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Surgical Case Reports Mar 2021Aneurysm of the left brachiocephalic vein is a very rare clinical disease and only 40 cases have been reported so far.
BACKGROUND
Aneurysm of the left brachiocephalic vein is a very rare clinical disease and only 40 cases have been reported so far.
CASE PRESENTATION
The patient was a 61-year-old woman with no related medical history. She underwent CT to investigate the cause of a cough and a mass was noted in the anterior mediastinum. Dynamic computed tomography with contrast medium injected into the left basilic vein demonstrated the venous aneurysm with blood flow to the left brachiocephalic vein. The patient had no symptoms, but because of the risk of pulmonary infarction and aneurysm rupture, the aneurysm was surgically resected. A median sternotomy was a reasonable approach because of the fragility of the venous aneurysm wall with little working space in the anterior mediastinum.
CONCLUSIONS
We diagnosed an aneurysm of the left brachiocephalic vein on preoperative imaging and excised it through a median sternotomy. The venous wall was thin and fragile in some areas and so this approach was appropriate in view of the possibility of intraoperative injury.
PubMed: 33687568
DOI: 10.1186/s40792-021-01148-0 -
Turkish Journal of Emergency Medicine 2021Coronavirus disease 2019 (COVID-19) disease leads to a hypercoagulable state and associated with thrombotic events that can cause mortality and morbidity. Thrombotic...
Coronavirus disease 2019 (COVID-19) disease leads to a hypercoagulable state and associated with thrombotic events that can cause mortality and morbidity. Thrombotic events include both venous and arterial thrombosis. In this case report, we present a 68-year-old COVID-19 patient with multisystemic infarction who was admitted to the hospital by splenic infarction and later pulmonary embolism diagnosed during the stay in hospital despite anticoagulant use. It is important for emergency physicians to know that patients who had COVID-19 infection but not confirmed or not tested can visit the emergency department due to complications of COVID-19 infection such as thromboembolic events primarily.
PubMed: 34849435
DOI: 10.4103/2452-2473.329627 -
Medicina (Kaunas, Lithuania) Mar 2023: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The majority of infected...
: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The majority of infected patients develop the clinical picture of a respiratory disease, although some may develop various complications, such as arterial or venous thrombosis. The clinical case presented herein is a rare example of sequential development and combination of acute myocardial infarction, subclavian vein thrombosis (Paget Schroetter syndrome), and pulmonary embolism in the same patient after COVID-19. : A 57-year-old man with a 10-day history of a SARS-CoV-2 infection was hospitalized with a clinical, electrocardiographic, and laboratory constellation of an acute inferior-lateral myocardial infarction. He was treated invasively and had one stent implanted. Three days after implantation, the patient developed shortness of breath and palpitation on the background of a swollen and painful right hand. The signs of acute right-sided heart strain observed on the electrocardiogram and the elevated D-dimer levels strongly suggested pulmonary embolism. A Doppler ultrasound and invasive evaluation demonstrated thrombosis of the right subclavian vein. The patient was administered pharmacomechanical and systemic thrombolysis and heparin infusion. Revascularization was achieved 24 h later via successful balloon dilatation of the occluded vessel. : Thrombotic complications of COVID-19 can develop in a significant proportion of patients. Concomitant manifestation of these complications in the same patient is extremely rare, presenting at the same time, quite a therapeutic challenge to clinicians due to the need for invasive techniques and simultaneous administration of dual antiaggregant therapy combined with an anticoagulant treatment. Such a combined treatment increases the hemorrhagic risk and requires a serious accumulation of data for the purpose of a long-term antithrombotic prophylaxis in patients with such pathology.
Topics: Male; Humans; Middle Aged; COVID-19; Subclavian Vein; SARS-CoV-2; Venous Thrombosis; Pulmonary Embolism; Myocardial Infarction; Upper Extremity Deep Vein Thrombosis; Thoracic Diseases
PubMed: 37109614
DOI: 10.3390/medicina59040656 -
Current Problems in Cardiology Aug 2023Since the report of the first case of COVID-19 in Wuhan, China, on December 31, 2019, several associated thrombotic complications have been reported, mainly venous... (Review)
Review
Since the report of the first case of COVID-19 in Wuhan, China, on December 31, 2019, several associated thrombotic complications have been reported, mainly venous thromboembolic events, and myocardial infarctions, in addition to peripheral arterial thrombosis and cerebral vascular events, which have been attributed to a hypercoagulable state. We aimed to know the prevalence and prognostic biomarkers in patients with pulmonary thromboembolism (PE) and SARS Cov-2 pneumonia. Hospitalized patients with SARS Cov-2 pneumonia who have had clinical, biomarker, and imaging data (chest angiography) of pulmonary thromboembolism were included. Descriptive statistics and prevalence rates were calculated. For the analysis between the groups, the paired Student's t and the Wilcoxon test were performed. CT angiography was performed on 26 patients at our institution, with a diagnosis of severe pneumonia secondary to SARS-CoV2. 9 of the patients (34.6%) had a venous thromboembolic disease. Type 2 DM was the most frequent comorbidity up to 55.5% of the total; it was followed by obesity and overweight in 55.5%, and in third place, by systemic arterial hypertension in 33.3% of the cases, 1 (11.1%) patient had chronic kidney disease and 1 (11.1%) patient with a history of cancer, only 1 patient met criteria and was treated with thrombolysis. 6 (66.6%) of the patients had segmental PE, 3 (33.3%) patients had subsegmental PE, and 4 (44.4%) patients presented pulmonary infarction.
Topics: Humans; COVID-19; Hospitals; Prevalence; Pulmonary Embolism; RNA, Viral; SARS-CoV-2; Venous Thromboembolism; Venous Thrombosis
PubMed: 35460689
DOI: 10.1016/j.cpcardiol.2022.101208 -
Expert Review of Cardiovascular Therapy Feb 2023Cardiovascular diseases (CVDs) are the leading cause of cardiovascular mortality and a major contributor to disability worldwide. The prevalence of CVDs is continuously...
INTRODUCTION
Cardiovascular diseases (CVDs) are the leading cause of cardiovascular mortality and a major contributor to disability worldwide. The prevalence of CVDs is continuously increasing, and from 1990 to 2019, it has doubled. Global cardiovascular mortality has increased from 12.1 million in 1990 to 18.6 million cases in 2019. The development of therapeutic options for these diseases is at the forefront of interest concerning the extensive socio-economic consequences. Modern endovascular transcatheter therapeutic options contribute to the reduction of cardiovascular morbidity and mortality.
AREAS COVERED
The article concentrates on the triad of the most common causes of acute cardiovascular mortality and morbidity - myocardial infarction, ischemic stroke, and pulmonary embolism. Current evidence-based indications, specific interventional techniques, and remaining unsolved issues are reviewed and compared. A personal perspective on the possible implications for the future is provided.
EXPERT OPINION
Primary angioplasty for ST-segment elevation myocardial infarction is a well-established therapeutic option with proven mortality benefits. We suppose that catheter-based interventions for acute stroke will spread quickly from centers of excellence to routine clinical practice. We believe that ongoing research will provide a basis for the expansion of interventional treatment of pulmonary embolism soon.
Topics: Humans; Myocardial Infarction; ST Elevation Myocardial Infarction; Stroke; Pulmonary Embolism; Treatment Outcome
PubMed: 36706282
DOI: 10.1080/14779072.2023.2174101 -
Journal of Ultrasound in Medicine :... Jul 2022This retrospective study aimed to describe the B-mode lung ultrasound (B-LUS) and contrast-enhanced ultrasound (CEUS) follow-up patterns of peripheral pulmonary lesions...
Peripheral Pulmonary Lesions in Confirmed Pulmonary Arterial Embolism: Follow-up Study of B-Mode Ultrasound and of Perfusion Patterns Using Contrast-Enhanced Ultrasound (CEUS).
PURPOSE
This retrospective study aimed to describe the B-mode lung ultrasound (B-LUS) and contrast-enhanced ultrasound (CEUS) follow-up patterns of peripheral pulmonary lesions (PPLs) in patients with confirmed pulmonary embolism (PE).
PATIENTS AND METHODS
Data from 27 patients with a confirmed diagnosis of PE and PPLs over 5 mm from October 2009 to November 2018 were included retrospectively in the study. The inclusion criteria were performance of a baseline CEUS examination, a short-term B-LUS and CEUS follow-up, and a long-term B-LUS follow-up of PPLs. The homogeneity of enhancement of PPLs (homogeneous/inhomogeneous/absent) on CEUS and the presence and size of PPLs on B-LUS were evaluated.
RESULTS
A total of n = 25/27 (92.6%) lesions showed absent or inhomogeneous enhancement during baseline examination or short-term follow-up, indicating impaired perfusion. On short-term CEUS follow-up, 9/27 cases (33.3%) showed a pattern shift. On B-LUS long-term follow-up, 26/27 lesions (96.3%) were detectable for an average of 10 weeks (range 3-32 weeks). The size of reference lesions was significantly reduced at the time of the final follow-up examination (P < .05).
CONCLUSION
B-LUS follow-up showed that, in patients with confirmed PE, PPLs had a delayed regression. On CEUS follow-up examination, various perfusion patterns of PPLs were observed, indicating the different ages and the variable reparative processes of pulmonary infarction. In PPLs independent of the underlying signs and symptoms, follow-up B-LUS and CEUS examinations may be helpful for a possible retrospective diagnosis of peripheral pulmonary infarction suggestive of PE.
Topics: Contrast Media; Follow-Up Studies; Humans; Hypertension, Pulmonary; Lung; Perfusion; Pulmonary Embolism; Pulmonary Infarction; Retrospective Studies; Ultrasonography
PubMed: 34694040
DOI: 10.1002/jum.15852 -
Medicina Clinica Jan 2021Lung retransplantation (LR) is a valid choice with a significant risk of perioperative morbidity and mortality in selected patients with graft dysfunction after lung...
BACKGROUND
Lung retransplantation (LR) is a valid choice with a significant risk of perioperative morbidity and mortality in selected patients with graft dysfunction after lung transplantation. Our goal is to analyse our experience in LR in terms of survival and lung function.
METHODS
Retrospective study of patients undergoing LR (1990-2019).
VARIABLES
recipients and procedure, early mortality, survival and lung function in patients with CLAD. Quantitative variables (mean±SD); qualitative (%). Student's t test or χ2 was used. Survival was estimated using Kaplan-Meier, compared with Log Rank. A p < 0.05 was established as significant.
RESULTS
Of 784 transplanted patients, 25 patients (mean age 38.41-16.3 years, 12 men and 13 women) were LR; (CLAD (n = 19), pulmonary infarction (n = 2), airway complications (n = 2), graft dysfunction (n = 1), hyperacute rejection (n = 1), mean time to retransplantation: 5.41 ± 3.87 years in CLAD and 21.2 ± 21.4 days in non-CLAD. The 90-day mortality was 52% and 36.8% in the second period (p = 0.007), being higher in patients who required preoperative ECMO (80 vs. 20%, p = 0.04). The 1- and 5-year survival was 53.9% and 37.7%, respectively (p = 0.016). Survival of the CLAD group was greater (p = 0.08). Pre LR ECMO decreased survival (p = 0.032). After LR, FEV improved an average of 0.98 ± 0.13L (25.6 ± 18.8%) (p = 0.001).
CONCLUSIONS
LR is a high mortality procedure that requires careful selection of patients with better results in patients with CLAD. The lung function of patients with CLAD improved significantly.
Topics: Female; Graft Rejection; Humans; Lung; Lung Transplantation; Male; Referral and Consultation; Respiratory Function Tests; Retrospective Studies; Risk Factors
PubMed: 32430205
DOI: 10.1016/j.medcli.2020.02.008 -
International Journal of Surgery Case... Aug 2021Renal infarction after pulmonary resection is relatively rare; however, it is associated with severe morbidity.
BACKGROUND
Renal infarction after pulmonary resection is relatively rare; however, it is associated with severe morbidity.
CASE PRESENTATION
An 80-year-old woman without any severe comorbidity or smoking history underwent left upper lobectomy (LUL) concomitant with mediastinal lymph node dissection for lung adenocarcinoma. She did not show fever, flank pain, and/or nausea; however, laboratory data revealed an elevated white blood cell count (WBC) (13,460 cells/mm) and elevated serum lactate dehydrogenase (LDH) (670 IU/L) and C-reactive protein (CRP) (23.6 mg/dL) levels on the fifth postoperative day. Contrast-enhanced computed tomography from the thorax to the pelvic cavity revealed a partial defect of the right kidney without any indication of infection and no pulmonary vein stump thrombosis. We diagnosed the patient with partial right renal infarction, and heparin (10,000 IU/day) was initiated. Laboratory data showed gradual reduction in the WBC (7700 cells/mm), as well as in the serum LDH (355 IU/L) and CRP (0.76 mg/dL) levels, 7 days after heparin initiation. Anticoagulation therapy including heparin administration was discontinued because renal function remained, and we observed no pulmonary vein stump thrombosis. Laboratory data remained within normal limits, and the patient was discharged on postoperative day 15.
CONCLUSIONS
LUL is considered a risk factor for this condition, and elevated WBC, as well as serum LDH and CRP levels are useful diagnostic indicators.
PubMed: 34358963
DOI: 10.1016/j.ijscr.2021.106254 -
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 -
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