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At least 19 recordsLinked to original sources
PubMed2005

Association of right ventricular dilatation with bilateral pulmonary embolism, pulmonary embolism in a main pulmonary artery and lobar, segmental and subsegmental pulmonary embolism in 190 patients with acute pulmonary embolism.

BACKGROUND: Acute pulmonary embolism (PE) may result in right ventricular (RV) pressure overload with a dilated RV which can be diagnosed by two-dimensional echocardiography. METHODS: A retrospective analysis was performed in 190 unselected patients who had acute PE documented by contrast-enhanced spiral computed tomographic scanning. The 190 patients included 104 women and 86 men, mean age 58 +/- 15 years. RESULTS: RV dilatation was present in 45 of 70 patients (64%) with bilateral PE, in 19 of 120 patients (16%) without bilateral PE, in 42 of 47 patients (89%) with main pulmonary artery embolism, in 34 of 84 patients (40%) with lobar PE, in 16 of 70 patients (23%) with segmental PE and in 6 of 36 patients (17%) with subsegmental PE; p < 0.001 comparing bilateral with no bilateral PE and main pulmonary artery embolism with no main pulmonary artery embolism, with lobar, segmental and subsegmental PE; p < 0.025 comparing lobar with segmental PE, and p < 0.02 comparing lobar with subsegmental PE. CONCLUSION: The prevalence of RV dilatation is highest in patients with main pulmonary artery embolism or bilateral pulmonary artery embolism; furthermore, the prevalence of RV dilatation is higher in patients with lobar PE than in patients with segmental or subsegmental PE.

Adult↗
PubMed1977

Pulmonary embolism, pulmonary hemorrhage and pulmonary infarction.

We compared 41 patients with angiographic proof of pulmonary embolism and clinical signs of pulmonary infarction (as evidenced by an infiltrate on x-ray study and pleuritic pain in the area of the embolus) with 24 patients with pulmonary embolism but without infarction. Only 18 of the 41 patients with pulmonary infarction had associated heart disease. Pulmonary infarction was uncommon when emboli obstructed central arteries but frequent when distal arteries were occluded. Follow-up x-ray examination showed that the infiltrates resolved in the patients with pulmonary infarction without heart disease, but persisted when heart disease was present. We suggest that obstruction of distal arteries results in pulmonary hemorrhage owing to an influx of bronchial arterial blood at systemic pressure. Hemorrhage causes symptoms and x-ray changes usually attributed to pulmonary infarction. However, hemorrhage resolves without infarction in patients without, but progresses to infarction in those with, heart disease.

Angiography↗
PubMed1991

Pulmonary embolism, pulmonary hypertension, and choriocarcinoma.

A rare cause of pulmonary embolism and pulmonary artery hypertension in young women is choriocarcinoma growing in the pulmonary artery. This growth is reversible, and the disorder can be cured. We describe three patients with this feature who have been treated with appropriate high-risk chemotherapy and who are now in remission. Contrast-enhanced computed tomography can be used to identify major emboli, and progress of the disease can be monitored by serial ventilation/perfusion scans and measurement of serum human chorionic gonadotropin. Recognition of this rare syndrome is important because of the generally excellent outlook with appropriate treatment.

Adult↗
PubMed2006

Severe pulmonary embolism:pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality.

PURPOSE: To retrospectively evaluate pulmonary artery (PA) clot load scores and computed tomographic (CT) cardiovascular parameters as predictors of mortality in patients with severe pulmonary embolism (PE). MATERIALS AND METHODS: Institutional review board approval was obtained with waiver of informed consent. A total of 82 consecutive patients (42 women, 40 men; mean age+/-standard deviation, 61 years+/-15) were admitted to the intensive care unit for PE-related conditions and were evaluated by using CT pulmonary angiography. Two independent readers who were blinded to clinical outcome quantified PA clot load by using four scoring systems. Cardiovascular measurements included right ventricular (RV) and left ventricular (LV) short-axis measurements; RV short axis to LV short axis (RV/LV) ratios; main PA, ascending aorta, azygos vein, and superior vena cava diameters; and main PA diameter to aorta diameter ratios. Reflux of contrast medium into the inferior vena cava, leftward bowing of the interventricular septum, pleural or pericardial effusion, pulmonary consolidation, infarct, platelike atelectasis, and mosaic ground-glass opacity were also recorded. Results were correlated with patient outcome during hospital stay by using the Wilcoxon rank sum and chi2 tests. RESULTS: Twelve patients died within 1-14 days. RV and LV short axis; RV/LV ratio; azygos vein, superior vena cava, and aorta diameters; and contrast medium reflux into the inferior vena cava were significantly different between survivors and nonsurvivors (P<.05). No significant relationship was found between PA clot load and mortality rate. RV/LV ratio and azygos vein diameter allowed correct prediction of survival in 89% of patients (P<.001). CONCLUSION: RV/LV ratio and azygos vein diameter are predictors of mortality in patients with severe PE.

Adult↗
PubMed2001

Newer diagnostic modalities for pulmonary embolism. Pulmonary angiography using CT and MR imaging compared with conventional angiography.

CTPA is a highly sensitive and excellent primary method for evaluating patients with symptoms of PE. Ongoing studies will demonstrate the good clinical outcome of patients with negative CTPA results. The ability to visualize the lung parenchyma in addition to the pulmonary vasculature, and the smaller number of nondiagnostic scans, make CT more cost effective than V/Q scans, and CT therefore should be used as a first-line evaluation. MR imaging is a continually developing modality with more imaging options that could make it an invaluable or adjunctive test in the near future.

Algorithms↗
PubMed2002

The rehabilitation of clinical assessment for the diagnosis of pulmonary embolism.

Pulmonary angiography is the gold standard for diagnosis of segmental pulmonary embolism, but no longer for subsegmental pulmonary embolism because the inter-observer agreement for angiographically documented subsegmental pulmonary embolism is only 60%. A normal rapid ELISA VIDAS D-dimer test result and a normal perfusion scan exclude pulmonary embolism with a negative predictive value of >99%, irrespective of clinical score. The positive predictive value for pulmonary embolism of a high probability VP-scan compared to pulmonary angiography is 87% indicating that 13% of patients with a high probability VP-scan do not have pulmonary embolism. The combination of a negative CUS, a low clinical score, and a non-diagnostic VP-scan safely excludes pulmonary embolism. Patients with a non-diagnostic VP-scan, a negative CUS, but a moderate to high clinical score are candidates for pulmonary angiography. The positive predictive value of helical spiral CT is >95 to 99%. The combination of a negative CUS, a low clinical score, and the presence of a clear alternative diagnosis is predicted to safely exclude pulmonary embolism. Helical spiral CT detects all clinical relevant pulmonary emboli and a large number of alternative diagnoses in symptomatic patients with a non-diagnostic or a high-probability VP-scan. The negative predictive value during 3 months followup after a negative spiral CT for pulmonary embolism in 4 retrospective studies and 1 prospective management study was >99%. Only a small group of patients (1-2%) with a non-diagnostic spiral CT are candidates for pulmonary angiography. Therefore, it is predicted that the spiral CT will replace both VP-scanning and pulmonary angiography to safely exclude or diagnose pulmonary emboli in patients with suspected pulmonary embolism.

Angiography↗
PubMed1984

The diagnosis of pulmonary embolism.

Pulmonary embolism is poorly diagnosed and therefore not treated in patients with chronic diseases, whereas it is overdiagnosed in formerly healthy patients. The diagnostic level is not satisfactory even in departments of cardiology. Insufficient use of auxiliary laboratory tests constitutes one of the main reasons for the unsatisfactory state of pulmonary embolism diagnostics. The clinical picture of pulmonary embolism depends on a) the size of pulmonary embolism, b) the previous state of the cardiopulmonary system. A massive pulmonary embolism can lead to a) sudden death, b) shock, c) acute cor pulmonale. The most typical diagnostic sign is suddenly developed or deteriorated dyspnea (present in 94% of patients). The presence of venous thrombosis and the appearance of sudden dyspnea always support the diagnosis very strongly. Dyspnea or tachypnea occur in more than 90% of patients. Dyspnea, tachypnea or deep venous thrombosis occur in 99% of patients with acute pulmonary embolism. Electrocardiographic signs of acute pulmonary embolism were present in 67% of our patients with hemodynamically significant pulmonary embolism. Electrocardiographic signs are most marked in cases in which pulmonary embolism originates suddenly, in patients with a normal cardiopulmonary system, if the pulmonary embolism is extensive and the electrocardiogram is carried out early and repeatedly. The electrocardiographic signs of pulmonary embolism in cardiac patients, however, are not specific and only rarely present. The principal advantages of the chest X-ray are simplicity, safety and low costs. A negative chest X-ray was found only in 16.6% of our patients with pulmonary embolism.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1992

[Pulmonary arteriography and bronchial arteriography in pulmonary embolism].

Pulmonary arteriography is the most reliable technique for evaluation of pulmonary embolism and other vascular abnormalities. A definitive diagnosis of pulmonary embolism is made on the basis of direct angiographic signs of emboli of intravascular filling defect and vessel cut-off sign. To obtain these findings, pulmonary arteriography needs to be performed as soon as possible, and in acutely ill patients who are in shock and under consideration for thrombolytic therapy or emergency embolectomy, the study should be performed on an emergency basis. Digital subtraction pulmonary angiography may be an useful technique for massive pulmonary embolism, but it cannot exclude clinically important peripheral pulmonary embolism. Wedged pulmonary arteriography can demonstrate the direct signs of distal emboli, which are difficult to obtain by main pulmonary artery injection angiogram. In the chronic stage of pulmonary embolism, bronchial arteriogram shows collaterals to pulmonary arteries. This study may be useful in patients with chronic pulmonary embolism, especially when thromboembolectomy is planned.

Angiography, Digital Subtraction↗
PubMed2002

Chronic dialysis patients have high risk for pulmonary embolism.

Pulmonary embolism has been considered uncommon in chronic dialysis patients, but has not been adequately studied in a large population. In the US Renal Data System (USRDS), 76,718 patients presenting with end-stage renal disease (ESRD) between January 1, 1996, and December 31, 1996, were analyzed in an historical cohort study. The outcome was hospitalizations with a primary discharge diagnosis of pulmonary embolism (International Classification of Diseases, Ninth Revision code 415.1x) occurring within 1 year of the first ESRD treatment and excluding those occurring after renal transplantation. For dialysis patients, hospitalization rates for pulmonary embolism were obtained from the hospitalization section of the 1999 USRDS. For the general population, hospitalization rates for pulmonary embolism were obtained from the National Hospital Discharge Survey for 1996. Comorbidities from the Medical Evidence Form (Centers for Medicare and Medicaid Services, previously known as the Health Care Financing Administration; form 2728) were used to generate approximated stratified models of adjusted incidence ratios for pulmonary embolism (comorbidities could not be stratified for the general population). In 1996, the overall incidence rate of pulmonary embolism was 149.90/100,000 dialysis patients compared with 24.62/100,000 persons in the US population, with an age-adjusted incidence ratio of 2.34 in dialysis patients. Younger dialysis patients had the greatest relative risk for pulmonary embolism. The age-adjusted incidence ratio of pulmonary embolism after excluding dialysis patients with known risk factors for pulmonary embolism was 2.11. Ninety-five percent confidence intervals for all age categories in both models were statistically significant. Chronic dialysis patients have high risk for pulmonary embolism, independent of comorbidity.

Adolescent↗
PubMed1976

Pulmonary embolism.

Pulmonary embolism is a common and often fatal postoperative complication. Dyspnea is the most common clinical manifestation in pulmonary embolism, and other signs are frequently inconsistent and often vague. The chest film and electrocardiogram may be helpful in excluding other cardiorespiratory diseases but they are frequently unreliable in establishing an objective diagnosis of pulmonary embolism. Documentation of a decreased arterial saturation provides suggestive evidence of pulmonary embolism. Lung scanning is a safe, sensitive procedure for the initial evaluation of symtoms suggestive of pulmonary embolism, and pulmonary arteriography may be necessary to confirm the diagnosis in certain patients. Anticoagulation is effective in the prevention and treatment of pulmonary embolism and proves successful in the vast majority of patients. Emboli that are not fatal gradually resolve in the pulmonary circulation. Vena caval interruption is occasionally beneficial in selected patients, especially those with septic emboli and cor pulmonale, but should only be performed when the indications are quite clear. Under certain selected circumstances pulmonary embolectomy may be indicated. Patients with massive embolism occluding more than one-half of the pulmonary arterial system and prooducing a markedly elevated pulmonary arterial pressure and severe hypoxemia may die in acute right heart failure. Intractable shock unresponsive to aggressive medical therapy in these patients represents an indication for pulmonary embolectomy. The hazards of these surgical procedures demand that a definite diagnosis of pulmonary embolism be made and a systematic approach to the diagnosis and treatment should be followed in all patients with the disorder.

Adult↗
PubMed1998

Successful delayed thrombolytic therapy in a patient with massive pulmonary embolism.

Pulmonary embolism can be a catastrophic event leading to early death or serious hemodynamic instability. Thrombolytic therapy, in addition to heparin therapy, may improve the clinical condition and reduce the chance of recurrent pulmonary embolism in some cases. However, the acceptable "time window" for thrombolytic therapy is not well documented, though it has been used successfully as late as 14 days after pulmonary embolism. Successful delayed thrombolytic therapy beyond this "time window" in patients with massive pulmonary embolism has not been reported. We report a case of massive pulmonary embolism in which thrombolytic therapy was delayed more than 1 month after symptom onset. A 56-year-old woman was taken to National Cheng Kung University Hospital because of an episode of recurrent syncope, followed by progressive shortness of breath of 1 month's duration. Hypoxemia and hemodynamic instability were noted on admission. Echocardiography and a lung perfusion scan provided strong evidence of pulmonary embolism. Subsequent pulmonary angiography confirmed the diagnosis of multiple pulmonary emboli. The patient received a standard dose of intravenous tissue plasminogen activator 7 days after admission because of persistent symptoms and hypoxemia. Her clinical condition dramatically improved after treatment. Follow-up imaging studies showed resolution of the emboli. She was discharged in good condition. This case suggests that delayed thrombolytic therapy in patients with massive pulmonary embolism can still be beneficial in selected cases, even if given more than 2 weeks after symptom onset.

Female↗