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Motiwala A, Tanwir H, Duarte A, Gilani S, DeAnda A, Zaidan MF, Jneid H. Multidisciplinary Approach to Pulmonary Embolism and the Role of the Pulmonary Embolism Response Team. Curr Cardiol Rep 2024; 26:843-849. [PMID: 38963612 DOI: 10.1007/s11886-024-02084-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE OF REVIEW Acute pulmonary embolism (PE) is a leading cause of cardiovascular death and morbidity, and presents a major burden to healthcare systems. The field has seen rapid growth with development of innovative clot reduction technologies, as well as ongoing multicenter trials that may completely revolutionize care of PE patients. However, current paucity of robust clinical trials and guidelines often leave individual physicians managing patients with acute PE in a dilemma. RECENT FINDINGS The pulmonary embolism response team (PERT) was developed as a platform to rapidly engage multiple specialists to deliver evidence-based, organized and efficient care and help address some of the gaps in knowledge. Several centers investigating outcomes following implementation of PERT have demonstrated shorter hospital and intensive-care unit stays, lower use of inferior vena cava filters, and in some instances improved mortality. Since the advent of PERT, early findings demonstrate promise with improved outcomes after implementation of PERT. Incorporation of artificial intelligence (AI) into PERT has also shown promise with more streamlined care and reducing response times. Further clinical trials are needed to examine the impact of PERT model on care delivery and clinical outcomes.
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Affiliation(s)
- Afaq Motiwala
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Hira Tanwir
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Alexander Duarte
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Syed Gilani
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Abe DeAnda
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | | | - Hani Jneid
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
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Weekes AJ, Trautmann A, Hambright PL, Ali S, Pikus AM, Wellinsky N, Goonan KL, Bradford S, O'Connell NS. Comparison of Treatment Approaches and Subsequent Outcomes within a Pulmonary Embolism Response Team Registry. Crit Care Res Pract 2024; 2024:5590805. [PMID: 38560480 PMCID: PMC10980543 DOI: 10.1155/2024/5590805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 02/19/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives To characterize the association between pulmonary embolism (PE) severity and bleeding risk with treatment approaches, outcomes, and complications. Methods Secondary analysis of an 11-hospital registry of adult ED patients treated by a PE response team (August 2016-November 2022). Predictors were PE severity and bleeding risk. The primary outcome was treatment approach: anticoagulation monotherapy vs. advanced intervention (categorized as "immediate" or "delayed" based on whether the intervention was received within 12 hours of PE diagnosis or not). Secondary outcomes were death, clinical deterioration, and major bleeding. Results Of the 1832 patients, 139 (7.6%), 977 (53.3%), and 9 (0.5%) were classified as high-risk, intermediate-high, intermediate-low, and low-risk severity, respectively. There were 94 deaths (5.1%) and 218 patients (11.9%) had one or more clinical deterioration events. Advanced interventions were administered to 86 (61.9%), 195 (27.6%), and 109 (11.2%) patients with high-risk, intermediate-high, and intermediate-low severity, respectively.Major bleeding occurred in 61/1440 (4.2%) on ACm versus 169/392 (7.6%) with advanced interventions (p <0.001): bleeding withcatheter-directed thrombolysiswas 19/145 (13.1%) versus 33/154(21.4%) with systemic thrombolysis,p= 0.07. High risk was twice as strong as intermediate-high risk for association with advanced intervention (OR: 5.3 (4.2 and 6.9) vs. 1.9 (1.6 and 2.2)). High risk (OR: 56.3 (32.0 and 99.2) and intermediate-high risk (OR: 2.6 (1.7 and 4.0)) were strong predictors of clinical deterioration. Major bleeding was significantly associated with advanced interventions (OR: 5.2 (3.5 and 7.8) for immediate, 3.3 (1.8 and 6.2)) for delayed, and high-risk PE severity (OR: 3.4 (1.9 and 5.8)). Conclusions Advanced intervention use was associated with high-acuity patients experiencing death, clinical deterioration, and major bleeding with a trend towards less bleeding with catheter-directed interventions versus systemic thrombolysis.
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Affiliation(s)
- Anthony J. Weekes
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Ariana Trautmann
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Parker L. Hambright
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Shane Ali
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Angela M. Pikus
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Nicole Wellinsky
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Kelly L. Goonan
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Sarah Bradford
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Nathaniel S. O'Connell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Evlice M, Kurt İH. The relationship between echocardiographic parameters and albumin bilirubin score in patients with acute pulmonary thromboembolism. Perfusion 2023:2676591231221706. [PMID: 38085551 DOI: 10.1177/02676591231221706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
PURPOSE The Albumin-Bilirubin (ALBI) score is useful and easy-to-use for objectively assessing liver function. We investigated whether the ALBI score, a parameter indicating liver stiffness, congestion and fibrosis, has any relationship with echocardiographic parameters in patients with acute pulmonary thromboembolism (PTE). MATERIAL AND METHODS A total of 140 patients diagnosed with acute PTE were retrospectively analyzed. These patients were divided into three groups according to the hemodynamic severity of acute PTE: Group I [Low risk]; Group II [Submassive or intermediate-risk]; and Group III [Massive or high-risk]. Biochemical data obtained from venous blood samples taken at admission were analyzed. In addition, data were also analyzed from transthoracic echocardiography and pulmonary computed tomographic angiography performed at admission. ALBI, Bova, and PESI scores were calculated. RESULTS ALBI scores (-3.32 ± 0.21 vs -2.86 ± 0.15 vs -2.46 ± 0.2, p < .001) were statistically significantly higher in Group III than Groups I and II. There was a significant difference between the three groups in terms of echocardiographic parameters, and LVEF and TAPSE values tended to decrease from group I to group III. In multivariate linear regression analysis, sPAP, RV/RA diameter, and NT-pro-BNP were found to be significantly associated with the ALBI score. An ALBI score higher than -2.87 was associated with Bova stage II-III in patients with Group I and Group II PTE, with a sensitivity of 87% and a specificity of 62% (AUC = 0.804; 95% CI 0.713-0.895; p < .001). CONCLUSION The ALBI score, which is a common, easy-to-use, and inexpensive method, may be beneficial to select intermediate and high-risk patients in patients with acute PTE. Additionally, it may have prognostic value in distinguishing low and intermediate-risk acute PTE patients.
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Affiliation(s)
- Mert Evlice
- Department of Cardiology, Health Sciences University-Adana City Training and Research Hospital, Adana, Turkey
| | - İbrahim H Kurt
- Department of Cardiology, Health Sciences University-Adana City Training and Research Hospital, Adana, Turkey
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Fulton B, Bashir R, Weinberg MD, Lakhter V, Rali P, Pugliese S, Giri J, Kobayashi T. Advanced Treatment of Hemodynamically Unstable Acute Pulmonary Embolism and Clinical Follow-up. Semin Thromb Hemost 2023; 49:785-796. [PMID: 37696292 DOI: 10.1055/s-0043-1772840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
High-risk acute pulmonary embolism (PE), defined as acute PE associated with hemodynamic instability, remains a significant contributor to cardiovascular morbidity and mortality in the United States and worldwide. Historically, anticoagulant therapy in addition to systemic thrombolysis has been the mainstays of medical therapy for the majority of patients with high-risk PE. In efforts to reduce the morbidity and mortality, a wide array of interventional and surgical therapies has been developed and employed in the management of these patients. However, the most recent guidelines for the management of PE have reserved the use of these advanced therapies in scenarios where thrombolytic therapy plus anticoagulation are unsuccessful. This is due largely to the lack of prospective, randomized studies in this population. Stemming from this, the approach to treatment of these patients varies widely depending on institutional experience and resources. Furthermore, morbidity and mortality remain unacceptably high in this population, with estimated 30-day mortality of at least 30%. As such, development of a standardized approach to treatment of these patients is paramount to improving outcomes. Early and accurate risk stratification in conjunction with a multidisciplinary team approach in the form of a PE response team is crucial. With the advent of novel therapies for the treatment of acute PE, in addition to the growing availability of and familiarity with mechanical circulatory support systems, such a standardized approach may now be within reach.
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Affiliation(s)
- Brian Fulton
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Riyaz Bashir
- Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Mitchell D Weinberg
- Zucker School of Medicine at Hofstra/Northwell, Staten Island University Hospital, Staten Island, New York
| | - Vladimir Lakhter
- Division of Cardiovascular Disease, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Steve Pugliese
- Division of Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jay Giri
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Cardiovascular Outcomes, Quality and Evaluative Research Center, Philadelphia, Pennsylvania
| | - Taisei Kobayashi
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Cardiovascular Outcomes, Quality and Evaluative Research Center, Philadelphia, Pennsylvania
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Ozden Sertcelik U, Ozkan E, Sertcelik A, Karalezli A. The relation between thrombus burden and early mortality risk in inpatients diagnosed with COVID-19-related acute pulmonary embolism: a retrospective cohort study. BMC Pulm Med 2023; 23:345. [PMID: 37704993 PMCID: PMC10500925 DOI: 10.1186/s12890-023-02647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND COVID-19-related acute pulmonary thromboembolism (APE) is associated with poor outcomes in patients with COVID-19. There are studies investigating the association between thrombus burden and high risk of early mortality in the pre-COVID-19 period. This study aimed to evaluate the relationship between clot burden and early mortality risk in COVID-19-related APE patients. METHODS In this single-center retrospective cohort study, the data of hospitalized adult patients followed up for COVID-19-related APE between April 1, 2020, and April 1, 2021, were electronically collected. A radiologist evaluated the computed tomography (CT) findings and calculated the Mastora scores to determine clot burden. The early mortality risk group of each patient was determined using 2019 the European Society of Cardiology guidelines. RESULTS Of the 87 patients included in the study, 58 (66.7%) were male, and the mean age was 62.5±16.2 years. There were 53 (60.9%) patients with a low risk of mortality, 18 (20.7%) with an intermediate-low risk, and 16(18.4%) with an intermediate-high/high risk. The median total simplified Mastora scores were 11.0, 18.5, and 31.5 in the low, the intermediate-low, and the intermediate-high/high-risk groups, respectively (p = 0.002). With the 80.61% of post-hoc power of the study, intermediate-high/high early mortality risk was associated statistically significantly with the total simplified Mastora score (adj OR = 1.06, 95%CI = 1.02-1.11,p = 0.009). Total simplified Mastora score was found to predict intermediate-high/high early mortality risk with a probability of 0.740 (95% CI = 0.603-0.877): At the optimal cut-off value of 18.5, it had 75.0% sensitivity, 66.2% specificity, 33.3% positive predictive value, and 92.2% negative predictive value. CONCLUSIONS The total simplified Mastora score was found to be positively associated with early mortality risk and could be useful as decision support for the risk assessment in hospitalized COVID-19 patients. Evaluation of thrombus burden on CT angiography performed for diagnostic purposes can accelerate the decision of close monitoring and thrombolytic treatment of patients with moderate/high risk of early mortality.
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Affiliation(s)
| | - Erdem Ozkan
- Ankara Bilkent City Hospital, Department of Radiology, Ankara, Türkiye
| | - Ahmet Sertcelik
- Faculty of Medicine, Department of Public Health, Division of Epidemiology, Hacettepe University, Ankara, Türkiye
| | - Aysegul Karalezli
- Faculty of Medicine, Department of Chest Diseases, Ankara Yildirim Beyazit University, Ankara, Türkiye
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Pietrasik A, Gąsecka A, Szarpak Ł, Pruc M, Kopiec T, Darocha S, Banaszkiewicz M, Niewada M, Grabowski M, Kurzyna M. Catheter-Based Therapies Decrease Mortality in Patients With Intermediate and High-Risk Pulmonary Embolism: Evidence From Meta-Analysis of 65,589 Patients. Front Cardiovasc Med 2022; 9:861307. [PMID: 35783825 PMCID: PMC9243366 DOI: 10.3389/fcvm.2022.861307] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Catheter-directed therapies (CDT) are an alternative to systemic thrombolysis (ST) in pulmonary embolism (PE) patients, but the mortality benefit of CDT is unclear. Objective We conducted a systematic review with meta-analysis to compare the efficacy and safety of CDT and ST in intermediate-high and high-risk PE. Methods We included (P) participants, adult PE patients; (I) intervention, CDT; (C) comparison, ST; (O) outcomes, mortality, complications, in-hospital treatment, and length of hospital stay; (S) study design, randomized controlled trials (RCTs), or cohort comparing CDT and ST. The primary endpoint was 30-day mortality. Secondary outcomes included treatment-related complications including bleeding, the use of hospital resources, and length of hospital stay. Results Eleven studies including 65,589 patients met the inclusion criteria. Thirty-day mortality was lower in the CDT group, compared to ST group [7.3 vs. 13.6%; odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.38–0.69, p < 0.001]. The rates of myocardial injury, cardiac arrest, and stroke were lower in CDT group, compared to ST group (p < 0.001 for all). The rates of any major bleeding, intracranial hemorrhage, hemoptysis, and red blood cell transfusion were lower in patients treated with CDT, compared to ST (p ≤ 0.01 for all). Extracorporeal life support was used more often in patients treated with CDT, compared to ST (0.5 vs. 0.2%, OR = 2.52, 95% CI 1.88–3.39, p < 0.001). The use of hospital resources and length of hospital stay were comparable in both groups. Conclusion CDT might decrease mortality in patients with intermediate-high and high-risk PE and were associated with fewer complications, including major bleeding.
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Affiliation(s)
- Arkadiusz Pietrasik
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- *Correspondence: Arkadiusz Pietrasik,
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Szarpak
- Research Unit, Maria Sklodowska-Curie Białystok Oncology Center, Białystok, Poland
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland
| | - Michał Pruc
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Tomasz Kopiec
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Szymon Darocha
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
| | - Marta Banaszkiewicz
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Kurzyna
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland
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Guru PK, Giri AR, Sanghavi DK, Ritchie C. Ultra-Low-Dose Systemic Tissue Plasminogen Activator in High-Risk Submassive Pulmonary Embolism. Mayo Clin Proc 2022; 97:1158-1163. [PMID: 35662428 DOI: 10.1016/j.mayocp.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 11/11/2021] [Accepted: 02/15/2022] [Indexed: 10/18/2022]
Abstract
Risk stratification of pulmonary embolism (PE) is vital for clinical management. While low-risk and high-risk PE management are clearly defined in many societal guidelines, the management of moderate-risk, also called submassive, PE remains unsettled. There is a subgroup of patients with submassive PE that progress to the severe category despite receiving systemic anticoagulation. The role of thrombolysis in the management of submassive PE remains to be established. We share our experience with ultra-low-dose (25-mg) systemic tissue plasminogen activator in a series of 4 patients with high-risk submassive PE.
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Affiliation(s)
- Pramod K Guru
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL; Division of Nephrology, Mayo Clinic, Jacksonville, Florida, United States of America; Department of Transplantation, Mayo Clinic, Jacksonville, Florida, United States of America.
| | - Abhishek R Giri
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL; Department of Transplantation, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Charles Ritchie
- Department of Diagnostic Radiology, Mayo Clinic, Jacksonville, FL
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Pizano A, Ray HM, Cambiaghi T, Saqib NU, Afifi R, Khan S, Martin G, Harlin SA. Initial experience and early outcomes of the management of acute pulmonary embolism using the FlowTriever mechanical thrombectomy device. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:222-228. [PMID: 34825796 DOI: 10.23736/s0021-9509.21.12081-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Submassive and massive pulmonary embolism is associated with a high risk of complications. We aimed to evaluate our initial experience with a mechanical thrombectomy device in the management of these patients. METHODS A single-center, retrospective study was performed in patients with acute submassive and massive pulmonary embolism treated with the FlowTriever device (Inari Medical, Irvine, CA, USA) between June 2019 and November 2020. Clinical and technical parameters were analyzed during the hospitalization and at 30- and 180-days after the procedure. RESULTS Fourteen patients were evaluated with a median (IQR) age of 60 (50-69) years and 64% were male. All had right heart strain as the main indication for thrombectomy. The procedure duration and fluoroscopic time was 52 (37-89) and 13 (9-24) minutes, respectively. There was 100% technical success, and the pulmonary arterial pressure went from 60 (48-65) mmHg to 40 (34-47) mmHg. Thrombolysis was used in two patients and nine patients required intensive care. 100% experienced improvement in symptoms at the time of discharge. There were no device-related complications, major bleeding events, myocardial infarctions, or deaths. Preprocedural hemoglobin was 13 (12-15) g/dL, and predischarge was 12 (10-13) g/dL. Overall postprocedural length of stay was three (2-6) days. All the patients were discharged with oral anticoagulation. There were no device-related complications or recurrence of embolism at 30 and 180 days. CONCLUSIONS The mechanical thrombectomy device for submassive and massive pulmonary embolism is promising and appears a safe and effective procedure with 100% technical success, no complications, short intensive care requirement/stay, and good early clinical outcomes.
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Affiliation(s)
- Alejandro Pizano
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA -
| | - Hunter M Ray
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Tommaso Cambiaghi
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Naveed U Saqib
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Rana Afifi
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Sophia Khan
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Gordon Martin
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Stuart A Harlin
- McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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A Case of Pulmonary Infarction Resembling Pneumonia during Immunosuppressive Treatment for Rheumatoid Arthritis. Case Rep Rheumatol 2021; 2021:5983580. [PMID: 34457368 PMCID: PMC8390160 DOI: 10.1155/2021/5983580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
A 67-year-old woman with rheumatoid arthritis (RA) presented with fever and dyspnea. Chest radiography and computed tomography (CT) revealed pulmonary infiltrates with ground-glass opacities. We considered bacterial or pneumocystis pneumonia because she was immunocompromised due to RA treatment. However, she had tachycardia and elevated D-dimer levels. We performed contrast-enhanced CT and subsequently diagnosed her with pulmonary embolism (PE). Though PE is not usually accompanied by parenchymal pulmonary shadows, pulmonary infarction may cause pulmonary infiltrates that can be mistaken for pneumonia. As RA is a thrombophilic disease, clinicians should be aware of PE and pneumonia as differential diagnoses in such patients.
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