1
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Gil-García CA, Cueto-Robledo G, Gonzalez-Hermosillo LM, Alfaro-Cruz A, Roldan-Valadez E. Nonthrombotic Pulmonary Embolism Associated With Non-Hodgkin Lymphoma. Curr Probl Cardiol 2023; 48:102001. [PMID: 37506958 DOI: 10.1016/j.cpcardiol.2023.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Nonthrombotic pulmonary embolism (NTPE) challenges the medical community with its diverse etiologies and potential life-threatening implications. The classification section delves into the multifaceted nature of NTPE, which includes various embolic agents that traverse the vascular system. From air and fat emboli to tumor and amniotic fluid emboli, this exploration of diverse etiologies sheds light on the complexity of NTPE. Diagnostic methods play a crucial role in the effective management of NTPE. This article describes a range of traditional and cutting-edge diagnostic techniques, from computed tomography angiography to novel biomarkers, enabling the accurate and timely identification of NTPE. NTPE treatment options are diverse and patient-specific, requiring customized approaches to address varying embolic sources. Anticoagulation, embolus removal, and emerging interventions under study are discussed, providing clinicians with a comprehensive understanding of management strategies. This article uncovers the rare but captivating association between NTPE and non-Hodgkin lymphoma. Although rare, documented cases have sparked curiosity among researchers and medical practitioners. We explore potential pathophysiological connections, discussing challenges and considerations when encountering this unique scenario. In conclusion, this captivating review encapsulates the multifaceted realm of NTPE, covering its classification, diagnostics, and treatment modalities. Moreover, it presents a fascinating connection with non-Hodgkin lymphoma. This article offers a comprehensive and concise review of NTPE, guiding readers through its intricate classification, diagnostic approaches, and therapeutic interventions.
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Affiliation(s)
- Cesar-Alejandro Gil-García
- Faculty of Medicine, Autonomous University of Sinaloa, Los Mochis, Sinaloa, México; Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Pulmonary Circulation Clinic, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | | | - Ana Alfaro-Cruz
- Department of Surgical Pathology, General Hospital of Mexico, "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico; Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
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2
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Shahbaz Z, Inban P, Patel DK, Sayeed T, Tarimci B, Adewole IO, Nadia N, Dundi POR, Sajjad T, Khan A. Pulmonary Tumor Embolism Complicated by Metastatic Liver Carcinoma in Female With Primary Breast Carcinoma. Cureus 2023; 15:e37416. [PMID: 37182067 PMCID: PMC10174671 DOI: 10.7759/cureus.37416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Pulmonary tumor embolism (PTE) is a rare phenomenon typically presenting as dyspnea in cancer patients. Primary pathophysiology is similar to the thromboembolic disease of the pulmonary vasculature, which involves large vessels to small arterioles. This phenomenon occurs mostly in lung, stomach, liver, and breast adenocarcinoma. The symptoms of hypoxemia and the signs of hemodynamic instability and high-resolution computed tomography (CT) scans, along with a histopathological examination, are essential to make a confirmatory diagnosis of pulmonary tumor embolism. However, treatment options to effectively treat pulmonary tumor embolus are limited and still under investigation. We present a rare case of pulmonary tumor embolism in a patient with metastatic liver carcinoma and its management in a female with primary breast carcinoma.
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Affiliation(s)
- Zanib Shahbaz
- Department of Research and Development, Windsor University School of Medicine, Chicago, USA
| | - Pugazhendi Inban
- Department of General Medicine, Government Medical College, Chennai, IND
| | - Dev K Patel
- Department of Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Tass Sayeed
- Department of Medicine, Windsor University School of Medicine, Chicago, USA
| | - Baris Tarimci
- Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, TUR
| | - Idowu O Adewole
- Department of Medicine, All Saints University School of Medicine, Roseau, DMA
| | - Nabi Nadia
- Department of Obstetrics and Gynecology, Government Medical College, Srinagar, IND
| | - Prashant Obed R Dundi
- Department of General Practice, Karnataka Institute of Medical Sciences, Bangalore, IND
| | - Taha Sajjad
- Department of Medical Education, Mountain Vista Medical Center (MVMC), Phoenix, USA
| | - Aadil Khan
- Department of Internal Medicine, Lala Lajpat Rai (LLR) Hospital, Kanpur, IND
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3
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Itzhaki Ben Zadok O, Padera R, Nohria A. A Picture Is Worth 2,000 Words. JACC: CARDIOONCOLOGY 2023; 5:271-274. [PMID: 37144099 PMCID: PMC10152187 DOI: 10.1016/j.jaccao.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 03/09/2023]
Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Address for correspondence: Dr Osnat Itzhaki Ben Zadok, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts 02115, USA.
| | - Robert Padera
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Anju Nohria
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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4
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Sirbu O, Sorodoc V, Floria M, Statescu C, Sascau R, Lionte C, Petris OR, Haliga RE, Morariu PC, Tirnoveanu A, Burduloi VM, Ursulescu C, Sorodoc L. Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences. J Pers Med 2023; 13:jpm13020202. [PMID: 36836436 PMCID: PMC9963227 DOI: 10.3390/jpm13020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Nontrombotic pulmonary embolism represents the embolization of different types of materials (cells, organisms, gas, foreign material) into pulmonary circulation. The disease is uncommon, and clinical presentation together with laboratory findings are nonspecific. Its pathology is usually misdiagnosed based on imaging findings as pulmonary thromboembolism, but the correct diagnosis is essential because different therapeutic approaches are required. In this context, knowledge of the risk factors associated with nontrombotic pulmonary embolism and specific clinical symptoms is fundamental. Our objective was to discuss the specific features of the most common etiologies of nontrombotic pulmonary embolism, gas, fat, amniotic fluid, sepsis and tumors, to provide assistance for a rapid and correct diagnosis. Because the most common etiologies are iatrogenic, knowledge of the risk factors could be an important tool for prevention or rapid treatment if the disease develops during different procedures. The diagnosis of nontrombotic pulmonary embolisms represent a laborious challenge, and endeavors should be made to prevent development and increase awareness of this disease.
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Affiliation(s)
- Oana Sirbu
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Victorita Sorodoc
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Correspondence: (V.S.); (C.S.)
| | - Mariana Floria
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Cristian Statescu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases “Dr. George I.M. Georgescu”, 700503 Iasi, Romania
- Correspondence: (V.S.); (C.S.)
| | - Radu Sascau
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases “Dr. George I.M. Georgescu”, 700503 Iasi, Romania
| | - Catalina Lionte
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Ovidiu Rusalim Petris
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Raluca Ecaterina Haliga
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Paula Cristina Morariu
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Andreea Tirnoveanu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Vladut Mirel Burduloi
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Corina Ursulescu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Radiology, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
| | - Laurentiu Sorodoc
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
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Prevalence, Treatment, and Prognosis of Tumor Thrombi in Renal Cell Carcinoma. JACC: CARDIOONCOLOGY 2022; 4:522-531. [DOI: 10.1016/j.jaccao.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022]
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6
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The spectrum of imaging findings in pulmonary hydatid disease and the additive value of T2-weighted magnetic resonance imaging in its diagnosis. Pol J Radiol 2021; 86:e53-e63. [PMID: 33708273 PMCID: PMC7934737 DOI: 10.5114/pjr.2021.103237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/15/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe the spectrum of imaging findings in pulmonary echinococcosis and to study the additive value of T2-weighted magnetic resonance imaging (MRI) in the characterisation of pulmonary hydatid disease. Material and methods This was a descriptive, prospective study conducted for a period of 3 years from December 2016 to November 2019. Patients suspected of having pulmonary echinococcosis (n = 110) on preliminary chest radiography were examined with chest computed tomography (CT). Among them 41 cases were additionally examined with T2-weighted MRI of thorax. Final diagnosis was based on surgery or histopathology. Results Of the 110 patients enrolled for the study 15 were lost to attrition, and among the final cohort of 95 patients CT correctly diagnosed 68/84 (80.9%) as hydatid cyst, whereas 16/84 (19.1%) received an erroneous alternate diagnosis on CT. Based on the classical findings of hyperintense pulmonary cystic lesion with T2-weighted hypointense rim or detached internal T2-weighted hypointense membrane, a correct diagnosis of hydatid cyst was possible in 30 patients whereas a correct alternate diagnosis was made in 8 cases. T2-weighted MRI was found to have sensitivity of 96.7%, specificity of 80%, positive predictive value (PPV) of 93.7% and negative predictive value (NPV) of 88.9% with an overall diagnostic accuracy of 92.6%. Using the McNemar test, MRI was found to be diagnostically superior to CT (p = 0.019). Conclusions Most of the pulmonary hydatid cysts can be diagnosed on CT; however, sometimes the findings may be indeterminate or atypical, leading to a diagnostic dilemma. MRI, owing to its ability to demonstrate hypointense endocyst, can act as a useful adjunct to correctly diagnose hydatid cyst or suggest an alternative diagnosis.
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7
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Chong T, Park J, Aslam HM, Ansari S, Wallach SL. Pulmonary Tumor Embolism: A Rare Cause of Acute Pulmonary Hypertension. Cureus 2020; 12:e11877. [PMID: 33415030 PMCID: PMC7781770 DOI: 10.7759/cureus.11877] [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] [Indexed: 11/05/2022] Open
Abstract
A rare cause of acute decompensated pulmonary hypertension is pulmonary tumor embolism (PTE), which is an uncommon complication of advanced lung malignancy. Patients diagnosed with PTE typically have a poor prognosis, and so patients with advanced lung tumors who present with signs of right heart failure and respiratory support should be evaluated for PTE. We present a case of a 54-year-old Hispanic female who initially presented with a one-month history of dysphagia, who was found to have acute pulmonary hypertension secondary to invasion of the pulmonary arteries by lung adenocarcinoma.
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Affiliation(s)
- Timothy Chong
- Internal Medicine, Drexel College of Medicine, Philadelphia, USA
| | - Joseph Park
- Internal Medicine, Drexel College of Medicine, Philadelphia, USA
| | - Hafiz M Aslam
- Hematology and Medical Oncology, East Carolina University, Greenville, USA
| | - Shahryar Ansari
- Internal Medicine, St. Francis Medical Center, Seton Hall University, Trenton, USA
| | - Sara L Wallach
- Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Trenton, USA
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8
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El Hadj Sidi C, Mgarrech I, Alimi F, Tarmiz A. Four pathways for hydatid pulmonary embolism. J Card Surg 2020; 35:1877-1884. [PMID: 32652654 DOI: 10.1111/jocs.14754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hydatid pulmonary embolism (HPE) is rare but remains an etiology that needs to be considered and kept in mind, especially in endemic areas, as regards nonthrombotic embolism. METHODS Between 2000 and 2014, 10 patients were treated in our department for the presence of hydatid material in the pulmonary arterial circulation. Through these 10 cases, we try to assess the radioclinical characteristics and results of the surgical treatment. RESULTS The study included six men and four women, average age 28 years. Discovery of HPE was made following the exploration of cardiorespiratory symptoms in nine cases and was incidental in a single patient. Computed tomography angiography (CTA) of the chest directly visualized the hydatid material in the pulmonary arteries in nine cases. Surgery consisted of an embolectomy under cardiopulmonary bypass in nine cases. This embolectomy was preceded by the treatment of an embolic hydatid cyst (HC) in seven cases (HCs of the right heart chambers in six cases and a liver HC ruptured in the inferior vena cava in one case), whereas for only one patient, who presented a HC pedunculated in the right ventricle and protruding into the pulmonary artery, the cure of the cardiac location was sufficient. Only one patient died on the third postoperative day. CONCLUSION Endoluminal hydatid involvement of pulmonary arteries is extremely rare. CTA chest has an important contribution to the positive diagnosis. Treatment is surgical when the patient's condition allows it.
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Affiliation(s)
- Chighaly El Hadj Sidi
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Imen Mgarrech
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Faouzi Alimi
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
| | - Amine Tarmiz
- Department of Cardiovascular and Thoracic Surgery, Sahloul University Hospital, Sousse, Tunisia
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9
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Liu M, Tao XC, Zhai Z, Ma Z, Zhu L, Luo J. The filling defect of pulmonary artery, an imaging finding what we should know. Pulm Circ 2020; 10:2045894020910687. [PMID: 32215201 PMCID: PMC7065294 DOI: 10.1177/2045894020910687] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 02/12/2020] [Indexed: 12/11/2022] Open
Abstract
The most common cause of pulmonary artery filling defects on computed tomography pulmonary angiography or magnetic resonance imaging is pulmonary thromboembolism, but not infrequently, the presentation of this finding lacks specificity. Given that the morbidity and mortality associated with pulmonary thromboembolism is high, proper diagnosis of the condition is essential. Unusual or more rarely encountered etiologies must be considered when clinical manifestations and imaging findings are inconsistent. With this review, our purpose is to describe possible causes of pulmonary arterial filling defects. We aim to provide clinicians with a comprehensive list of differential diagnoses to facilitate a measured approach to the assessment of pulmonary arterial filling defects on computed tomography pulmonary angiography or magnetic resonance imaging.
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Affiliation(s)
- Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Xin Cao Tao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhanhong Ma
- Department of Radiology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Li Zhu
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jie Luo
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
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10
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Riley L, Machuca T, Alnuaimat H, Ataya A. Migrated Endovascular Coil. An Unwelcome Guest. Am J Respir Crit Care Med 2020; 200:384-385. [PMID: 30860859 DOI: 10.1164/rccm.201811-2172im] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Leonard Riley
- 1Division of Pulmonary, Critical Care, and Sleep Medicine and
| | - Tiago Machuca
- 2Department of Surgery, University of Florida, Gainesville, Florida
| | | | - Ali Ataya
- 1Division of Pulmonary, Critical Care, and Sleep Medicine and
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11
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Abstract
Here in Canada, we often think of gun violence as confined to conflict zones, terrorism, and more of a problem for our southern neighbor. However, in recent years, it has also become a Canadian problem with increased gun violence related to criminal activity presenting in daily practice. Radiologists play a critical role in the evaluation of ballistic trauma and must therefore be familiar with both the common and uncommon patterns of ballistic injury. In this article, we review the mechanisms of ballistic trauma as well as their resultant injury patterns in order to guide image interpretation.
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Affiliation(s)
- Noah G Ditkofsky
- Emergency, Trauma and Acute Care Radiology, St. Michael's Hospital, University of Toronto Emergency, Toronto, Ontario, Canada
| | - Hillel Maresky
- Department of Radiology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shobhit Mathur
- Emergency, Trauma and Acute Care Radiology, St. Michael's Hospital, University of Toronto Emergency, Toronto, Ontario, Canada
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12
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Ufuk F, Kaya F, Sagtas E, Kupeli A. Non-thrombotic pulmonary embolism in emergency CT. Emerg Radiol 2020; 27:343-350. [PMID: 32002737 DOI: 10.1007/s10140-020-01755-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/24/2020] [Indexed: 02/06/2023]
Abstract
Non-thrombotic pulmonary embolism (NTPE) results from the embolization of non-thrombotic materials. It can often be a challenging diagnosis due to non-specific (similar to thrombotic pulmonary embolism) or uncommon clinical and imaging findings. Patients with NTPE often present to the emergency department with acute respiratory distress, and contrast-enhanced computed tomography (CT) of the chest and CT pulmonary angiography are the imaging modalities of choice for respiratory distress. Since the treatment of NTPE is entirely different from thromboembolism, its distinction is essential. Moreover, early diagnosis of NTPE is necessary. Radiologists must be familiar with the diagnostic findings of NTPE, and this article aims to review the imaging features of various causes of NTPE.
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Affiliation(s)
- Furkan Ufuk
- Department of Radiology, University of Pamukkale, Denizli, Turkey.
| | - Furkan Kaya
- Department of Radiology, University of Kocatepe, Afyonkarahisar, Turkey
| | - Ergin Sagtas
- Department of Radiology, University of Pamukkale, Denizli, Turkey
| | - Ali Kupeli
- Department of Radiology, Erzincan Binali Yildirim University, Erzincan, Turkey
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13
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Makino Y, Kojima M, Yoshida M, Motomura A, Inokuchi G, Chiba F, Torimitsu S, Hoshioka Y, Yamaguchi R, Saito N, Urabe S, Tsuneya S, Horikoshi T, Yajima D, Iwase H. Postmortem CT and MRI findings of massive fat embolism. Int J Legal Med 2019; 134:669-678. [PMID: 31375910 DOI: 10.1007/s00414-019-02128-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 07/26/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To elucidate postmortem computed tomography (PMCT) and postmortem magnetic resonance (PMMR) imaging findings suggesting massive fat embolism. MATERIALS AND METHODS Consecutive forensic cases with PMCT and PMMR scans of subjects prior to autopsy were assessed. For PMCT, 16- or 64-row multidetector CT scans were used; for PMMR, a 1.5 T system was used. MRI sequences of the chest area included T2- and T1-weighted fast spin-echo imaging, T2*-weighted imaging, T1-weighted 3-dimensional gradient-echo imaging with or without a fat-suppression pulse, short tau inversion recovery, and in-phase/opposed-phase imaging. At autopsy, forensic pathologists checked for pulmonary fat embolism with fat staining; Falzi's grading system was used for classification. RESULTS Of 31 subjects, four were excluded because fat staining for histopathological examination of the lung tissue could not be performed. In three of the remaining 27 subjects, histology revealed massive fat embolism (Falzi grade III) and the cause of death was considered to be associated with fat embolism. CT detected a "fat-fluid level" in the right heart or intraluminal fat in the pulmonary arterial branches in two subjects. MRI detected these findings more clearly in both subjects. In one subject, CT and MRI were both negative. There were no positive findings in the 24 subjects that were fat embolism-negative by histology. DISCUSSION AND CONCLUSION In some subjects, a massive fat embolism can be suggested by postmortem imaging with a "fat-fluid level" in the right heart or intraluminal fat in the pulmonary arterial branches. PMMR potentially suggests fat embolism more clearly than PMCT.
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Affiliation(s)
- Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Masatoshi Kojima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Maiko Yoshida
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, 286-8686, Japan
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Rutsuko Yamaguchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoki Saito
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shumari Urabe
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shigeki Tsuneya
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takuro Horikoshi
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Daisuke Yajima
- Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita, 286-8686, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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14
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Rudkovskaia AA, Bandyopadhyay D. Intraluminal Arterial Filling Defects Misdiagnosed as Pulmonary Emboli: What Else Could They Be? Clin Chest Med 2019; 39:505-513. [PMID: 30122175 DOI: 10.1016/j.ccm.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pulmonary artery filling defects can be observed in various pathologic processes other than pulmonary embolism, for example, nonthrombotic pulmonary embolism with biological and nonbiological materials and intrinsic pulmonary artery lesions. They have also been described in rare conditions, such as fibrosing mediastinitis and congenital absence or stenosis of pulmonary artery, and some pulmonary parenchymal and airway malignancies. Misdiagnosis is common owing to the relative rarity of these conditions. Correct diagnosis is based on the appropriate clinical suspicion considering the unique clinical features, laboratory findings, and additional radiologic clues inferring a pathology other than pulmonary embolism.
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Affiliation(s)
- Anastasiia A Rudkovskaia
- Pulmonary and Critical Care Medicine, Geisinger, 100 North Academy Avenue, Danville, PA 17822-1334, USA.
| | - Debabrata Bandyopadhyay
- Pulmonary and Critical Care Medicine, Geisinger, 100 North Academy Avenue, Danville, PA 17822-1334, USA
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Chatzaraki V, Heimer J, Thali MJ, Ampanozi G, Schweitzer W. Approaching pulmonary fat embolism on postmortem computed tomography. Int J Legal Med 2019; 133:1879-1887. [PMID: 30972495 DOI: 10.1007/s00414-019-02055-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/27/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Pulmonary fat embolism (PFE) is a relevant diagnosis playing a role as a sign of vitality or a cause of death. Its severity is assessed according to histological grading systems like that of Falzi. The aim of this study was to determine the utility of unenhanced postmortem computed tomography (PMCT) for PFE diagnosis based on the detection of fat layers. METHODS Consecutive cases with PMCT and autopsy were studied retrospectively. The case group consisted of cases with positive PFE, and the control group included cases with negative PFE. Three observers independently assessed PMCT data for fat layers in the pulmonary trunk and the right and left pulmonary artery. For cases with fat layers, autopsy protocols were assessed for the cause of death, relation to trauma, and undertaken resuscitation measures. RESULTS Eight hundred thirty cases were included: 366 PFE positive cases (144 of Falzi grade 1, 63 of 1.5, 99 of 2, 28 of 2.5, and 32 of 3) and 464 PFE negative cases. Interrater reliabilities varied between substantial and almost perfect, and discrepancies were solved according to majority. Eighteen cases showed fat layers on PMCT (2 controls-traumatic instantaneous deaths-, 16 PFE positive cases). PMCT showed low sensitivity but high specificity for PFE diagnosis. The layers were located at the same position in the pulmonary trunk directly adjacent to the pulmonary valve distal to the right ventricle. CONCLUSION Fat layer on PMCT is a rare finding but relates to PFE diagnosis, especially of severe histological grade. It is to be expected in a typical position within the pulmonary trunk.
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Affiliation(s)
- Vasiliki Chatzaraki
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
| | - Jakob Heimer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Garyfalia Ampanozi
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Wolf Schweitzer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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Rahimi B, Boroofeh B, Dinparastisaleh R, Nazifi H. Cement pulmonary embolism after percutaneous vertebroplasty in a patient with cushing's syndrome: A case report. Respir Med Case Rep 2018; 25:78-85. [PMID: 30073141 PMCID: PMC6068333 DOI: 10.1016/j.rmcr.2018.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/16/2018] [Accepted: 06/17/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vertebroplasty is a procedure most commonly used for vertebral compression fractures. Although it is a relatively safe procedure, complications have been reported. Cement embolism is seen in 2.1%-26% of patients after percutaneous vertebroplasty. CASE PRESENTATION a 38-year-old male who was diagnosed with cushing's syndrome, underwent percutaneous vertebroplasty for his thoracic osteoporotic compression fractures. 24-hours following vertebroplasty, he presented to emergency department with acute-onset dyspnea and chest pain. Chest radiography showed an opaque linear lesion in left pulmonary artery which was suggestive of cement embolism. Pulmonary spiral CT-scan further confirmed the diagnosis. The patient's symptoms improved over time, and warfarin was started with close cardiopulmonary assessments for indicators of cement embolus removal. CONCLUSION in patients with pulmonary cement embolism, conservative treatment may be recommended rather than a surgical removal except when the obstruction is extensive enough to cause hemodynamic changes. Given that all the related studies have suggested that pulmonary thromboembolism can occur as a complication due to bone cement leakage, discovering new cement alternatives and/or injection devices, seems beneficial.
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Affiliation(s)
- Besharat Rahimi
- Pulmonology Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behdad Boroofeh
- Pulmonology Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshan Dinparastisaleh
- Internal Medicine Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Hale Nazifi
- Internal Medicine Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
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Pitfalls in the Diagnosis of Acute Pulmonary Embolism on Computed Tomography: Common Pathologic and Imaging Mimics. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0273-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Sammel AM, Fung S, Omari A. Images in Vascular Medicine: Non-thrombotic pulmonary artery embolism - Don't forget the differential. Vasc Med 2017; 23:185-186. [PMID: 29096590 DOI: 10.1177/1358863x17739145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anthony Michael Sammel
- 1 St Vincent's Hospital Sydney, Sydney, Australia
- 2 University of Sydney, Sydney, Australia
| | - Sebastian Fung
- 3 St Vincent's Private Hospital Sydney, Sydney, Australia
| | - Abdullah Omari
- 1 St Vincent's Hospital Sydney, Sydney, Australia
- 3 St Vincent's Private Hospital Sydney, Sydney, Australia
- 4 University of Technology, Sydney, Australia
- 5 University of Tasmania, Hobart, Australia
- 6 University of Notre Dame, Sydney, Australia
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