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PubMed1995

Incidence of pulmonary thromboembolism, infarction and haemorrhage in disseminated intravascular coagulation: a necroscopic analysis.

BACKGROUND: The pathological features of the lung in disseminated intravascular coagulation (DIC) have not been established. This study was carried out on lungs taken at necropsy to examine the incidence and extent of thromboembolism, infarction, and haemorrhage. METHODS: The subjects were 87 patients whose illnesses were complicated by DIC and 64 patients who showed no abnormalities of blood coagulation in their terminal illness. The lungs were fixed by intrabronchial infusion of 10% formalin, cut into 5 mm thick slices, and each cut surface was carefully examined for macroscopic thromboembolism, infarction, and haemorrhage. Five tissue blocks per case were taken for quantitative analysis of microscopic thromboembolism. RESULTS: In the control group macroscopic thromboembolism was identified in 20 cases (31.3%), infarction in one, and haemorrhage also in one. Moreover, fibrin thrombosis was seen in 13 cases (20.3%) and microthromboembolism in 24 (37.5%). Of the 87 patients with DIC, thromboembolism was found in 51 cases (58.6%), infarction in six, haemorrhage in 14, microscopic fibrin thrombosis in 43 (49.4%), and microthromboembolism in 45 (51.7%). Macroscopic thromboembolism, haemorrhage, and fibrin thrombosis were found more often in the patients with DIC. CONCLUSIONS: In addition to fibrin thrombosis, macroscopic thromboembolism and haemorrhage were the main pathological findings in the lungs of patients dying with DIC. The frequency of pulmonary infarction increased in proportion to the frequency of thromboembolism.

Aged↗
PubMed1990

[Lung infarcts detected with ultrasonography].

33 patients with clinical signs of pulmonary infarction were investigated by intercostal chest sonography. 40 preponderant triangular sharply outlined echo-poor lesions were detected with an airdense reflex in the centre of the area as a sign of segmental involvement. Sonomorphology of pulmonary infarction is compared to pneumonias (n = 22) and carcinomas (n = 20). The sensitivity of chest sonography in pulmonary infarction is 96%, whereas the diagnostic accuracy is 82%.

Diagnosis, Differential↗
PubMed1992

[Acute respiratory insufficiency in sickle cell disease].

Two cases are reported of acute respiratory failure occurring during sickling crises. In the first one, the crisis was characterised by priapism, and in the other one, by abdominal pain. The different causes of these respiratory effects are discussed: infection, fat embolism, pulmonary infarct, haemodynamic pulmonary oedema, as was probably the case in the first patient, or non haemodynamic pulmonary oedema due to sickling, as during conventional treatment of a sickling crisis (oxygen, antibiotics, blood transfusion, cytapheresis). Invasive investigations may contribute to keeping up the clinical picture, because of hypoxic sickling. The water equilibrium of these patients must be monitored with great care. Worsening of the patient's condition despite 48 h of correct treatment must lead to the search for a specific cause.

Acute Disease↗
PubMed1999

Clinical and laboratory features of lupus patients with complicating pulmonary disease.

The objective of this study was to determine the incidence of pulmonary involvement in patients with systemic lupus erythematosus (SLE) and to clarify the clinical and laboratory characteristics in SLE patients with various pulmonary involvements. A retrospective study (n = 137) revealed that the types of pulmonary involvement found in SLE patients were: pleuritis (9%), interstitial pneumonia (8%), pulmonary infarction (7%), pulmonary infection (4%), pulmonary hypertension (2%), restrictive dysfunction (28%) and decreased diffusion capacity (43%). The incidences of pericarditis (P < 0.01), arthralgia (P < 0.05) and hypoalbuminemia (P < 0.05) were significantly greater in patients with pleuritis than in those without, while in patients with interstitial pneumonia, the incidence of anti-SS-A antibody (P < 0.05) and sicca syndrome (P < 0.05) were significantly greater than in those without. A longitudinal follow-up study of patient groups with various pulmonary involvements revealed: 1. significant changes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lactate dehydrogenase (LDH) and thrombomodulin (TM) in patients with pleuritis, and 2. significant changes of WBC and LDH in patients with interstitial pneumonia. The increased ESR, CRP and TM levels during disease episodes suggest that the involvement of inflammatory processes is related to vasculitic events in the pathogenesis of lupus pleuritis. A higher incidence of anti-SS-A antibody in lupus patients with interstitial pneumonia suggests a potential role for this autoantibody in the pathogenesis of this complication.

Adolescent↗
PubMed2004

Candida endocarditis with mycotic pulmonary emboli following re-do Rastelli operation.

A case of a 19 year old patient with Candida endocarditis complicated by pulmonary infarction and pulmonary mycotic abscesses following replacement of a right ventricle to pulmonary artery homograft conduit is presented. Despite preceding hospital admissions with probable septic pulmonary emboli, diagnosis was made only after massive pulmonary haemorrhage that ultimately proved fatal. This case highlights that Candida endocarditis should be considered in patients with symptoms and signs compatible with bacterial endocarditis when blood cultures are negative, especially in the setting of congenital cardiac malformations, and illustrates the high mortality associated with delayed diagnosis.

Adult↗
PubMed1987

Pulmonary artery agenesis presenting as massive hemoptysis--a case report.

Massive hemoptysis is the expectoration of approximately 600 ml of blood in twenty-four hours. Major causes of massive hemoptysis are tuberculosis, bronchiectasis, pulmonary neoplasm, fungus ball, bronchial adenomas, lung abscess, intrabronchial rupture of an aortic aneurysm, cystic fibrosis, pulmonary infarction, and pulmonary trauma. Other, less common causes include Goodpasture's syndrome, broncholiths, pulmonary varix, A-V malformation, and bleeding disorders. Agenesis of the pulmonary artery usually occurs in association with congenital cardiac anomalies, and isolated unilateral absence of the pulmonary artery is uncommon. About 10% of the patients with pulmonary artery agenesis develop inconsequential hemoptysis, but massive hemoptysis is a very rare complication of this anomaly. The following is a case report of a twenty-nine-year-old man with agenesis of the left pulmonary artery, who presented with massive hemoptysis requiring embolization and, eventually, pneumonectomy.

Adult↗
PubMedDate not supplied

Fine needle aspiration cytology of renal infarcts. Cytomorphologic findings and potential diagnostic pitfalls in two cases.

The fine needle aspiration (FNA) cytologic features of two cases of renal infarction are presented. Both patients did not have a classic clinical history for infarction, and the radiologic findings were suggestive of neoplasia. In one of our cases, necrotic glomeruli and tubules were present, which suggested the correct diagnosis of renal infarction and permitted appropriate early treatment. In the other case, groups of atypical renal tubular cells undergoing repair secondary to the infarction was misinterpreted as renal cell carcinoma. This case illustrates that renal infarction, like pulmonary infarction, can be a potential pitfall for a false-positive cytologic diagnosis of malignancy in FNA biopsy. A conservative approach is warranted when there is scanty cellularity and atypical cells having features of a repairlike reaction are present.

Adult↗
PubMed2006

Clinical syndromes and clinical outcome in patients with pulmonary embolism: findings from the RIETE registry.

INTRODUCTION: The influence of the clinical syndromes of pulmonary embolism (PE) on clinical outcome has not been evaluated. PATIENTS AND METHODS: The Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) is an ongoing registry of consecutive patients with acute venous thromboembolism. In this study, all enrolled patients with acute PE without preexisting cardiac or pulmonary disease were classified into three clinical syndromes: pulmonary infarction, isolated dyspnea, or circulatory collapse. Their clinical characteristics, laboratory findings, and 3-month outcomes were compared. RESULTS: As of January 2005, 4,145 patients with acute, symptomatic, objectively confirmed PE have been enrolled in RIETE. Of them, 3,391 patients (82%) had no chronic lung disease or heart failure: 1,709 patients (50%) had pulmonary infarction, 1,083 patients (32%) had isolated dyspnea, and 599 patients (18%) had circulatory collapse. Overall, 149 patients (4.4%) died during the first 15 days of therapy: 2.5% with pulmonary infarction, 6.2% with isolated dyspnea (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7 to 3.8), and 6.5% with circulatory collapse (OR, 2.7; 95% CI, 1.7 to 4.2). From days 16 to 90, 31 patients had recurrent PE; 5 of 14 patients (36%) with pulmonary infarction died of their new PE, compared with 5 of 10 patients (50%) with isolated dyspnea, and all 7 patients (100%) with circulatory collapse. CONCLUSIONS: PE patients with pulmonary infarction (50% of the whole series) had a significantly lower mortality rate both during initial therapy and after discharge.

Acute Disease↗
PubMed2004

[Correlation of serum IgE levels with severity of acute pulmonary thromboembolism].

UNLABELLED: We aimed to investigate whether there is a direct correlation of serum IgE concentration with severity of acute pulmonary thromboembolism (PTE). DESIGN: Prospective study. SETTINGS: University medical center. Forty-six patients (27 female, 19 male) who were diagnosed as acute PTE in our clinic between 01 October 2000 and 30 November 2001 comprised the study group. Mean age was 55 (range was 20-82). The study group was divided into three groups according to severity of PTE: Group A, submassive PTE without pulmonary infarction (20 patients); group B, submassive PTE with pulmonary infarction (15 patients); and group C, massive PTE (11 patients). Serum IgE concentrations were measured by ELISA method at 1st, 5th, 15th, 30th, 60th, 90th days, and 120th days, if needed, after the diagnosis. Statistical analysis was made by Post hoc Tukey test. First day serum IgE levels were highest in group B (mean 507.7) followed by group C (mean 324.2), and were lowest in group A (mean 117.2). The differences between group B and group C, between group B and group A, and also between group C and A were all statistically significant (p< 0.5, p< 0.0001, p< 0.015, respectively). 5th day and 15th day results showed statistically significant differences between group B and A, and between group C and A (at 5th day: p<0.0001, p< 0.015 respectively, and at 15th day: p< 0.0001, p< 0.012 respectively). At 30th, 60th, and 90th days of diagnosis serum IgE concentrations were higher in group B than in group A which were statistically significant (p< 0.0001, p< 0.0001, p< 0.019 respectively). Patients with submassive PTE and pulmonary infarction had the highest serum IgE concentrations and the longest duration of high levels of IgE.

Acute Disease↗
PubMed2000

Long-term effects of diltiazem and verapamil on mortality and cardiac events in non-Q-wave acute myocardial infarction without pulmonary congestion: post hoc subset analysis of the multicenter diltiazem postinfarction trial and the second danish verapamil infarction trial studies.

The main objective of this retrospective analysis was to evaluate the long-term effect of the heart rate-lowering calcium antagonists verapamil and diltiazem on the incidence of combined cardiac events and all-cause mortality in patients who had experienced a non-Q-wave acute myocardial infarction (AMI), but who did not also have pulmonary congestion. In addition, factors having an independent association with these 2 outcomes were identified. Of 817 non-Q-wave patients, 81 (9.9%) died during 12 to 52 months of follow-up. The unadjusted mortality rate was 42% lower in patients randomized to calcium antagonist therapy than placebo (7.2% vs 12.4%, p = 0.010). Non-Q-wave patients who died during follow-up were older than patients who survived (62 vs 58 years, p = 0.001). Other factors found to have an independent association with all-cause mortality included diuretic use (RR 2.79), diabetes mellitus (RR 2.86), and New York Heart Association class >I (RR 1.73). The covariate adjusted all-cause mortality risk ratio associated with randomization to calcium antagonist therapy was 0.65 (95% confidence interval [0.40 to 1.05, p = 0.079]). Overall, 153 patients (18.7%) died or had nonfatal reinfarction. The unadjusted combined event rate was 31% lower in patients randomized to calcium antagonist therapy than to placebo (15.2% vs 21.9%, p <0.006). Factors found to have an independent association with cardiac events included age, diabetes (RR 2.82), diuretic use (RR 2.04), and previous AMI (RR 1. 71). In addition, randomization to the calcium antagonist group had a significant independent association with reduced cardiac events (p = 0.031). The covariate adjusted event rate RR associated with randomization to the calcium antagonist group was 0.69 (95% confidence interval [0.49 to 0.97]). In conclusion, the heart rate-lowering calcium antagonists diltiazem and verapamil may play an important role in reducing long-term mortality and reinfarction in non-Q-wave AMI without pulmonary congestion.

Adult↗
PubMed1976

Comparison of left and right ventricular function in acute myocardial infarction.

Pulmonary arterial end-diastolic and mean right atrial pressures were compared in 25 patients with acute myocardial infarction and in one patient with unstable angina. No consistent relationship was observed between these pressures. Simultaneous ventricular function curves relating the stroke work of each ventricle to its respective filling pressure were constructed on 34 occasions, dextran infusion or diuresis being used to alter the filling pressure. The curves from each ventricle were described mathematically by a quadratic (parabolic) function as well as by a straight line function and then compared by canonical correlation analysis. Alterations in the left ventricular function curves occurred with and without depression or right ventricular function curves. These hemodynamic measurements demonstrate that acute myocardial infarction can alter the relationship between left and right ventricular function.

Adult↗
PubMed1991

Liquid crystal thermography as a screening test for deep vein thrombosis in patients with cerebral infarction.

Pulmonary embolism secondary to deep vein thrombosis is a frequent cause of death in stroke patients. In a multicentre study of deep vein thrombosis prophylaxis, 112 patients with cerebral infarction and leg paresis were given aspirin 300 mg three times a day (t.d.s.) alone or with dipyridamole 100 mg t.d.s. To screen for deep vein thrombosis liquid crystal thermography of the legs was performed daily for 15 days on all patients. Those patients with positive thermography underwent immediate X-ray venography of the appropriate limb as the definitive investigation for venous thrombosis. Twenty-two patients had positive thermograms, of whom 16 had confirmed deep vein thrombosis as demonstrated by X-ray venography. Only 8 of the 22 had clinical signs of deep vein thrombosis and 2 of those had a negative venogram. Of the 14 patients with positive thermography but negative clinical signs 10 had positive venograms. Difference in the incidence of deep vein thrombosis in the two treatment groups was not demonstrated. It is concluded that occult deep venous thrombosis is common after ischaemic stroke and it can occur without clinical signs. Liquid crystal thermography is a simple, rapid and cheap screening test that will allow the detection of clinically unrecognized thrombosis.

Aged↗
PubMed1999

Thrombotic pulmonary arteriopathy in polycythemia vera.

Pulmonary infarction and hemorrhage are important differential diagnoses in pulmonary coin lesions, especially in patients with underlying hematologic malignancies. We report a 58-year-old female patient suffering from polycythemia vera presenting with multiple pulmonary coin lesions. Open lung biopsy and subsequent histologic investigations showed organized pulmonary infarction and primary pulmonary thrombotic arteriopathy. Although histologic features are non-contributory in distinguishing organized thrombosis from organized thromboembolism, the clinical setting and localization of the lesions suggest that in the present case the vascular lesions are due to organized thrombosis.

Biopsy↗