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JAMA Network Open May 2023Most patients presenting to US emergency departments (EDs) with acute pulmonary embolism (PE) are hospitalized, despite evidence from multiple society-based guidelines...
IMPORTANCE
Most patients presenting to US emergency departments (EDs) with acute pulmonary embolism (PE) are hospitalized, despite evidence from multiple society-based guidelines recommending consideration of outpatient treatment for those with low risk stratification scores. One barrier to outpatient treatment may be clinician concern regarding findings on PE-protocol computed tomography (CTPE), which are perceived as high risk but not incorporated into commonly used risk stratification tools.
OBJECTIVE
To evaluate the association of concerning CTPE findings with outcomes and treatment of patients in the ED with acute, low-risk PE.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used a registry of all acute PEs diagnosed in the adult ED of an academic medical center from October 10, 2016, to December 31, 2019. Acute PE cases were divided into high- and low-risk groups based on PE Severity Index (PESI) class alone or using a combination of PESI class and biomarker results. The low-risk group was further divided based on the presence of concerning CTPE findings: (1) bilateral central embolus, (2) right ventricle-to-left ventricle ratio greater than 1.0, (3) right ventricle enlargement, (4) septal abnormality, or (5) pulmonary infarction. Data analysis was conducted from June to October 2022.
MAIN OUTCOMES AND MEASURES
The primary outcome was all-cause mortality at 7 and 30 days. Secondary outcomes included hospitalization, length of stay, need for intensive care, use of echocardiography and/or bedside ultrasonography, and activation of the PE response team (PERT) .
RESULTS
Of 817 patients (median [IQR] age, 58 [47-71] years; 417 (51.0%) female patients; 129 [15.8%] Black and 645 [78.9%] White patients) with acute PEs, 331 (40.5%) were low risk and 486 (59.5%) were high risk by PESI score. Clinical outcomes were similar for all low-risk patients, with no 30-day deaths in the low-risk group with concerning CTPE findings (0 of 151 patients) vs 4 of 180 (2.2%) in the low-risk group without concerning CTPE findings and 88 (18.1%) in the high-risk group (P < .001). Low-risk patients with concerning CTPE findings were less frequently discharged from the ED than those without concerning CTPE findings (3 [2.0%] vs 14 [7.8%]; P = .01) and had more frequent echocardiography (87 [57.6%] vs 49 [27.2%]; P < .001) and PERT activation for consideration of advanced therapies (34 [22.5%] vs 11 [6.1%]; P < .001).
CONCLUSIONS AND RELEVANCE
In this single-center study, CTPE findings widely believed to confer high risk were associated with increased hospitalization and resource utilization in patients with low-risk PE but not short-term adverse clinical outcomes.
Topics: Adult; Humans; Female; Middle Aged; Male; Cohort Studies; Pulmonary Embolism; Risk Factors; Biomarkers; Tomography, X-Ray Computed
PubMed: 37256624
DOI: 10.1001/jamanetworkopen.2023.11455 -
Indian Journal of Hematology & Blood... Jun 2016We report a 42 year old non-smoker male who presented with progressive exertional dyspnoea, productive cough with streaky hemoptysis and progressive pedal edema. His...
We report a 42 year old non-smoker male who presented with progressive exertional dyspnoea, productive cough with streaky hemoptysis and progressive pedal edema. His physical examination, ECG, chest X-ray and 2D-ECHO revealed features suggestive of right heart failure and pulmonary hypertension. On further evaluation for the cause of pulmonary hypertension, his CT pulmonary angiography revealed features of chronic pulmonary thromboembolism with calcified thrombus in the main pulmonary artery along with pulmonary hypertension. Incidentally the CT also revealed a cavity in the right lung with soft tissue within it. A, trans-thoracic needle aspiration of this tissue was suggestive of an aspergilloma. This is a rare case report of co-existence of two uncommon complications of pulmonary embolism-chronic thrombo-embolic pulmonary hypertension and pulmonary Aspergilloma in the same patient.
PubMed: 27408402
DOI: 10.1007/s12288-015-0614-2 -
Jornal Brasileiro de Pneumologia :... 2015
Topics: Adult; Cryptogenic Organizing Pneumonia; Diagnosis, Differential; Humans; Lung; Male; Pulmonary Infarction; Tomography, X-Ray Computed
PubMed: 26785969
DOI: 10.1590/S1806-37562015000000235 -
International Heart Journal Sep 2021A 20-year-old man with arrhythmogenic right ventricular cardiomyopathy (ARVC) was resuscitated from ventricular fibrillation. He was transferred to our hospital because...
A 20-year-old man with arrhythmogenic right ventricular cardiomyopathy (ARVC) was resuscitated from ventricular fibrillation. He was transferred to our hospital because of progressive multiorgan dysfunction despite mechanical circulatory support with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP). At admission to our hospital, chest X-ray showed bilateral complete lung opacification, and echocardiography revealed a massive thrombus occupying the left atrium (LA) and left ventricle (LV). Conversion to central ECMO with transapical LV venting and thrombectomy were performed. The huge LA thrombus occluded all pulmonary veins (PVs). Despite the surgery and intensive care, complete lung opacity remained, and he died of multiorgan failure associated with sepsis. Autopsy demonstrated bilateral pulmonary multiple red infarctions, and histopathology showed alveolar wall necrosis with extensive hemorrhage, confirming a diagnosis of pulmonary hemorrhagic infarction. Extensive pulmonary infarction was attributable to PV occlusion due to massive LA thrombus. PV thrombosis should be considered when refractory lung opacities are encountered during VA-ECMO and necessitates early intervention.
Topics: Arrhythmogenic Right Ventricular Dysplasia; Autopsy; Echocardiography; Extracorporeal Membrane Oxygenation; Fatal Outcome; Heart Atria; Heart Ventricles; Hemorrhage; Humans; Intra-Aortic Balloon Pumping; Male; Multiple Organ Failure; Pulmonary Infarction; Pulmonary Veins; Pulmonary Veno-Occlusive Disease; Resuscitation; Sepsis; Thrombectomy; Thrombosis; Ventricular Fibrillation; Young Adult
PubMed: 34544989
DOI: 10.1536/ihj.21-226 -
The British Journal of Radiology Apr 2020The clinical diagnosis of pulmonary embolism is often difficult, as symptoms range from syncope and chest pain to shock and sudden death. Adding complexity to this...
The clinical diagnosis of pulmonary embolism is often difficult, as symptoms range from syncope and chest pain to shock and sudden death. Adding complexity to this picture, some patients with non-diagnosed pulmonary embolism may undergo unenhanced imaging examinations for a number of reasons, including the prevention of contrast medium-related nephrotoxicity, anaphylactic/anaphylactoid reactions and nephrogenic systemic fibrosis, as well as due to patients' refusal or lack of venous access. In this context, radiologists' awareness and recognition of indirect signs are cornerstones in the diagnosis of pulmonary embolism. This article describes the indirect signs of pulmonary embolism on chest X-ray, unenhanced CT, and MRI.
Topics: Diagnosis, Differential; Humans; Incidental Findings; Lung Diseases; Magnetic Resonance Imaging; Multimodal Imaging; Pulmonary Artery; Pulmonary Embolism; Pulmonary Infarction; Thrombosis; Tomography, X-Ray Computed
PubMed: 31944831
DOI: 10.1259/bjr.20190635 -
Singapore Medical Journal Nov 2015Cardiovascular and noncardiovascular conditions are commonly encountered in the emergency department. While the majority of patients have underlying cardiovascular... (Review)
Review
Cardiovascular and noncardiovascular conditions are commonly encountered in the emergency department. While the majority of patients have underlying cardiovascular aetiologies, such as acute myocardial infarction, congestive heart failure, aortic dissection and pulmonary embolism, a small subset of patients have underlying noncardiovascular conditions, although they present with similar symptoms of chest pain, dyspnoea, cough, haemoptysis and haematemesis. This article aims to describe the imaging findings in common noncardiovascular conditions of the chest that are frequently encountered in the emergency department, with a review of the existing literature.
Topics: Chest Pain; Diagnosis, Differential; Diagnostic Imaging; Emergencies; Humans; Myocardial Infarction; Pulmonary Embolism
PubMed: 26668404
DOI: 10.11622/smedj.2015168 -
Cleveland Clinic Journal of Medicine Oct 2019Systemic sclerosis, an autoimmune disease characterized by fibrosis of the skin and various internal organs, is associated with cardiovascular abnormalities including... (Review)
Review
Systemic sclerosis, an autoimmune disease characterized by fibrosis of the skin and various internal organs, is associated with cardiovascular abnormalities including pulmonary hypertension, atherosclerosis, right and left ventricular dysfunction, arrhythmias, conduction defects, pericardial disease, and valvular heart disease. Clinicians caring for patients with this disease should regularly screen for cardiac symptoms, and patients with abnormal findings should be managed in conjunction with a cardiologist to optimally modify cardiovascular risks.
Topics: Arrhythmias, Cardiac; Atherosclerosis; Cardiovascular Diseases; Echocardiography; Humans; Hypertension, Pulmonary; Mass Screening; Myocardial Infarction; Scleroderma, Systemic; Ventricular Dysfunction, Right
PubMed: 31597076
DOI: 10.3949/ccjm.86a.18109 -
Scientific Reports Sep 2022This study was undertaken to determine the risk of bevacizumab-induced lung toxicity, time to onset, and post hoc outcomes using the Japanese Adverse Drug Event Report...
This study was undertaken to determine the risk of bevacizumab-induced lung toxicity, time to onset, and post hoc outcomes using the Japanese Adverse Drug Event Report database. We analysed data for the period between April 2004 and March 2021. Data on lung toxicities were extracted, and relative risk of adverse events (AEs) was estimated using the reporting odds ratio. We analysed 5,273,115 reports and identified 20,399 reports of AEs caused by bevacizumab. Of these, 1679 lung toxicities were reportedly associated with bevacizumab. Signals were detected for nine lung toxicities. A histogram of times to onset showed occurrence from 35 to 238 days, but some cases occurred even more than one year after the start of administration. Approximately 20% of AEs were thromboembolic events. Among these, pulmonary embolism was the most frequently reported and fatal cases were also reported. The AEs showing the highest fatality rates were pulmonary haemorrhage, pulmonary infarction, and pulmonary thrombosis. In conclusion, we focused on lung toxicities caused by bevacizumab as post-marketing AEs. Some cases could potentially result in serious outcomes, patients should be monitored for signs of onset of AEs not only at the start of administration, but also over a longer period of time.
Topics: Adverse Drug Reaction Reporting Systems; Bevacizumab; Databases, Factual; Drug-Related Side Effects and Adverse Reactions; Humans; Lung
PubMed: 36114412
DOI: 10.1038/s41598-022-19887-x -
BMC Cardiovascular Disorders Jun 2021Due to its low incidence and diverse manifestations, paradoxical embolism (PDE) is still under-reported and is not routinely considered in differential diagnoses....
BACKGROUND
Due to its low incidence and diverse manifestations, paradoxical embolism (PDE) is still under-reported and is not routinely considered in differential diagnoses. Concomitant acute myocardial infarction (AMI) and acute pulmonary embolism (PE) caused by PDE has rarely been reported.
CASE PRESENTATION
A 45-year-old woman presented with acute chest pain and difficulty with breathing. Multiple imaging modules including ECG, echocardiography, emergency cardioangiogram (CAG), and CT angiography of the pulmonary arteries showed acute occlusion of the posterolateral artery and acute PE. After coronary aspiration, no residual stenosis was observed. One month later, a bubble study showed inter-atrial communication via a patent foramen ovale (PFO). The AMI in this patient was finally attributed to PDE via the PFO. PFO closure was performed, and long-term anticoagulation was prescribed to prevent recurrent thromboembolic events.
CONCLUSIONS
PDE via PFO is a rare etiology of AMI, especially in patients with concomitant AMI and PE. Clinicians should be vigilant of this possibility and close the inter-atrial channel for secondary prevention.
Topics: Anticoagulants; Embolism, Paradoxical; Female; Foramen Ovale, Patent; Humans; Inferior Wall Myocardial Infarction; Middle Aged; Pulmonary Embolism; Recurrence; ST Elevation Myocardial Infarction; Secondary Prevention; Treatment Outcome
PubMed: 34167471
DOI: 10.1186/s12872-021-02123-1 -
Archives of Academic Emergency Medicine 2020Since the novel coronavirus emerged in late December, 2019 in Wuhan, China, millions of people have been infected and thousands of patients have died. Fever and dyspnea...
Since the novel coronavirus emerged in late December, 2019 in Wuhan, China, millions of people have been infected and thousands of patients have died. Fever and dyspnea are the most common symptoms of infection with SARS-CoV-2. However, these symptoms are neither specific nor diagnostic for COVID-19. Symptom overlap between COVID-19 and some other conditions may lead other diseases to be missed and underdiagnosed. Just like COVID-19, pulmonary thromboembolism (PTE) and pulmonary infarction may present with fever and respiratory symptoms. Since COVID-19 emerged and spread worldwide, many clinicians are focused on diagnosis and treatment of this novel viral infection. Hence, other diseases presenting with the same symptoms as COVID-19 may remain underdiagnosed. Here, we report three cases of PTE and pulmonary infarction presenting with fever and respiratory symptoms mimicking COVID-19.
PubMed: 33244523
DOI: No ID Found