-
Cureus Jan 2021Focused abdominal sonography in trauma (FAST) and contrast-enhanced computed tomography (CECT) abdomen are important radiological tests for evaluating the abdomen in...
Focused abdominal sonography in trauma (FAST) and contrast-enhanced computed tomography (CECT) abdomen are important radiological tests for evaluating the abdomen in polytrauma cases. When vitals are stable, they help to reach a diagnosis in the majority of patients. However, in a small number of cases they fail to explain the clinical scenario. A continued serial clinical assessment may be helpful in these circumstances. A polytrauma patient was found to be FAST positive. The CT scan revealed pulmonary embolism, splenic infarction, perisplenic and perihepatic hematoma. The patient was complaining of pain abdomen and it worsened on day three of the injury. An exploratory laparotomy was performed. A circumferential intestinal wall hematoma with a tear in mesentery was found. This is a rare case of traumatic splenic infarction with evidence of pulmonary embolism. The serial clinical assessment was helpful as it indicated the need for intervention.
PubMed: 33564519
DOI: 10.7759/cureus.12514 -
Vascular and Endovascular Surgery Apr 2023Bullet embolization is a rare but dangerous phenomenon. Based on the location of embolization, migration of bullets can cause limb or intra-abdominal ischemia, pulmonary... (Review)
Review
PURPOSE
Bullet embolization is a rare but dangerous phenomenon. Based on the location of embolization, migration of bullets can cause limb or intra-abdominal ischemia, pulmonary infarction, cardiac valve injury, or cerebrovascular accident. Bullet emboli can present a diagnostic challenge given the varied nature of complications based on location of embolization, which may not coincide with the site of initial injury. The purpose of this study is to present several cases of bullet embolization from our busy urban trauma center and make recommendations for management.
METHODS
We present 3 cases of bullet embolization seen in injured patients at our Level 1 trauma center. We describe our management of these injuries and make recommendations for management in the context of our institutional experience and comment on the available literature regarding bullet embolization.
RESULTS
Two of our patients presented in extremis and required operative intervention to achieve stability. The intravascular missile was discovered intraoperatively in one patient and removed in the operating room, while the missile was discovered on postoperative imaging in another patient and again removed operatively after an unsuccessful attempt at minimally invasive retrieval. Our third patient remained hemodynamically stable throughout his hospitalization and had endovascular management of his bullet embolus.
CONCLUSION
Bullet emboli present a challenging complication of penetrating trauma. We recommend removal of all arterial bullet emboli and those within the pulmonary venous system. In hemodynamically stable patients, we recommend initial attempts of endovascular retrieval followed by open surgical removal. We recommend open removal in cases of hemodynamic instability.
Topics: Humans; Foreign-Body Migration; Wounds, Gunshot; Treatment Outcome; Embolism; Foreign Bodies
PubMed: 36408888
DOI: 10.1177/15385744221141295 -
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 -
BMJ Case Reports Nov 2013
Topics: Chest Pain; Hemoptysis; Humans; Male; Middle Aged; Pleura; Pulmonary Embolism; Pulmonary Infarction; Radiography
PubMed: 24197813
DOI: 10.1136/bcr-2013-201789 -
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 -
International Journal of Legal Medicine Sep 2020Pulmonary thromboembolism may be accompanied by pulmonary infarction. Even though pulmonary thromboembolism (PTE) is a frequently found cause of death at autopsy,...
Pulmonary thromboembolism may be accompanied by pulmonary infarction. Even though pulmonary thromboembolism (PTE) is a frequently found cause of death at autopsy, pulmonary infarction accompanying PTE is a less common finding and may therefore easily be misinterpreted as infectious or cancerous lung disease. Appearance of pulmonary infarction in post-mortem imaging and acquisition parameters helping to identify pulmonary infarctions are not described yet. Based on a case of a 50-year-old man who died due to PTE and presented pulmonary infarction, we suggest using a pulmonary algorithm in post-mortem computed tomography combined with post-mortem magnetic resonance imaging of the lungs using conventional T1- and T2-weighted sequences.
Topics: Autopsy; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pulmonary Embolism; Pulmonary Infarction; Tomography, X-Ray Computed
PubMed: 32239316
DOI: 10.1007/s00414-020-02273-5 -
International Journal of Chronic... 2011Smoking is the leading modifiable risk factor for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), and lung cancer. Smoking cessation is the... (Review)
Review
Smoking is the leading modifiable risk factor for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), and lung cancer. Smoking cessation is the only proven way of modifying the natural course of COPD. It is also the most effective way of reducing the risk for myocardial infarction and lung cancer. However, the full benefits of tobacco treatment may not be realized until many years of abstinence. All patients with COPD, regardless of severity, appear to benefit from tobacco treatment. Similarly, patients with recent CVD events also benefit from tobacco treatment. The risk of total mortality and rate of recurrence of lung cancer is substantially lower in smokers who manage to quit smoking following the diagnosis of early stage lung cancer or small cell lung cancer. Together, these data suggest that tobacco treatment is effective both as a primary and a secondary intervention in reducing total morbidity and mortality related to COPD, CVD, and lung cancer. In this paper, we summarize the evidence for tobacco treatment and the methods by which smoking cessation can be promoted in smokers with lung disease.
Topics: Health Promotion; Humans; Lung Neoplasms; Myocardial Infarction; Pulmonary Disease, Chronic Obstructive; Risk Assessment; Risk Factors; Risk Reduction Behavior; Smoking; Smoking Cessation; Time Factors; Tobacco Use Disorder; Treatment Outcome
PubMed: 21814462
DOI: 10.2147/COPD.S10771 -
The American Journal of Case Reports Nov 2019BACKGROUND Risk factors for venous thromboembolism can include a combination of genetic, anatomic, and physiologic factors, some of which are modifiable. Patients...
BACKGROUND Risk factors for venous thromboembolism can include a combination of genetic, anatomic, and physiologic factors, some of which are modifiable. Patients presenting to the hospital with venous thromboembolism may have multiple risk factors that require testing beyond the initial admission labs and hypercoagulability screening panel. CASE REPORT We describe a right-handed patient who lifts weights for exercise, who presented with pulmonary infarcts and clot in the right superior vena cava/subclavian vein. These were due to a combination of 1) an acquired hypercoagulability from minimal change disease and 2) dynamic anatomic narrowing of the subclavian vein, which is known as Paget-Schroetter syndrome. Despite normal serum levels of antithrombin, protein C and S, his serum albumin was low, which prompted workup for proteinuria. Testing revealed nephrotic range proteinuria as well as dynamic occlusion of the right subclavian vein on magnetic resonance venography only when the patient lifted and externally rotated his arms. CONCLUSIONS This case report highlights the need for a thorough history and physical examination, as well as additional testing in some patients beyond the initial admission laboratory tests and screening panel for hypercoagulability. Tests could include diagnostic imaging testing with provoking maneuvers, which can help elucidate dynamic physiology. Such testing, when appropriate, can help to inform the treatment plan and prevent recurrent thromboses.
Topics: Anticoagulants; Combined Modality Therapy; Diagnosis, Differential; Humans; Male; Mechanical Thrombolysis; Nephrotic Syndrome; Pulmonary Infarction; Upper Extremity Deep Vein Thrombosis; Young Adult
PubMed: 31727870
DOI: 10.12659/AJCR.919141 -
BMC Pregnancy and Childbirth Aug 2023Pulmonary arteriovenous fistula is rare during pregnancy. Pulmonary arteriovenous fistula presents no pulmonary symptoms in most patients but can be exacerbated by... (Review)
Review
BACKGROUND
Pulmonary arteriovenous fistula is rare during pregnancy. Pulmonary arteriovenous fistula presents no pulmonary symptoms in most patients but can be exacerbated by pregnancy. If not diagnosed and treated promptly, pulmonary arteriovenous fistula can lead to respiratory failure, stroke, spontaneous hemothorax, or other fatal complications.
CASE PRESENTATION
A 29-year-old healthy pregnant woman presented with a transient drop in blood oxygen level of unknown cause during a routine examination at 34 weeks of gestation and during a cesarean section at 38 weeks of pregnancy. The patient's oxygen saturation quickly returned to normal and was not further investigated. On day 3 postpartum, the patient suddenly displayed slurred speech and right limb myasthenia. A head magnetic resonance imaging revealed cerebral infarction in the left basal ganglia. Subsequent computed tomography pulmonary arteriography revealed bilateral pulmonary arteriovenous fistula, which was likely the cause of cerebral infarction. The patient was transferred to the Department of Thoracic Surgery after one month of treatment and successfully underwent percutaneous embolization of pulmonary arteriovenous fistula.
CONCLUSION
Pulmonary arteriovenous fistula should not be neglected if a pregnant woman presents with transient hypoxemia and cerebral infarction. A transient decrease in pulse oxygen saturation that cannot be explained by common clinical causes can be an early warning sign of the disease. Early diagnosis and multidisciplinary management could improve the prognosis.
Topics: Pregnancy; Humans; Female; Adult; Cesarean Section; Cerebral Infarction; Stroke; Hypoxia
PubMed: 37653522
DOI: 10.1186/s12884-023-05946-2 -
Clinical Medicine (London, England) Dec 2015A 55-year-old man presented with acute ST-elevation myocardial infarction. He received rescue angioplasty with one drug eluting stent. He developed marked breathlessness...
A 55-year-old man presented with acute ST-elevation myocardial infarction. He received rescue angioplasty with one drug eluting stent. He developed marked breathlessness and haemoptysis two days later. Investigations led to the diagnosis of pulmonary haemorrhage, possibly from pneumonitis caused by ticagrelor. He was successfully managed with high-dose steroids and ticagrelor was replaced with clopidogrel. On stopping the steroids a month later, mild haemoptysis recurred and this was managed conservatively. Pneumonitis and pulmonary haemorrhage is rarely reported with acute myocardial infarction, but poses serious challenge to the patient and the clinician. Diagnosis may be delayed as breathlessness can occur due to myriad causes after myocardial infarction. Interrupting dual anti-platelet therapy after angioplasty could lead to devastating stent thrombosis.
Topics: Adenosine; Angioplasty; Hemoptysis; Hemorrhage; Humans; Male; Middle Aged; Myocardial Infarction; Pneumonia; Purinergic P2Y Receptor Antagonists; Radiography, Thoracic; Thrombosis; Ticagrelor
PubMed: 26621956
DOI: 10.7861/clinmedicine.15-6-591