one case of cardiac embolism, two cases of cardiac embolism with comorbid pulmonary embolism, one case of internal carotid artery and pulmonary embolism, one case of combined internal carotid artery and the cerebral infarction, and one case combined cardiac embolism and lower limb artery embolism. All cases had elevated D-dimer levels. After thrombolysis and anticoagulation therapy, three cases with cerebral embolism still suffered from neurological sequelae. In contrast, the remaining cases did not develop complications.
CONCLUSION
MPP-associated thrombosis can occur in any vessel of the body. Thrombosis-associated symptoms may be complex and non-specific. Elevated D-dimer levels in a child with refractory mycoplasma pneumoniae pneumonia should raise suspicion of thrombosis. The long-term prognosis of thrombosis was favorable after the timely administration of anticoagulant therapy.
Topics: Child; Humans; Child, Preschool; Retrospective Studies; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Pulmonary Embolism; Thrombosis
PubMed: 36600223
DOI: 10.1186/s12872-022-03030-9 -
SAGE Open Medical Case Reports 2023Acute myocardial infarction and pulmonary embolism can have life-threatening consequences such as congestive heart and respiratory failure, respectively. Cancer patients...
Acute myocardial infarction and pulmonary embolism can have life-threatening consequences such as congestive heart and respiratory failure, respectively. Cancer patients are at great risk of both acute myocardial infarction and pulmonary embolism complications because the malignancy sparks the patient's blood hypercoagulable state. Nevertheless, the literature currently offers only a few reports on acute myocardial infarction associated with pulmonary embolism, and two of them occurred in the same cancer patient. Here, we present a case of a 60-year-old woman who had been diagnosed with lung cancer. She was admitted to the emergency department twice. She was diagnosed with acute myocardial infarction at her first admission, when she experienced sudden-onset chest pain. Electrocardiography showed ST-segment elevation in leads V1-V3 with inverted T wave and pathological Q wave, suggesting an acute myocardial infarction. Coronary angiography revealed a thrombus in the left anterior descending coronary artery, and thrombus aspiration was performed. After 1 month, she had an attack of pulmonary embolism with syncope upon the second admission. A computed tomographic pulmonary angiography showed branches of right and left pulmonary embolism. Anticoagulation and antiplatelet measures were taken. In this article, we discuss the relationship between cancer and thrombosis with a special focus on the conservative management strategy regarding anticoagulant and antiplatelet therapy in our case.
PubMed: 37434900
DOI: 10.1177/2050313X231181979 -
European Journal of Case Reports in... 2024A patient initially treated with corticosteroids for cryptogenic organising pneumonia following pulmonary infarction, developed a worsening condition with progressive...
UNLABELLED
A patient initially treated with corticosteroids for cryptogenic organising pneumonia following pulmonary infarction, developed a worsening condition with progressive cavitary formations in both lower lung lobes. Contrast-enhanced chest computed tomography revealed a pulmonary embolism, and serum anti-Aspergillus IgG antibody analysis yielded a strong positive result. Consequently, the patient was diagnosed with pulmonary infarction with Aspergillus infection; organising pneumonia in surrounding areas reflected the repair process. Following treatment with anticoagulants and antifungal agents, the patient was successfully discharged. Hence, pulmonary infarction should be considered in cases of refractory lung lesions.
LEARNING POINTS
Pulmonary infarction should be considered in case of refractory lung lesions, even if the patient does not have the risk of embolism.Organising pneumonia should be assessed carefully because it may occur as a repair process of various lung diseases.
PubMed: 38846666
DOI: 10.12890/2024_004501 -
The Indian Journal of Radiology &... Oct 2023The Qanadli index can be used to assess the severity of pulmonary arterial involvement in patients with acute pulmonary embolism. However, it seems that considering...
Does Adding the Pulmonary Infarction and Right Ventricle to Left Ventricle Diameter Ratio to the Qanadli Index (A Combined Qanadli Index) More Accurately, Predict Short-Term Mortality in Patients with Pulmonary Embolism?
The Qanadli index can be used to assess the severity of pulmonary arterial involvement in patients with acute pulmonary embolism. However, it seems that considering pulmonary infarction and right ventricle/left ventricle (RV/LV) ratio along with this index (called the combined Qanadli index) can provide a more accurate view of changes in cardiovascular parameters in these patients and help predict mortality in a better manner. In this regard, we evaluated the ability of the combined Qanadli index versus the Qanadli index in predicting short-term mortality in patients with pulmonary embolism. This retrospective study enrolled 234 patients with acute pulmonary embolism. Patients were divided into two groups: those who expired in 30 days and who survived. Then they were evaluated by computed tomography angiography of pulmonary arteries. The RV/LV diameter ratio and also pulmonary artery obstruction index (PAOI) were calculated. The patient's computed tomography scans were reviewed for pulmonary infarction. By adding the RV/LV ratio and pulmonary infarction to PAOI, a new index called the modified Qanadli score was made. Univariable and multivariable logistic regression was done for finding predictors of mortality. Nine cases (40%) of patients in the mortality group and 42 (20%) of survivors had ischemic heart disease and the difference was significantly meaningful. The mean Qanadli index in the mortality group was 16.8 ± 8.45 and in survivors was 8.3 ± 4.2. By adding the pulmonary infarction score and PAOI score to RV/LV ratio score, the odds ratio (OR) for predicting mortality increased significantly to 13 and 16, respectively, which were significantly meaningful. Based on our findings, the highest OR for predicting short-term mortality was obtained through a combined Qanadli index (PAOI score + pulmonary infarction score + RV/LV score) that was 17 in univariable and 18 in multivariable logistic regression analysis ( -value = 0.015). The new combined Qanadli index has more ability than the Qanadli index and RV/LV ratio for predicting changes in cardiovascular parameters and short-term mortality in patients with pulmonary embolism.
PubMed: 37811186
DOI: 10.1055/s-0043-1769590 -
BMJ Open Sep 2015Cardiovascular disease is an important comorbidity in patients with chronic obstructive pulmonary disease (COPD). We aimed to systematically review the evidence for: (1)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Cardiovascular disease is an important comorbidity in patients with chronic obstructive pulmonary disease (COPD). We aimed to systematically review the evidence for: (1) risk of myocardial infarction (MI) in people with COPD; (2) risk of MI associated with acute exacerbation of COPD (AECOPD); (3) risk of death after MI in people with COPD.
DESIGN
Systematic review and meta-analysis.
METHODS
MEDLINE, EMBASE and SCI were searched up to January 2015. Two reviewers screened abstracts and full text records, extracted data and assessed studies for risk of bias. We used the generic inverse variance method to pool effect estimates, where possible. Evidence was synthesised in a narrative review where meta-analysis was not possible.
RESULTS
Searches yielded 8362 records, and 24 observational studies were included. Meta-analysis showed increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22 to 2.42) for cohort analyses, but not in case-control studies: OR 1.18 (0.80 to 1.76). Both included studies that investigated the risk of MI associated with AECOPD found an increased risk of MI after AECOPD (incidence rate ratios, IRR 2.27, 1.10 to 4.70, and IRR 13.04, 1.71 to 99.7). Meta-analysis showed weak evidence for increased risk of death for patients with COPD in hospital after MI (OR 1.13, 0.97 to 1.31). However, meta-analysis showed an increased risk of death after MI for patients with COPD during follow-up (HR 1.26, 1.13 to 1.40).
CONCLUSIONS
There is good evidence that COPD is associated with increased risk of MI; however, it is unclear to what extent this association is due to smoking status. There is some evidence that the risk of MI is higher during AECOPD than stable periods. There is poor evidence that COPD is associated with increased in hospital mortality after an MI, and good evidence that longer term mortality is higher for patients with COPD after an MI.
Topics: Comorbidity; Disease Progression; Humans; Myocardial Infarction; Observational Studies as Topic; Population Surveillance; Pulmonary Disease, Chronic Obstructive; Risk Factors
PubMed: 26362660
DOI: 10.1136/bmjopen-2015-007824