Acute cardiac disorder or pneumonia and concomitant presence of pulmonary embolism

Clinical characteristics of pulmonary embolism with concomitant pneumonia

Although pneumonia is associated with an increased risk of venous thromboembolism, patients with pulmonary embolism and concomitant pneumonia are uncommon. The aim of the present study was to investigate the clinical features of pulmonary embolism with coexisting pneumonia. We retrospectively compared clinical, radiologic and laboratory parameters between patients with pulmonary embolism and concomitant pneumonia (pneumonia group) and those with unprovoked pulmonary embolism (unprovoked group), and then between the pneumonia group and those with pulmonary infarction (infarction group). Of 794 patients with pulmonary embolism, 36 (5%) had coexisting pneumonia and six (1%) had no provoking factor other than pneumonia. Stroke was significantly more common in the pneumonia group, than either the unprovoked group or the infarction group. In the pneumonia group, fever was significantly more common and serum C-reactive protein levels were significantly higher. By contrast, central pulmonary embolism and right ventricular dilation on computed tomography were significantly less frequent in the pneumonia group. In addition, an adverse outcome due to pulmonary embolism was less common in the pneumonia group than in either of the other two groups. The coexistence of pulmonary embolism and pneumonia is rarely encountered in clinical practice, especially without the presence of other factors that could provoke venous thromboembolism and is commonly associated with stroke. It is characterized by lower incidences of central pulmonary embolism and right ventricular dilation and by a lower rate of adverse outcomes due to pulmonary embolism itself.

The Role of Serum Coagulation Factors in the Differential Diagnosis of Patients with Pneumonia and Parapneumonic Effusion

The aim of this study was to identify the participations of the serum coagulations and fibrinolysis factors that contribute to the differential diagnosis of the patients with community-acquired pneumonia (CAP) without effusion, uncomplicated parapneumonic effusion (UCPPE) and complicated parapneumonic effusion (CPPE). The coagulations system is fundamental for the maintenance of homeostasis, and contributes to the inflammatory process responsible for CAP and the parapneumonic effusion. The factors of coagulations and fibrinolysis participate in the cellular proliferation and migration as in the synthesis of the inflammatory mediators. We evaluated the laboratory profile of coagulations and fibrinolysis in the serum of 148 patients with CAP without effusion, 50 with UCPPE and 44 with CPPE. We determined the test of the coagulation cascade which measures the time elapsed from the activation of the coagulation cascade at different points to the fibrin generation. As a consequence, there is an activation of the fibrinolytic system with the increased D-dimer levels measured in the plasma in the three groups. The patients were with mean age ± SD (53,82 ± 17,5) min - max 18-93 years. A significantly higher number of thrombocytes was in the group with CPPE with median 412 × 109/L (rank 323-513 × 109/L). The extended activation of the prothrombin time (aPTT) was significantly higher in the same group of patients with median of 32 sec. (rank 30-35 sec). The mean D-dimer plasma level was 3266,5 ± 1292,3 ng/ml in patients with CPPE, in CAP without effusion 1646,6 ± 1204 ng/ml and in UCPPE 1422,9 ± 970 ng/ml. The coagulations system and the fibrinolysis play important role in the development and pathophysiology of CAP and the parapneumonic effusions.

Pulmonary embolism as the initial clinical presentation of Kimura disease: case report and literature review

Pulmonary embolism is clinically critical in that if misdiagnosed or delayed, the mortality is very high. The recognition of its risk factor or underlying disease is important for prevention of recurrence. Kimura disease is a rare, chronic inflammatory disease, which is seldom associated with thrombosis. We reported a 47-year-old male case presenting with pleural pain and dyspnoea and was found to have pulmonary embolism. After successful management of pulmonary embolism, he was noticed to have eosinophilia and lymphadenopathy. Pathologic examination of a resected lymph node has confirmed the diagnosis of Kimura disease. The patient was treated with corticosteroid and cyclosporine A, with a significant improvement of the symptoms and signs of Kimura disease and no recurrence of any thromboembolism. Associated literatures were reviewed to explore the pathogenesis underlying the thrombotic event in Kimura disease cases. It is suggested that hypereosinophilia may play a key role in thrombosis formation. The control of hypereosinophilia may contribute to the prevention of thrombosis and its recurrence in patients with Kimura disease.