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PubMed1992

Pneumatocele complicating hyperimmunoglobulin E syndrome (Job's Syndrome).

The case of a boy with hyperimmunoglobulin E syndrome or Job's syndrome is presented to demonstrate the occurrence of pneumatoceles in this syndrome as well as their unusual natural history and failure to spontaneously resolve. Surgical resection was required for two complications in this patient, persistent bronchopleural fistula and a pulmonary abscess that destroyed one lung and required pneumonectomy. Pathologic examination of the specimens demonstrated the wall of the cysts consisted of granulation tissue with chronic active inflammation surrounded by infarcted pulmonary parenchyma with coagulative necrosis. The mechanism responsible for increased immunoglobulin E production in this syndrome is unknown, as is the manner in which elevated immunoglobulin E levels impair normal immune function.

Aspergillosis↗
PubMed1989

[CT in pulmonary embolism].

In 47 patients with clinically suspected pulmonary emboli CT and scintillation tests were performed. Our result is, that in case of defects in the a. pulmonalis filled with contrast medium and pronounced CT-signs of pulmonary infarction embolization is likely even for a negative or unclear outcome of the scintillation tests.

Humans↗
PubMed1979

Scintigraphic evaluation of pulmonary perfusion in dogs experimentally infected with Dirofilaria immitis.

Pulmonary arterial perfusion was evaluated by perfusion lung scans in ten dogs experimentally infected with heartworm. After larval inoculation, scans were done once a month for 11 months. In 8 of 10 dogs, pulmonary arterial perfusion deficits were detected. The perfusion deficits involved the left cranial, right cranial, and right caudal lung lobes. Generally, there was a poor correlation between vascular abnormalities detected on the survey thoracic radiographs and the perfusion deficits detected by lung scanning. The perfusion deficits did not produce clinical signs or pulmonary infarction.

Animals↗
PubMed1988

Solitary coin lesion in patients with malignant melanoma: an indication for thoracotomy?

In five patients solitary pulmonary lesions were detected radiographically during routine follow up after malignant melanoma. Surgical removal was done in each case under the tentative diagnosis of metastases. Histologically, two lesions turned out as benign chondroma, one as organized pulmonary infarction and one as bronchogenic carcinoma. Only in one patient was a melanoma metastasis present. The findings underline the usefulness also in malignant melanoma of a surgical approach in suspected solitary pulmonary metastases.

Adult↗
PubMed1985

Pulmonary scar cancer. A pathologic reappraisal.

A total of 49 consecutive specimens of lung cancer were collected prospectively at surgical resection or autopsy from 40 men and nine women, aged 40-74 years. Of the 49 tumors, the gross appearance of 22 fitted the description of a scar cancer, i.e., a tumor with pleural puckering and central pigmentation. Nineteen of the "scar cancers" were peripheral (17 adenocarcinomas and two squamous cell carcinomas); three were central (one squamous cell carcinoma and two adenocarcinomas). In the 19 peripheral "scar cancers," elastic stains demonstrated the presence of collapsed, unfibrosed lung tissue at the center with traction of the overlying pleura toward it. Elsewhere in the tumor, the elastic framework was either destroyed or expanded by tumor filling the alveolar spaces. None of the "scar cancers" had a significant desmoplastic reaction that might otherwise explain the scarred appearance. It appeared that local atelectasis was solely responsible for the pleural puckering and central pigmentation. On the other hand, atelectatic lung tissue was not seen in the 27 cancers that did not have the appearance of a scar cancer. Tuberculosis was found in 10 of the 49 lung specimens. In only one specimen was the tuberculous lesion anatomically associated with the tumor. There was no evidence of pulmonary infarct in any of the specimens. The term "scar cancer" was considered inappropriate as there was no preformed fibrous tissue. The scarred appearance was thought to be the result of localized pulmonary atelectasis owing to small airways obstruction by tumor. Association with tuberculosis was considered incidental.

Adenocarcinoma↗
PubMed1977

Sickle cell lung disease.

When a patient with sickle cell disease has fever and a lung infiltrate, usually it will be due to infection, even though cultures may be negative. However, pulmonary infarction can be virtually indistinguishable from pneumonia. Pneumonia is likely to be present in those younger than five years, with purulent sputum and upper lobe infiltrates. Coexisting crisis, a normal or low leukocyte alkaline phosphatase score and microangiopathic changes on peripheral blood smear favor thromboembolic disease. The fat embolism syndrome, caused by bone marrow necrosis and infarction, occurs in sickle cell disease.

Anemia, Sickle Cell↗
PubMed1992

[A case of coronary artery-pulmonary artery fistula in tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries (MAPCA)].

UNLABELLED: A case of four year old girl with tetralogy of Fallot, pulmonary atresia, major aortopulmonary collateral arteries and coronary artery to pulmonary artery fistula is reported. The patient was misdiagnosed as truncus arteriosus, pulmonary stenosis and major aortopulmonary collateral arteries (MAPCA) preoperatively. The ligation of MAPCAs was carried out through left thoracotomy as an initial procedure, because we believed that the area fed by MAPCAs had dual blood supply. However, the patient demonstrated pulmonary infarction post operatively. This complication forced us to postpone an intracardiac repair. At the time of intracardiac repair, after mentioned diagnosis was established and a Rastelli type operation and ligation of coronary-pulmonary artery fistula were carried out. A 18 mm Carpentier-Edwards valved conduit was used as an extracardiac conduit. IN CONCLUSION: 1) We experienced a rare association of coronary artery fistula in TOF with PA. 2) The MAPCAs functioning as a sole source of blood-supply to the lung should be precisely diagnosed preoperatively and uniforcalized before an intracardiac repair.

Arterio-Arterial Fistula↗
PubMed1991

[Obstruction of pulmonary arteries. Contribution of the scanner and MRI. Apropos of 10 cases].

We present a retrospective study of ten patients presenting non specific clinical manifestations in whom the diagnosis of pulmonary embolism was documented by CT scan and/or MRI. Results of CT scan and/or MRI were compared to DSA bi-selective pulmonary angiography findings. In a large number of cases, CT scan and MRI allowed the detection of the obstruction within the right and left pulmonary arteries (RPA and LPA). Although these techniques did not permit the diagnosis of peripheral clots, pulmonary infarcts were usually depicted by these two procedures. CT scan and/or MRI could be performed as first-line investigations in case of atypical clinical symptoms because of their high relevance for proximal pulmonary artery obstruction, although these two non-invasive procedures cannot indicate the aetiology of the obstruction etiology.

Evaluation Studies as Topic↗
PubMed1994

[Primary diagnosis and follow-up in acute pulmonary embolism: comparison of digital subtraction angiography and spiral CT].

The aim of this prospective study was to evaluate Spiral CT in the primary diagnosis of acute pulmonary emboli and for follow-up after thrombolytic treatment. Digital subtraction angiography of the lung was used as the reference method. 38 patients were subjected to both procedures. 79% of Spiral CT and 63% of DSA examinations were optimal. The two methods agreed in the diagnosis of thrombo-embolism in 30 patients and excluded it in eight patients. Spiral CT verified thrombi in a total of 213 cases; of these 23 were in a main pulmonary artery (11%), 88 in lobar arteries (41%), and 102 in segmental arteries (48%). DSA demonstrated 180 thrombi. 17% of the adherent and partially occlusive thrombi were not shown. 38 pulmonary infarcts were found in 18 patients. In 15 patients resolution of thrombi following thrombolytic treatment was shown by Spiral CT. Spiral CT is an excellent alternative to DSA and its use in the diagnosis of pulmonary emboli is entirely appropriate.

Acute Disease↗
PubMed2003

[Role of computed angiopulmonography in current diagnosis of pulmonary artery thromboembolism].

AIM: To study potentialities of tomographic methods in diagnosis of pulmonary artery thromboembolism (PATE). MATERIAL AND METHODS: Electron-beam tomography (EBT) was used for diagnosis in 34 patients (mean age 41.3 +/- 16.5 years) suspected of PATE (Imatron C-150 unit, USA). The procedure included standard examination of the lungs and EBT angiopulmonography in intravenous introduction of the contrast agent (80-100 ml, the rate 3-3.5 ml/s). RESULTS: The pulmonary artery was found to contain thrombi in 56% patients. 18% of PATE patients had pulmonary infarction. A complete coincidence of EBT and scintigraphy was registered in 31% cases, no PATE by both methods was in 19% cases. Angiopulmonography and EBT findings were the same. In 1 case the result of pulmonary scintigraphy was false negative. 24% patients showed symptoms of thrombophlebitis or varicosity of the lower limbs. EBT has detected signs of PATE in 83% of them. CONCLUSION: EBT-angiopulmonography is a precise, highly informative non-invasive method in diagnosis of PATE.

Adolescent↗
PubMedDate not supplied

[A case of Duchenne muscular dystrophy complicated by thrombotic thrombocytopenic purpura].

We experienced a patient with Duchenne muscular dystrophy (DMD) complicated by thrombotic thrombocytopenic purpura (TTP). This patient exhibited abrupt high fever, renal dysfunction and thrombocytopenia from February 2, 2002. Hemolysis was also indicated by indirect dominant hyperbilirubinemia, although hemoglobin was only slightly decreased. No central nervous system signs and symptoms were detected. TTP was suggested by these findings and confirmed by decreased activity (21%) of von Willebrand factor cleaving protease activity. Plasma exchange was performed for 4 days from February 5, and enabled recovery. Thrombosis, such as cerebral and lung infarction, has occasionally been seen in DMD. Recently, several findings associating muscle degeneration with hypercoagulation have been reported, for example, a strong correlation between serum CK level and FDP. In seven cases of DMD with pulmonary infarction, transient elevation of serum CK was detected prior to LDH elevation. However, there have been no reports of TTP in DMD patients. Since serum CK was not elevated during our patient's clinical course, it is unlikely that muscle degeneration played a role in TTP in this patient. It should be noted that endothelial abnormalities have been reported in DMD, since endothelial injury is considered a fundamental factor in TTP.

ADAM Proteins↗
PubMed1985

Clinical diagnosis of haemodynamically significant pulmonary embolism in a coronary care unit.

The study analyses 58 consecutive (1971-1981) cases with haemodynamically significant pulmonary embolism (PE) treated in a coronary unit. The diagnosis was confirmed either by pulmonary angiography or a combination of scintigraphy with haemodynamic examination, or by autopsy. In 75.8% of cases there were present predisposing factors. A combination of sudden dyspnoea with venous thrombosis or with recurrent thrombophlebitis in the anamnesis was present in 59.3% acute cor pulmonale in 1/3 of the patients. The chest X-ray showed in 83.9% of the patients one of the following signs: pulmonary infarction, oligaemia, elevation of the diaphragm, enlargement of the hili, amputation of the hili, pleural effusion. In 62.7% of the patients, PE could be diagnosed on the basis of the ECG. Most patients had elevated pulmonary artery pressure, with a worse prognosis in patients exhibiting a pressure higher than 40 mmHg. For suspecting the presence of haemodynamically significant PE, it is in most patients sufficient to rely on the anamnesis and the results of physical, ECG and X-ray examination. The diagnosis should be confirmed by scintigraphy or angiography and haemodynamic examination.

Adult↗
PubMedDate not supplied

[Complications of the use of the pulmonary flotation catheter in surgery. Prospective study].

UNLABELLED: We studied 120 insertions of the Swan-Ganz catheter in 119 patients who needed hemodynamic monitorization for cardiovascular surgery. All catheter insertions were carried out soon after the anesthetic induction employing the modified Seldinger technique through the internal jugular vein, taking as reference the intracavitary pressure waves to get the pulmonary artery wedge position. The time of insertion, time of use, complications of puncture, difficulty and complications of insertion, thoracic and pulmonary complications, and loop or knot in the catheter were examined. RESULTS: multiple punctures in 15 cases (12.5%), 8 carotid artery punctures (6.6%), 14 hematomas (11.6%), difficulty for pass through the right ventricle in 8 cases (6.6%) and pulmonary artery in 32 (26.6%) impossibility to get the pulmonary wedge position in 13 cases (10.8%), loop of catheter in 3 (2.5%), ectopic atrial beats in 30 cases (25%), atrial tachycardia in 4 (3.3%), ectopic ventricular beats in 73 (60.8%). General arrhythmia incidence was 67.5%, none serious. All complications were minor and not life-threatening. Only in two cases (1.6%) the complications were major, both pulmonary infarction, but were life-threatening to patients; in 20 patients (16.6%) the outcome was without complications. There were no deaths for the catheter use. The results of this study showed that complications caused by the pulmonary artery flotation catheter were smaller than the benefit obtained in the management of these patients.

Adolescent↗
PubMed1997

[A case of radical operation for right-sided infective endocarditis due to Pseudomonas aeruginosa concurrent with VSD in the elderly person].

The case is a 60-year-old male. He was seen at this department because of a slight fever of less than 37.5 degrees C from half a year earlier. Echocardiography revealed vegetations under the tricuspid valve and pulmonary valve, and on scintigraphy of the pulmonary blood flow he was diagnosed with multiple pulmonary infarction. Causative bacteria were not identified by blood culture on admission. As the intraoperative findings, vegetations were seen attached to the area from the septal cusp to the anterior cusp in the tricuspid valve. With the pulmonary valve, a part of the valvular cusp was perforated. After closing VSD with a patch, the vegetations attached to the valvular cusps were excised and the tricuspid valve was reconstructed. As for the pulmonary valve, valve replacement was performed because of the destructive degeneration of the valvular cusp. Pseudomonas aeruginosa was detected on culture of the tissue of the valvular cusp resected during operation. Post operative course was uneventful. The patient was discharged on the 21st postoperative day.

Bioprosthesis↗
PubMed2002

[Pulmonary artery aneurysms in Behçet's disease: contribution of imaging in 5 cases].

Pulmonary involvement in Behçet's disease is an uncommon condition (12%). Thromboembolism of the superior vena cava and/or other mediastinal veins, aneurysms of the aorta and pulmonary arteries are the main vascular manifestations in addition to pulmonary infarct and intrathoracic hemorrhage. Despite their scarcity, respiratory symptoms may be life-threatening. The aim of this study was to assess the contribution of thoracic imaging for one of the most serious aspects of the disease: pulmonary artery aneurysm. We report five patients with pulmonary artery aneurysms (mean age: 39.5 years). Hemoptysia revealed Behçet's disease in three. Initially explored by conventional radiography, computed tomography and angiography, pulmonary artery aneurysms are currently investigated well with helicoidal computed tomography, digital angiography, magnetic resonance imaging (MRI) and angio-MRI. These imaging techniques provide helpful information for the diagnosis of Behçet's disease.

Adult↗
PubMedDate not supplied

[Lymphocytes in sputum].

The authors analysed 116 hospitalized patients who, in their routine cytologic examination of the sputum, had also a cytomorphologic finding of lymphocytes. The greatest majority of these patients, 63 of them or 54.3% suffered from malignant neoplasm. Out of these 63 patients, 53 of them or 45.7% suffered from primary bronchial carcinoma, whereas 10 patients or 8.6% had non-Hodgkin's lymphoma, metastatic lung cancer of extrathoracic primary localization, Hodgkin's lymphoma, while two patients were supposed to have lung neoplasm. Our study also revealed that 14 patients (out of 116 hospitalized patients) or 12.0% suffered from broncho-pleuropneumonia, 13 or 11.2% from an active pulmonary tuberculosis, 7 or 6.0% from a chronic obstructive bronchitis, 5.1% from sarcoidosis, 3.4% from post tuberculosis pulmonary changes while 2.5% of the patients were found to have a pleural empyema. One case of bronchial asthma, tuberculous pleurisy, bronchiectasis, hamartoma, hemoptysis and a pulmonary infarction were found as well. Due to their own experience the authors conclude that the lymphocytes in the sputum were found to be the most frequent in patients suffering from primary bronchial carcinoma, broncho-pleuropneumonia and pulmonary tuberculosis but that they could also be found in many others pathologic changes of pulmonary parenchyma.

Adult↗
PubMed1987

Hemodynamic effects of intravenous isosorbide dinitrate and nitroglycerine in acute myocardial infarction and elevated pulmonary artery wedge pressure.

We compared in a randomized fashion the hemodynamic effects of intravenous (IV) isosorbide dinitrate (ISDN) and nitroglycerine (NTG) in 45 patients with acute myocardial infarction and elevated pulmonary artery wedge pressure (Paw). Titration of ISDN dose to lower Paw greater than or equal to 25 percent resulted in a fall of this parameter from 32 +/- 8 to 24 +/- 5 mm Hg and was associated with a fall in mean blood pressure (96 +/- 15 to 90 +/- 14 mm Hg, p less than 0.05), systemic vascular resistance (1715 +/- 572 to 1548 +/- 414 dynes X s X cm-5, (p less than 0.05), pulmonary vascular resistance (182 +/- 106 to 154 +/- 78 dynes X s X cm-5, p less than 0.05) and mean right atrial pressure (11 +/- 4 to 7 +/- 4 mm Hg, p less than 0.05). In addition, ISDN significantly (p less than 0.05) increased cardiac index from 2.37 +/- 0.54 to 2.54 +/- 0.59 L/min/m2, stroke volume index from 28 +/- 8 to 31 +/- 8 ml/m2, and stroke work index from 28 +/- 11 to 31 +/- 12 g X m/m2. The ISDN dose ranged from 50 to 533 micrograms/min (mean +/- SD 326 +/- 176 micrograms/min) and could not be predicted from baseline hemodynamic values. A comparison between the effect of ISDN and NTG in doses producing comparable reduction in Paw showed similar hemodynamic changes. It was concluded that IV ISDN in patients with elevated mean pulmonary artery wedge pressure due to acute myocardial infarction results in a decrease in right and left ventricular preload and afterload and improvement of cardiac output and cardiac work. The effective dose ranges from 50 to 533 micrograms/min and cannot be predicted from baseline hemodynamic values. In doses producing comparable reduction in Paw, ISDN and NTG had similar hemodynamic effects.

Aged↗