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PubMed1980

Radiographic signs of pulmonary embolism.

Contrary to popular belief, the chest x-ray is abnormal in most patients with documented pulmonary emboli. Radiographic signs include elevation of the diaphragm, infiltrate without infarction, pulmonary infarction, atelectasis, pleural effusion, pulmonary edema, signs of reduced blood flow and changes in the pulmonary vasculature. Recognition of these nonspecific signs can alert the physician to the need for definitive testing by lung scanning and angiography.

Aged↗
PubMed1993

Left ventricular function in patients with acute myocardial infarction, acute pulmonary edema, and mechanical ventilation: relationship to prognosis.

OBJECTIVES: To evaluate the relationship between left ventricular function and prognosis in patients treated with mechanical ventilation for severe, persistent pulmonary edema as a consequence of acute myocardial infarction. DESIGN: A prospective study. SETTING: A nine-bed coronary care unit in a 900-bed teaching hospital. PATIENTS: Sixty-nine successive patients. INTERVENTIONS: All patients had acute pulmonary edema not responding to classical treatment and were treated with mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: The inhospital mortality rate was 67%. Thirteen of 23 patients surviving hospitalization died during follow-up, a mean of 5.8 +/- 7.7 months after infarction. Six of ten long-term survivors are in functional capacity class 1 or 2 (New York Heart Association) and four survivors are in class 3. Echocardiographic examination indicated that severe left ventricular dysfunction was present in most patients during the time of mechanical ventilation. Repeat echocardiographic examination performed 14.2 +/- 8.1 months after infarction showed a remarkable improvement in left ventricular function among the survivors. Multivariate analysis indicated that the small group of patients with a good long-term prognosis could not be separated prospectively from the larger group dying during or after hospitalization using variables obtained at the time of mechanical ventilation. CONCLUSIONS: The mortality rate is high in this group of patients. Left ventricular function of survivors is severely diminished at the time of infarction but improves markedly during follow-up. The small subgroup of patients with a good long-term prognosis cannot be identified prospectively when evaluated during the acute stage of infarction and the provision of mechanical ventilation.

Acute Disease↗
PubMed1991

[A case of fulminant hepatic failure secondary to congestive heart failure].

It has been generally accepted that congestive heart failure does not lead to fulminant hepatic failure, unless it is associated with cardiac shock or low cardiac output. Only three cases have been reported, in which liver congestion is followed by fulminant hepatic failure without a history of shock or low cardiac output. Here we present a case of a 48-year-old man with dilated cardiomyopathy and pulmonary infarction, who developed fulminant hepatic failure from congestion. When he was admitted for the control of diabetes mellitus, hepatomegaly of 3-finger breadth and marked cardiomegaly without pulmonary congestion was noted. Diabetes was controlled using insulin. But 3 weeks after admission, he sometimes complained of back dullness because of pulmonary infarction. His heart gradually increased in size, and Jugular venous dilatation and pretibial pitting edema also worsened. Jaundice was noted and serum GOT and GPT increased. A large liver of 6-finger breath below the right costal margin was able to be felt. But within one week, the size of the liver markedly decreased and the signs of hepatic failure such as jaundice, hepatic encephalopathy and numerous petechiae appeared. Blood pressure was maintained and no hypotension or cardiac shock was noted. The patient died of fulminant hepatic failure on the 20th days after onset of the hepatic failure. The autopsy revealed liver atrophy with severe central lobular necrosis, and thrombus in the right main pulmonary artery which caused severe pulmonary infarction. The mechanism of fulminant hepatic failure not accompanied with low cardiac output is discussed.

Cardiomyopathy, Dilated↗
PubMed1965

PREVENTING, RECOGNIZING, TREATING PULMONARY EMBOLISM.

PULMONARY EMBOLISM OCCURS IN THREE FORMS: (1) Asymptomatic "silent" embolization of lungs; (2) pulmonary infarction; and (3) massive pulmonary embolization leading to acute cor pulmonale. The commonest source of emboli are veins of the lower extremities and of the pelvic organs. The prevention and the treatment of pulmonary embolism overlap, for except for the heroic procedure of pulmonary embolectomy, treatment is equivalent to the prevention of further emboli. The diagnosis may be easy in typical cases and very difficult in others.

Acute Disease↗
PubMed1979

The value of serum fibrinogen degradation products in the differential diagnosis between acute myocardial infarction and pulmonary embolism.

Serum-FDP was measured in 148 patients with AMI or pulmonary embolism within 48 hours of the onset of symptoms or within 48 hours of the admission to hospital. Within 48 hours of the hospitalisation 14.6% of the patients with AMI Rand 81.8% of the patients pulmonary embolism showed a serum-FDP elevation to over 10 units/ml. The use of the analysis is limited by the time which elapses until the result is available, by the short duration of the serum-FDP elevation and by the lack of specificity of the examination.

Adult↗
PubMed1975

Infarcted extralobar pulmonary sequestration.

A 32-year-old man who presented with symptoms suggesting empyema was found at thoracotomy to have infarction of an extralobar pulmonary sequestration. He was completely relieved by excision of the sequestration after securing the systemic vascular pedicle which had undergone torsion. Recognition of the anomalous bloody supply and other congenital anomalies in such cases is emphasized.

Adult↗
PubMed2006

Diffuse large B-cell lymphoma presenting as a unilateral solitary round pulmonary hilar node infarction.

Unilateral solitary pulmonary hilar node adenopathy is a rare presentation of diffuse large B-cell lymphoma. In this report, the authors present a case with a solitary pulmonary hilar lymph node infarction caused by diffuse large B-cell lymphoma. Enhanced CT examinations revealed a well-defined round mass with homogenous low attenuation in the left pulmonary hilum. Both radiological imaging and pathological examination can provide useful information for the interpretation of abnormalities and may enable the diagnosis of rare aetiologies.

Biopsy↗
PubMed1999

Differences in the platelet proaggregatory activity of immune complexes isolated from patients with myocardial infarction or pulmonary cancer.

Immune complexes were isolated immediately after the onset of the symptoms of myocardial infarction on an anti-Clq affinity column. The platelet proaggregatory effects of these immune complexes were compared with those isolated from patients suffering from pulmonary cancer. A markedly increased proaggregatory effect of immune complexes derived from patients with myocardial infarction and changes in the sensitivity of platelets from healthy volunteers to PGI(2) (prostacyclin) and PGD(2) were found. In contrast, immune complexes from patients with pulmonary cancer did not show any significant effect. The antigenic part of immune complexes is probably relevant in the induction of platelet aggregation.

Journal Article↗
PubMed1998

Flitting radiographic shadows: an unusual presentation of cancer in the lungs.

Tumour involvement of pulmonary blood vessels occurs frequently in advanced lung cancer and occasionally may cause pulmonary infarction. A case is reported of diffuse obstruction of pulmonary arteries by cancer in which no primary tumour was found, and which presented as flitting radiographic opacities due to pulmonary infarction.

Aged↗
PubMed1998

[Fatal pulmonary thromboembolism in a patient with paroxysmal nocturnal hemoglobinuria].

A 38 year old woman with paroxysmal nocturnal hemoglobinuria was admitted to our hospital because of hemoptysis. Pulmonary infarction was diagnosed by the perfusion lung scan. In spite of the administration of prednisolone, dextran, low molecular weight heparin, and warfarin, she died of pulmonary infarction and secondary pulmonary hypertension. Autopsy revealed thromboembolism of both pulmonary arteries and hepatic central vein thrombosis. Recent understanding of the pathogenesis and incidence of thromboembolism in paroxysmal nocturnal hemoglobinuria was discussed.

Adult↗
PubMed1998

Acute Pulmonary Embolism Presenting as Pulmonary Hemorrhage/Infarction Syndrome in the Elderly.

PURPOSE: The purpose of this investigation was to determine the characteristics of the history, physical examination, chest radiograph, electrocardiogram, and the ventilation/perfusion lung scan probability in elderly patients with pulmonary embolism who present with the syndrome of pulmonary infarction or hemorrhage. BACKGROUND: In considering a possible diagnosis of acute pulmonary embolism, it is helpful to focus on the characteristics of the patient in terms of the characteristics of the presenting syndrome. The syndrome of pulmonary hemorrhage or pulmonary infarction is the most common syndrome of acute pulmonary embolism. It is defined by the presence of pleuritic pain or hemoptysis. Whether there are features of the pulmonary hemorrhage/infarction syndrome that are specific to elderly patients, or would suggest or tend to exclude a diagnosis is unknown. Therefore, this investigation was undertaken. METHODS: Patients reported in this investigation participated in the national collaborative trial of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). All had pulmonary embolism diagnosed by pulmonary angiography. Patients with associated cardiac pulmonary disease were excluded. Elderly patients (N equals 17) were defined as patients at or above 70 years of age. Comparisons were made with patients age 40-69 years (N equals 67) and with patients under 40 years of age (N equals 35). RESULTS: In elderly patients, malignancy was a frequent predisposing factor (29%) in addition to immobilization (76%). Dyspnea or tachypnea, in addition to pleuritic pain or hemoptysis, were present in 94% of elderly patients. Among elderly patients with the pulmonary hemorrhage/infarction syndrome, pleuritic pain was more frequent than hemoptysis (88% vs. 12%). The electrocardiogram was normal in 62% of elderly patients. If abnormal, the most frequent abnormalities were nonspecific ST segment or T-wave changes (38%). The chest radiograph showed atelectasis or a pulmonary parenchymal abnormality in 82% of elderly patients. The central pulmonary artery dilated in 29% of elderly patients. A normal chest radiograph was uncommon, occurring in only 6%. The ventilation/perfusion lung scan was useful and was interpreted as high probability for pulmonary embolism in 41% of elderly patients. Elderly patients had a higher pulmonary artery mean pressure (25 Â+/-9 vs. 17 Â+/-7 mm Hg) and lower partial pressure of oxygen in arterial blood (64 Â+/-10 vs. 81 Â+/-14 mm Hg) than patients less than 40 years, and elderly patients tended to have more mismatched segmental perfusion defects on the ventilation/perfusion lung than patients less than 40 years (4.8 Â+/-5.5 vs. 2.1 Â+/-2.9 mismatched perfusion defects). CONCLUSIONS: Although a few clinical features of the pulmonary hemorrhage/infarction syndrome of pulmonary embolism in elderly patients differ from patients less than 40 years of age, in general, the clinical characteristics are comparable to younger patients.

Journal Article↗
PubMed1995

CT-guided automated needle biopsy of the chest.

OBJECTIVE: The purpose of this study was to determine the diagnostic accuracy and frequency of complications of CT-guided transthoracic needle biopsy done with an automated biopsy system. MATERIALS AND METHODS: Thirty-three consecutive biopsies were performed on 32 patients between February 1992 and July 1994 (mean age, 55 +/- 15 years; 18 men and 14 women). An 18-gauge (n = 28) or 20-gauge (n = 5) needle was used. Core specimens were submitted for pathologic examination in 10% formalin. No cytopathologist or frozen section analysis was available at the time of biopsy. All biopsies but one were performed by one chest radiologist. RESULTS: Thirty-one lung biopsies and two mediastinal biopsies yielded a mean lesion size of 4.0 cm (range, 1.2-13.0 cm). Postbiopsy pneumothorax occurred in three (9%) of 33 biopsies; none of the pneumothoraces required placement of a chest tube. The mean number of needle passes was 1.3 (+/- 0.6). Thirty biopsies (91%) yielded sufficient tissue for pathologic evaluation. The diagnoses included carcinoma in 14 cases, acute or chronic pneumonia in 4 cases, non-Hodgkin's lymphoma in two cases, and Kaposi's sarcoma, plasma cell granuloma, hypersensitivity pneumonitis, Pneumocystis carinii pneumonia, and fibrosis in one case each. One patient with a 1.5-cm nodule stable for 1 year on CT had fibrosis and chronic inflammation found on needle biopsy, and the nodule was considered benign. Overall, biopsies in 12 (80%) of 15 patients without carcinoma were diagnostic. In three patients, the tissue obtained was not representative of the underlying abnormality. The biopsy specimen showed only inflammatory changes in two patients who ultimately had proved carcinoma. One patient with multiple pulmonary infarcts due to tumor emboli showed evidence of only pulmonary infarct on biopsy. Three patients had insufficient tissue for analysis; none of the three had malignant tumor on follow-up. The sensitivity of CT-guided automated needle biopsy of the chest was 84%. CONCLUSION: CT-guided transthoracic needle biopsy of the chest done with an automated biopsy system is safe, with a pneumothorax rate comparable to that of skinny needle aspiration. An overall accurate tissue diagnosis was made in 26 (81%) of 32 patients. Biopsies in 12 (80%) of 15 patients without carcinoma were diagnostic, which compares favorably with the reported accuracy of skinny needle aspiration.

Biopsy, Needle↗
PubMed1995

[Spiral computerized tomography of the pulmonary arteries: diagnosis of acute and chronic lung embolism].

The use of tailored acquisition spiral CT protocols together with standardized contrast medium injections result in a detailed visualization of the pulmonary arteries. Since spiral CT is a quick and noninvasive imaging modality, it is especially suited for severely ill patients suspected to be suffering from acute pulmonary embolism. In contrast to perfusion scintigraphy, spiral CT will directly visualize the emboli, and should be performed if scintigraphy is not conclusive before the patient is referred to angiography. In cases of chronic pulmonary embolism spiral CT will directly visualize thromboemboli, consecutive wall thickening, pulmonary infarctions, and relative hyperperfusion as well as signs of pulmonary arterial hypertension and right heart failure. Acquisition protocols, diagnostic criteria, and clinical value of spiral CT are presented.

Acute Disease↗