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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 -
Respirology Case Reports Sep 2021A 28-year-old woman with a history of treatment with a low-dose oestrogen-progestin (LEP) formulation presented to our hospital due to right chest pain. She had just...
A 28-year-old woman with a history of treatment with a low-dose oestrogen-progestin (LEP) formulation presented to our hospital due to right chest pain. She had just been discharged from another hospital for pneumonia and pleurisy which had improved with antibiotics. Contrast-enhanced computed tomography (CT) revealed bilateral pulmonary emboli corresponding to the peripheral consolidations. The pulmonary emboli indicated that the peripheral consolidation was due to pulmonary infarction (PI). No aetiological factors were identified except for the history of LEP therapy. Although the typical CT images of PI are consolidations in the peripheral area, these finding are non-specific for PI. This case of PI was misdiagnosed as infection because of response to antibiotics and similar CT findings. Therefore, careful evaluation of the patient history and clinical findings are imperative for accurate diagnosis. Venous thromboembolism can occur frequently around 3 months after the start of LEP treatment.
PubMed: 34430034
DOI: 10.1002/rcr2.833 -
The Lancet. Respiratory Medicine Jun 2021The emergent 21st century betacoronaviruses, including SARS-CoV-2, lead to clinicopathological manifestations with unusual features, such as early-onset chest pain,... (Review)
Review
The emergent 21st century betacoronaviruses, including SARS-CoV-2, lead to clinicopathological manifestations with unusual features, such as early-onset chest pain, pulmonary infarction, and pulmonary and systemic thromboembolism that is pathologically linked to extensive capillary, arteriolar, and venular thrombosis. Early ground glass opacities detected by CT, which are reminiscent of lung infarcts associated with pulmonary embolism, point to a novel vascular pathology in COVID-19. Under physiological conditions, normal parenchymal oxygenation is maintained by three sources: the alveolus itself and dual oxygen supply from the pulmonary and bronchial artery circulations. We propose a model in which these three components are disrupted in COVID-19 pneumonia, with severe viral alveolitis and concomitant immunothrombotic obstruction of the pulmonary and bronchiolar circulation. Tricompartmental disruption might have two main consequences: systemic clot embolisation from pulmonary vein territory immunothrombosis, and alveolar-capillary barrier disruption with systemic access of thrombogenic viral material. Our model encompasses the known pathological and clinical features of severe COVID-19, and has implications for understanding patient responses to immunomodulatory therapies, which might exert an anti-inflammatory effect within the vascular compartments.
Topics: COVID-19; Humans; Lung; Models, Biological; Oxygen Consumption; Pulmonary Circulation; Pulmonary Embolism; SARS-CoV-2
PubMed: 34000237
DOI: 10.1016/S2213-2600(21)00213-7 -
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 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 -
Diagnostic and Interventional Imaging Jan 2017The complications following surgery for lung cancer vary depending upon the comorbidities and the type of surgery. Hemorrhage, infections and pulmonary edemas are not... (Review)
Review
The complications following surgery for lung cancer vary depending upon the comorbidities and the type of surgery. Hemorrhage, infections and pulmonary edemas are not specific to the type of resection but frequently occur following pneumonectomies. Morbidity following pneumonectomies is related to the significant changes in the contents of the intrathoracic space. Pulmonary infarction and torsion are emergency situations that develop following lobectomy. CT shows features of localized congestion and stenosis or occlusion of a vein or bronchus. Rapid identification of severe events, in particular by systematic CT is essential for appropriate management of a postoperative or delayed complication of lung cancer surgery.
Topics: Arterial Occlusive Diseases; Chylothorax; Diaphragm; Empyema, Pleural; Foreign Bodies; Heart Diseases; Hernia; Humans; Lung Neoplasms; Mononeuropathies; Neoplasm Recurrence, Local; Phrenic Nerve; Pneumonectomy; Postoperative Complications; Pulmonary Edema; Pulmonary Embolism; Pulmonary Infarction; Torsion Abnormality
PubMed: 26342532
DOI: 10.1016/j.diii.2015.06.022 -
The Korean Journal of Internal Medicine Jul 2022
Topics: COVID-19; Hemoptysis; Humans; Pulmonary Artery; Pulmonary Infarction
PubMed: 35263839
DOI: 10.3904/kjim.2021.493 -
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