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Menezes TFC, Lee MH, Lucena J, Sperandio PCA, Ota-Arakaki JS, Ferreira EVM, Oliveira RKF. Dyspnea Investigation in Behçet's Disease: The Role of Advanced Diagnostic Methods to Elucidate Dyspnea in Systemic Diseases. Ann Am Thorac Soc 2024; 21:977-982. [PMID: 38819136 PMCID: PMC11160131 DOI: 10.1513/annalsats.202309-790cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/10/2024] [Indexed: 06/01/2024] Open
Affiliation(s)
- Thais F. C. Menezes
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil; and
| | - Michael H. Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Juliana Lucena
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil; and
| | - Priscila C. A. Sperandio
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil; and
| | - Jaquelina S. Ota-Arakaki
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil; and
| | - Eloara V. M. Ferreira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil; and
| | - Rudolf K. F. Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil; and
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Tajik Jalayeri MH, Mazandarani M, Lashkarbolouk N. Diagnosis of Behcet's disease in a young male patient with acute bilateral pulmonary embolism; A case report and literature review. Respir Med Case Rep 2024; 49:102009. [PMID: 38584762 PMCID: PMC10995881 DOI: 10.1016/j.rmcr.2024.102009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Behcet's disease (BD) is a chronic and inflammatory vasculitis characterized by recurrent oral and genital aphthous ulcers, uveitis, and skin lesions. Although there is a high rate of deep vein thrombosis in BD, pulmonary arterial thromboembolism (PTE) is a rare complication. We present a 30-year-old patient who was admitted with pleuritic chest pain, non-massive hemoptysis since 4 days ago and medical history of intermittent genial aphthous lesions, and skin lesions. During our evaluation, he had an S1Q3T3 pattern in the electrocardiogram, a high level of D-dimer, a low level of FDP and fibrinogen along with pulmonary emboli in lobar and segmental branches of the right pulmonary artery and segmental branches of left lower lobe pulmonary artery were detected in his pulmonary CT Angiography. Then, he was positive for HLA-B51. Based on his clinical condition and history of recurrent genital and skin lesions, a positive pathergy test. Therefore, the diagnosis of BD was confirmed for him. Diagnosis of PTE can be difficult due to the rarity of PTE in BD and nonspecific clinical symptoms; therefore, a high degree of suspicion and appropriate radiographic imaging is essential for the diagnosis.
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Affiliation(s)
- Mohammad Hadi Tajik Jalayeri
- Pulmonary and Critical Care Division, Sayyad Medical and Educational Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahdi Mazandarani
- Golestan University of Medical Sciences, Gorgan, Iran
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Lashkarbolouk
- Golestan University of Medical Sciences, Gorgan, Iran
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Osman S, Girdharry NR, Karvasarski E, Bentley RF, Wright SP, Sharif N, McInnis M, Granton JT, dePerrot M, Mak S. Exercise and pulsatile pulmonary vascular loading in chronic thromboembolic pulmonary disease. Pulm Circ 2024; 14:e12331. [PMID: 38249723 PMCID: PMC10799664 DOI: 10.1002/pul2.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 12/01/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Chronic thromboembolic pulmonary disease (CTEPD) is characterized by organized nonresolving thrombi in pulmonary arteries (PA). In CTEPD with pulmonary hypertension (PH), chronic thromboembolic PH (CTEPH), early wave reflection results in abnormalities of pulsatile afterload and augmented PA pressures. We hypothesized that exercise during right heart catheterization (RHC) would elicit more frequent elevations of pulsatile vascular afterload than resistive elevations in patients with CTEPD without PH. The interdependent physiology of pulmonary venous and PA hemodynamics was also evaluated. Consecutive patients with CTEPD without PH (resting mean PA pressure ≤20 mmHg) undergoing an exercise RHC were identified. Latent resistive and pulsatile abnormalities of pulmonary vascular afterload were defined as an exercise mean PA pressure/cardiac output >3 WU, and PA pulse pressure to PA wedge pressure (PA PP/PAWP) ratio >2.5, respectively. Forty-five patients (29% female, 53 ± 14 years) with CTEPD without PH were analyzed. With exercise, 19 patients had no abnormalities (ExNOR), 26 patients had abnormalities (ExABN) of pulsatile (20), resistive (2), or both (4) elements of pulmonary vascular afterload. Exercise elicited elevations of pulsatile afterload (53%) more commonly than resistive afterload (13%) (p < 0.001). ExABN patients had lower PA compliance and higher pulmonary vascular resistance at rest and exercise and prolonged resistance-compliance time product at rest. The physiological relationship between changes in PA pressures relative to PAWP was disrupted in the ExABN group. In CTEPD without PH, exercise RHC revealed latent pulmonary vascular afterload elevations in 58% of patients with more frequent augmentation of pulsatile than resistive pulmonary vascular afterload.
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Affiliation(s)
- Sinan Osman
- Division of CardiologyMount Sinai Hospital/University Health NetworkTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
| | - Natasha R. Girdharry
- Division of CardiologyMount Sinai Hospital/University Health NetworkTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
| | - Elizabeth Karvasarski
- Division of CardiologyMount Sinai Hospital/University Health NetworkTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
| | - Robert F. Bentley
- Faculty of Kinesiology and Physical EducationUniversity of TorontoTorontoOntarioCanada
| | - Stephen P. Wright
- School of Health and Exercise Sciences, Centre for Heart, Lung and Vascular HealthUniversity of British ColumbiaKelownaBritish ColumbiaCanada
| | - Nadia Sharif
- Department of Medicine, Division of RespirologyUniversity Health NetworkTorontoOntarioCanada
| | - Micheal McInnis
- Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - John T. Granton
- Department of Medicine, Division of RespirologyUniversity Health NetworkTorontoOntarioCanada
| | - Marc dePerrot
- Department of Surgery, Division of Thoracic SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Susanna Mak
- Division of CardiologyMount Sinai Hospital/University Health NetworkTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
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Julià-Torras J, Almeida Felipe JM, Gándara Del Castillo Á, González-Barboteo J, Forero D, Alegre S, Cuervo-Pinna MÁ, Serna J, Muñoz-Unceta N, Alonso-Babarro A, Miró Catalina Q, Moreno-Alonso D, Porta-Sales J. Prevalence, Clinical Characteristics, and Management of Episodic Dyspnea in Advanced Lung Cancer Outpatients: A Multicenter Nationwide Study-The INSPIRA-DOS Study. J Palliat Med 2022; 25:1197-1207. [PMID: 35196465 DOI: 10.1089/jpm.2021.0562] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Episodic dyspnea (ED) is a common problem in patients with advanced lung cancer (LC). However, the prevalence of ED and other related aspects in this patient population is not known. Objectives: To assess and describe the prevalence, clinical features, treatment, and risk factors for ED in outpatients with advanced LC. Design: Multicenter cross-sectional study. Subjects: Consecutive sample of adult outpatients with advanced LC. Measurements: We assessed background dyspnea (BD), the characteristics, triggers, and management of ED. Potential ED risk factors were assessed through multivariate logistic regression. Results: A total of 366 patients were surveyed. Overall, the prevalence of ED was 31.9% (90% in patients reporting BD). Patients reported a median of one episode per day (interquartile range [IQR]: 1-2), with a median intensity of 7/10 (IQR: 5-8.25). ED triggers were identified in 89.9% of patients. ED was significantly associated with chronic obstructive pulmonary disease (p = 0.011), pulmonary vascular disease (p = 0.003), cachexia (p = 0.002), and palliative care (p < 0.001). Continuous oxygen use was associated with higher risk of ED (odds ratio: 9.89; p < 0.001). Opioids were used by 44% patients with ED. Conclusions: ED is highly prevalent and severe in outpatients with advanced LC experiencing BD. The association between intrathoracic comorbidities and oxygen therapy points to alveolar oxygen exchange failure having a potential etiopathogenic role in ED in this population. Further studies are needed to better characterize ED in LC to better inform treatments and trial protocols.
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Affiliation(s)
- Joaquim Julià-Torras
- Palliative Care Department, Institut Català d'Oncologia, Badalona, Spain.,School of Medicine and Health Science, Universitat Internacional de Catalunya, Barcelona, Spain
| | - J M Almeida Felipe
- Palliative Care Unit, Complejo Hospitalario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | | | - Jesús González-Barboteo
- Palliative Care Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain.,Palliative Care Research Group, EPIBELL Programme, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat (Barcelona), Spain
| | - Diana Forero
- Palliative Care Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Salvador Alegre
- Internal Medicine Department, Hospital de San Lázaro, Sevilla, Spain
| | | | - Judit Serna
- Support and Palliative Care Unit, Hospital Universitari Campus Vall d'Hebron, Barcelona, Spain
| | - Nerea Muñoz-Unceta
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Medical Oncology Department, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVALL), Santander, Spain
| | | | - Queralt Miró Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain.,Servei d'Atenció Primària Bages-Berguedà-Moianès, Gerència Territorial de Barcelona, Institut Català de la Salut, Manresa, Spain
| | - Deborah Moreno-Alonso
- School of Medicine and Health Science, Universitat Internacional de Catalunya, Barcelona, Spain.,Palliative Care Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Josep Porta-Sales
- School of Medicine and Health Science, Universitat Internacional de Catalunya, Barcelona, Spain.,Universitat Internacional de Catalunya, Sant Cugat del Vallès-Barcelona, Spain
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Abstract
Dyspnea in low-preload states is an underrecognized but growing diagnosis in patients with unexplained dyspnea. Patients can often experience debilitating symptoms at rest and with exertion, as low measured preload often leads to decreased cardiac output and ultimately dyspnea. In the present article, we performed a review of the literature and a multidisciplinary evaluation to understand the pathophysiology, diagnosis, and treatment of dyspnea in low-preload states. We explored selected etiologies and suggested an algorithm to approach unexplained dyspnea. The mainstay of diagnosis remains as invasive cardiopulmonary exercise testing. We concluded with a variety of nonpharmacological and pharmacological therapies, highlighting that a multifactorial approach may lead to the best results.
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Ngo D, Aftab G, Madhavan A, Bukhari A. Idiopathic pulmonary vein thrombosis treated with apixaban. Respirol Case Rep 2021; 9:e00803. [PMID: 34306707 PMCID: PMC8292945 DOI: 10.1002/rcr2.803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/25/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
Pulmonary vein thrombosis (PVT) is a rare clinical finding that is potentially fatal and with an unknown incidence rate as known cases exist predominantly in case reports. We present the case of a 58-year-old female who reported sudden onset of chest pain, shortness of breath, and dyspnoea on exertion. A computed tomography (CT) pulmonary angiogram was negative for evidence of pulmonary embolism; however, it did demonstrate the evidence of thrombosis of the right lower lobe segmental pulmonary vein. She had no identifiable aetiologies for her PVT; therefore, she was diagnosed with idiopathic PVT and was treated successfully with apixaban. This case represents the 14th incidence of idiopathic PVT in the current body of medical literature and the first case of successful treatment with apixaban.
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Affiliation(s)
- Dallis Ngo
- Division of Pulmonary, Critical Care and Sleep MedicineSaint Peter's University HospitalNew BrunswickNJUSA
| | - Ghulam Aftab
- Division of Pulmonary, Critical Care and Sleep MedicineSaint Peter's University HospitalNew BrunswickNJUSA
| | - Arjun Madhavan
- Division of Pulmonary, Critical Care and Sleep MedicineSaint Peter's University HospitalNew BrunswickNJUSA
| | - Amar Bukhari
- Division of Pulmonary, Critical Care and Sleep MedicineSaint Peter's University HospitalNew BrunswickNJUSA
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