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Insights Into Imaging Nov 2020Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since December 2019. Although... (Review)
Review
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since December 2019. Although the reference diagnostic test is a real-time reverse transcription-polymerase chain reaction (RT-PCR), chest-computed tomography (CT) has been frequently used in diagnosis because of the low sensitivity rates of RT-PCR. CT findings of COVID-19 are well described in the literature and include predominantly peripheral, bilateral ground-glass opacities (GGOs), combination of GGOs with consolidations, and/or septal thickening creating a "crazy-paving" pattern. Longitudinal changes of typical CT findings and less reported findings (air bronchograms, CT halo sign, and reverse halo sign) may mimic a wide range of lung pathologies radiologically. Moreover, accompanying and underlying lung abnormalities may interfere with the CT findings of COVID-19 pneumonia. The diseases that COVID-19 pneumonia may mimic can be broadly classified as infectious or non-infectious diseases (pulmonary edema, hemorrhage, neoplasms, organizing pneumonia, pulmonary alveolar proteinosis, sarcoidosis, pulmonary infarction, interstitial lung diseases, and aspiration pneumonia). We summarize the imaging findings of COVID-19 and the aforementioned lung pathologies that COVID-19 pneumonia may mimic. We also discuss the features that may aid in the differential diagnosis, as the disease continues to spread and will be one of our main differential diagnoses some time more.
PubMed: 33226521
DOI: 10.1186/s13244-020-00933-z -
Medicine Oct 2015In the setting of acute pulmonary embolism (PE), pulmonary infarction is deemed to occur primarily in individuals with compromised cardiac function.The current study was... (Observational Study)
Observational Study
In the setting of acute pulmonary embolism (PE), pulmonary infarction is deemed to occur primarily in individuals with compromised cardiac function.The current study was undertaken to establish the prevalence of pulmonary infarction in patients with acute PE, and the relationship between infarction and: age, body height, body mass index (BMI), smoking habits, clot burden, and comorbidities.The authors studied prospectively 335 patients with acute PE diagnosed by computed tomographic angiography (CT) in 18 hospitals throughout central Italy. The diagnosis of pulmonary infarction on CT was based on Hampton and Castleman's criteria (cushion-like or hemispherical consolidation lying along the visceral pleura). Multivariable logistic regression was used to model the relationship between covariates and the probability of pulmonary infarction.The prevalence of pulmonary infarction was 31%. Patients with infarction were significantly younger and with significantly lower prevalence of cardiovascular disease than those without (P < 0.001). The frequency of infarction increased linearly with increasing height, and decreased with increasing BMI. In logistic regression, the covariates significantly associated with the probability of infarction were age, body height, BMI, and current smoking. The risk of infarction grew with age, peaked at approximately age 40, and decreased afterwards. Increasing body height and current smoking were significant amplifiers of the risk of infarction, whereas increasing BMI appeared to confer some protection.Our data indicate that pulmonary infarction occurs in nearly one-third of the patients with acute PE. Those with infarction are often young and otherwise healthy. Increasing body height and active smoking are predisposing risk factors.
Topics: Acute Disease; Adult; Age Factors; Aged; Aged, 80 and over; Body Height; Body Mass Index; Cardiovascular Diseases; Female; Humans; Italy; Male; Middle Aged; Prevalence; Pulmonary Embolism; Pulmonary Infarction; Risk Factors; Smoking; Tomography, X-Ray Computed
PubMed: 26469892
DOI: 10.1097/MD.0000000000001488 -
Journal of Korean Medical Science Mar 2022In acute pulmonary embolism (PE), circulatory failure and systemic hypotension are important clinically for predicting poor prognosis. While pulmonary artery (PA) clot... (Review)
Review
In acute pulmonary embolism (PE), circulatory failure and systemic hypotension are important clinically for predicting poor prognosis. While pulmonary artery (PA) clot loads can be an indicator of the severity of current episode of PE or treatment effectiveness, they may not be used directly as an indicator of right ventricular (RV) failure or patient death. In other words, pulmonary vascular resistance or patient prognosis may not be determined only with mechanical obstruction of PAs and their branches by intravascular clot loads on computed tomography pulmonary angiography (CTPA), but determined also with vasoactive amines, reflex PA vasoconstriction, and systemic arterial hypoxemia occurring during acute PE. Large RV diameter with RV/left ventricle (LV) ratio > 1.0 and/or the presence of occlusive clot and pulmonary infarction on initial CTPA, and clinically determined high baseline PA pressure and RV dysfunction are independent predictors of oncoming chronic thromboembolic pulmonary hypertension (CTEPH). In this pictorial review, authors aimed to demonstrate clinical and serial CTPA features in patients with acute massive and submassive PE and to disclose acute CTPA and clinical features that are related to the prediction of oncoming CTEPH.
Topics: Angiography; Humans; Hypertension, Pulmonary; Pulmonary Artery; Pulmonary Embolism; Tomography, X-Ray Computed
PubMed: 35289137
DOI: 10.3346/jkms.2022.37.e76 -
The Journal of International Medical... Jan 2022Pulmonary embolism and splenic infarction are rare in patients with polycythemia vera. We herein describe a man in his early 60s whose main symptoms were chest...
Pulmonary embolism and splenic infarction are rare in patients with polycythemia vera. We herein describe a man in his early 60s whose main symptoms were chest tightness, cough, and sputum expectoration. Antibiotics, bronchodilators, and mucoactive agents did not improve his symptoms. Pulmonary artery computed tomography angiography showed pulmonary embolism, and abdominal computed tomography showed multiple hypodense foci in the spleen. Bone marrow aspiration cytology, biopsy, and genetic testing confirmed polycythemia vera. The patient's symptoms were relieved after treatment with hydroxyurea and rivaroxaban. This case emphasizes that although pulmonary embolism and splenic infarction are relatively rare in patients with polycythemia vera, the possibility of polycythemia vera should be considered in clinical practice.
Topics: Angiography; Humans; Male; Polycythemia Vera; Pulmonary Embolism; Splenic Infarction; Tomography, X-Ray Computed
PubMed: 35023386
DOI: 10.1177/03000605211072801 -
BMJ Case Reports May 2018A 59-year-old woman presented with a sudden onset of breathlessness and chest pain. An echocardiography and CT scan showed pulmonary embolism and infarction with a...
A 59-year-old woman presented with a sudden onset of breathlessness and chest pain. An echocardiography and CT scan showed pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria. For haemodynamically stable patients, the optimal management strategy is poorly defined. Three main strategies were considered: surgical thrombectomy, thrombolysis and anticoagulation. Surgery with reversal of anticoagulation may lead to further coagulation and increased risk of bleeding complications. The significant pulmonary hypertension and right ventricular infarction raised the prospect of difficult weaning from cardiopulmonary bypass following thrombectomy. Thrombolysis, which has significant mortality rate, and systemic embolisation including pulmonary infarction with haemorrhagic transformation were also contraindications. A multidisciplinary approach was adopted and anticoagulation was therefore believed to be the safest and effective approach. Here, the use of anticoagulation alone was fortunately successful but could as easily end in disaster. This approach should be considered the ideal paradigm to yield optimum outcomes.
Topics: Anticoagulants; Computed Tomography Angiography; Drug Therapy, Combination; Embolism, Paradoxical; Female; Heart Atria; Heart Diseases; Heparin; Humans; Middle Aged; Pulmonary Embolism; Pulmonary Infarction; Thrombosis; Treatment Outcome; Warfarin
PubMed: 29848540
DOI: 10.1136/bcr-2018-225195 -
Clinical Nuclear Medicine Jun 2022This study aimed to summarize the clinical and 18F-FDG PET/CT manifestations of hilar tumor-induced pulmonary infarction.
PURPOSE
This study aimed to summarize the clinical and 18F-FDG PET/CT manifestations of hilar tumor-induced pulmonary infarction.
METHODS
A retrospective analysis was performed on patients with hilar masses who underwent FDG PET/CT scans between July 2015 and January 2021 and had complete clinical data. Pulmonary infarction was confirmed by concurrent chest CT and imaging follow-up or pathology.
RESULTS
A total of 58 patients (mean age, 56 [SD, 13] years; 44 males) with 122 infarcts were included in the study. Hilar masses were mostly associated with small cell lung cancer (64%). The most common clinical manifestations were cough (64%) and hemoptysis (36%). Most patients (62%) had multiple pulmonary infarcts. The CT findings of pulmonary infarcts included the "Hampton hump" (48%) and patchy consolidation (52%). The density of infarcts included "bubbly consolidation" (61%) and "homogenous consolidation" (39%). The metabolic activity of 95 infarcts (78%) was higher than lung parenchyma, with the SUVmax of 3.3 (SD, 1.1). The metabolic patterns on PET/CT were "rim sign," "mismatch between PET and CT," and "no metabolism." Pulmonary vein involvement was found in 25 patients (43%), pleural effusion in 22 patients (38%), and the pleural curvilinear sign in 8 patients (14%).
CONCLUSIONS
The clinical manifestations of hilar tumor-induced pulmonary infarction are not specific, and 18F-FDG PET/CT could be an effective diagnostic tool.
Topics: Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Pulmonary Infarction; Radiopharmaceuticals; Retrospective Studies; Small Cell Lung Carcinoma
PubMed: 35426843
DOI: 10.1097/RLU.0000000000004180 -
Pulmonary Circulation Oct 2023Patients with pulmonary embolism (PE) commonly manifest concomitant "pneumonia," which is generally believed to be either a cause (infection) or a consequence...
Patients with pulmonary embolism (PE) commonly manifest concomitant "pneumonia," which is generally believed to be either a cause (infection) or a consequence (infarction) of PE. This study aimed to clarify the relationship between PE and "pneumonia-like" lesions beyond pulmonary infection and infarction. Chest computed tomography (CT) images of patients with PE and deep vein thrombosis (DVT) were retrospectively analyzed to compare the incidence of pneumonia lesions. The pathological damage and wet/dry ratio of lung tissues were observed in PE rats and PE plasma-injected rats. In total, 793 and 914 inpatients were enrolled in the PE and DVT groups, respectively. Pneumonia lesions were observed in 36.9% and 26.3% of patients in the PE and DVT groups, respectively ( < 0.0001). Among PE rats, 33.3% exhibited focal severe lung injury, which closely resembled the pathological damage of community-acquired pneumonia. The wet/dry ratio was significantly higher in the PE group than in the PE-control group (4.98 ± 0.08 vs. 4.39 ± 0.06, < 0.0001). Among PE plasma-injected rats, individuals with focal proven lung injury were found at all experimental points, with an incidence of 27.6%. The lung wet/dry ratio was significantly higher in the PE plasma group than in the PE-control plasma group at 1 and 2 h postinjection (5.02 ± 0.12 vs. 4.61 ± 0.06 and 4.76 ± 0.16 vs. 4.34 ± 0.09, respectively; < 0.05). In conclusion, the manifestation of pneumonia lesions in chest CT images was higher among PE patients than among DVT patients. Plasma of PE rats could induce focal pneumonia-like lung injury in healthy rats.
PubMed: 38111797
DOI: 10.1002/pul2.12322 -
JACC. Case Reports Feb 2020This report describes a case of embolic myocardial infarction secondary to a pulmonary arteriovenous malformation. Pulmonary arteriovenous malformations are rare and...
This report describes a case of embolic myocardial infarction secondary to a pulmonary arteriovenous malformation. Pulmonary arteriovenous malformations are rare and mostly congenital and are inherited as an autosomal dominant disorder known as hereditary hemorrhagic telangiectasia. Myocardial infarction is an uncommon complication in patients with untreated pulmonary arteriovenous malformations. ().
PubMed: 34317232
DOI: 10.1016/j.jaccas.2019.11.046 -
Gastroenterology Research Jun 2023The aim of the present study was to report different sites of thrombotic events during and after coronavirus disease 2019 (COVID-19) in a 49-year-old patient who had...
The aim of the present study was to report different sites of thrombotic events during and after coronavirus disease 2019 (COVID-19) in a 49-year-old patient who had acute mesenteric infarction in acute phase, stroke 2 months after and pulmonary thromboembolism 4 months after infection by COVID-19. The obese, previously healthy patient experienced myalgia and headache with subfebrile peaks and was tested positive for COVID-19 with a fast polymerase chain reaction (PCR) assay. Ten days after the onset of symptoms, the patient was submitted to exploratory laparotomy, which revealed 20 cm of small intestine loop with signs of suffering and thickening of the wall approximately 120 cm from the ileocecal valve. Two months after the event, angiotomography was performed, revealing effacement of the sulci in the right parietal region and hypersignal of the right middle cerebral artery with stop in M1. Two months later (4 months after the mesenteric infarction), chest angiotomography revealed signs of acute pulmonary thromboembolism, with no typical image of pulmonary infarction. Despite all these complications in the postoperative period, the patient survived.
PubMed: 37351076
DOI: 10.14740/gr1525 -
BMJ Case Reports Oct 2021
Topics: Humans; Pulmonary Embolism; Pulmonary Heart Disease; Pulmonary Infarction; Staphylococcal Infections
PubMed: 34625446
DOI: 10.1136/bcr-2021-246306