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Bayfield N, Wang E, Andrews D. Chronic inflammatory pulmonary artery lesion causing right pulmonary artery stenosis 15 years post Blalock-Taussig shunt ligation. BMJ Case Rep 2023; 16:e254103. [PMID: 37793846 PMCID: PMC10551977 DOI: 10.1136/bcr-2022-254103] [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] [Indexed: 10/06/2023] Open
Abstract
Discrete central endovascular pulmonary arterial lesions raise clinical concern for malignancy such as primary pulmonary artery sarcoma. We present a case of a female in her late teens who had an obstructive mid right pulmonary artery lesion found on follow-up imaging 15 years after Tetralogy of Fallot repair. The lesion was in the vicinity of a previously ligated Blalock-Taussig shunt and causing right PA stenosis with delayed perfusion to the right lung, and a flow-related distal left PA aneurysm. The lesion was excised and confirmed histologically to be inflammatory in nature. Intraoperative microbiology demonstrated growth of the Kytococcus species, and she was managed with 6 weeks of intravenous antibiotics, with a full recovery.
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Affiliation(s)
| | - Edward Wang
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - David Andrews
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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2
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Saeed H, Marmolejos L, Patel R, Shankar T, Latif A, Naqi M, Farrer W, Remolina C. Pleurisy secondary to nonthrombotic pulmonary emboli in a patient with intravenous drug use. Respir Med Case Rep 2023; 45:101884. [PMID: 37577124 PMCID: PMC10415754 DOI: 10.1016/j.rmcr.2023.101884] [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: 02/19/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 08/15/2023] Open
Abstract
Patients with injection drug use can have nonthrombotic pulmonary emboli (NTPE) of foreign insoluble particles that are either parts of the equipment used or mixed with the drug as an additive. These foreign particles can become a nidus for infection and inflammation. We present a case of a 31-year-old man with active intravenous drug use who initially presented with signs and symptoms of pleurisy and was found to have NTPE of septic refractile crystalline material as seen on bronchial wash and brush biopsy. We believe our patient likely had embolism of either crack particles, needle fragments or cotton-wool fragments that led to a localized inflammatory reaction and infection. This highlights the importance of obtaining detailed history and diagnostic workup. Once the diagnoses of bacterial endocarditis and thrombophlebitis are ruled out with blood cultures, transthoracic echocardiogram, trans-esophageal echocardiogram and/or CT scan (depending on the suspicion), NTPE should be considered and bronchoscopy with bronchoalveolar lavage with biopsy should be performed.
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Affiliation(s)
- Hasham Saeed
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Leonardo Marmolejos
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Roma Patel
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Tanya Shankar
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Asnia Latif
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Muniba Naqi
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - William Farrer
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Carlos Remolina
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
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3
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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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Philip J, Bond MC. Emergency Considerations of Infective Endocarditis. Emerg Med Clin North Am 2022; 40:793-808. [DOI: 10.1016/j.emc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hughes D, Linchangco R, Reyaldeen R, Xu B. Expanding utility of cardiac computed tomography in infective endocarditis: A contemporary review. World J Radiol 2022; 14:180-193. [PMID: 36160630 PMCID: PMC9350612 DOI: 10.4329/wjr.v14.i7.180] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/26/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
There is increasing evidence on the utility of cardiac computed tomography (CCT) in infective endocarditis (IE) to investigate the valvular pathology, the extra-cardiac manifestations of IE and pre-operative planning. CCT can assist in the diagnosis of perivalvular complications, such as pseudoaneurysms and abscesses, and can help identify embolic events to the lungs or systemic vasculature. CCT has also been shown to be beneficial in the pre-operative planning of patients by delineating the coronary artery anatomy and the major cardiovascular structures in relation to the sternum. Finally, hybrid nuclear/computed tomography techniques have been shown to increase the diagnostic accuracy in prosthetic valve endocarditis. This manuscript aims to provide a contemporary update of the existing evidence base for the use of CCT in IE.
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Affiliation(s)
- Diarmaid Hughes
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Richard Linchangco
- Section of Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Reza Reyaldeen
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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6
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A rare case of septic pulmonary embolism: A case report. Respir Med Case Rep 2022; 38:101692. [PMID: 35799862 PMCID: PMC9253841 DOI: 10.1016/j.rmcr.2022.101692] [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: 03/06/2022] [Revised: 03/24/2022] [Accepted: 06/20/2022] [Indexed: 11/27/2022] Open
Abstract
Septic pulmonary embolism occurs when septic material separates from its source and infiltrates the pulmonary parenchyma, resulting in substantial clinical symptoms. Here we report a 13-year-old female patient admitted to the hospital with a fever and chest discomfort. In the past days, she had bilateral limb pain, which induced traditional cauterization in the bilateral inguinal regions. On inspection, she had edema and erythema at the cauterization site, indicating wound infection. Multiple lung nodules were discovered on computed tomography, indicating SPE. High-dose antibiotics were started immediately after debridement. SPE is frequently associated with deep tissue infections, and cases of SPE following minor traumas are uncommon.
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7
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Affiliation(s)
- Satish Swain
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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8
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Singh H, Alam A, Tilak TVSVGK, Kinra P, Soni BK. Pitfalls in interpretation of FDG PET/CT: Septic pulmonary emboli mimicking metastases in a case of gastric carcinoma. Indian J Radiol Imaging 2021; 26:524-527. [PMID: 28104952 PMCID: PMC5201088 DOI: 10.4103/0971-3026.195792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammatory lesions may sometimes show intense tracer uptake and mimic neoplastic lesions on (18) F-fluoro-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). We report one such false positive case on FDG PET/CT, where septic pulmonary emboli (SPE) mimicked pulmonary metastases. A 45-year-old man with stomach cancer had an indwelling central venous catheter (CVC) in situ while on neoadjuvant chemotherapy. He underwent FDG PET/CT scan for response assessment and the images revealed multiple, intensely FDG avid, peripheral, lung nodules with feeding vessels, which were suspicious for pulmonary metastases. A day later, the patient developed fever with chills and his blood culture showed bacterial growth (Enterobacter cloacae). A provisional diagnosis of SPE from an infected CVC was made. Chemotherapy was withheld, CVC removed, and the catheter tip was sent for bacterial culture. Following a 4-week course of antibiotic treatment, the patient became afebrile. Culture from the CVC tip grew the same organism, as was seen earlier in the patient's blood culture, thus pin-pointing the source of infection in our case. Diagnosis of SPE was clinched when follow-up CT chest done after completion of antibiotic course showed complete resolution of the lung lesions.
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Affiliation(s)
- Harkirat Singh
- Department of Nuclear Medicine, Command Hospital (AF), Bengaluru, Karnataka, India
| | - Aftab Alam
- Department of Radiology, Command Hospital (AF), Bengaluru, Karnataka, India
| | - T V S V G K Tilak
- Department of Medical Oncology, Command Hospital (AF), Bengaluru, Karnataka, India
| | - Prateek Kinra
- Department of Pathology, Command Hospital (AF), Bengaluru, Karnataka, India
| | - Brijesh K Soni
- Department of Radiology, Command Hospital (AF), Bengaluru, Karnataka, India
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9
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Abstract
The diagnosis of pulmonary embolism (PE) is often made more challenging by the presence of diseases that can mimic thromboembolic disease. There is no specific or sensitive constellation of clinical signs or symptoms that can be used to diagnose PE. Ventilation/perfusion scans can have false-positive findings related to mediastinal conditions that can compress the pulmonary arteries, and pulmonary hemorrhage can resemble PE on V/Q scanning with potentially devastating consequences if anticoagulation is started. CT-scan related issues l eading to potential false-positive diagnoses range from inadequate imaging technique, to systemic-pulmonary shunting, to non-thrombotic occlusion of pulmonary arteries by tumor, septic emboli, and emboli of fat, air, and foreign material, as well as vasculitic processes. Careful assessment of the patient and consideration of these potential mimickers is imperative to correct diagnosis of this potentially life-threatening condition.
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Affiliation(s)
- Yuri Matusov
- Cedars-Sinai Medical Center - Pulmonary & Critical Care Medicine, Los Angeles, California, United States
| | - Victor F Tapson
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Cedars-Sinai Medical Center - Venous Thromboembolism and Pulmonary Vascular Disease Research Program, Los Angeles, California, United States
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10
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Gimbel IA, Mulder FI, Bosch FTM, Freund JE, Guman N, van Es N, Kamphuisen PW, Büller HR, Middeldorp S. Pulmonary embolism at autopsy in cancer patients. J Thromb Haemost 2021; 19:1228-1235. [PMID: 33501757 PMCID: PMC8252008 DOI: 10.1111/jth.15250] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) is a potentially fatal disease, but data on the incidence of fatal PE in cancer patients are scant. OBJECTIVE We sought to estimate the proportion of cancer patients with PE at autopsy. METHODS For this retrospective cohort study, all autopsy reports of cancer patients were retrieved from PALGA: Dutch Pathology Registry and used for data extraction. The primary outcome was PE at time of autopsy, defined as any clot obstructing a pulmonary artery. The secondary outcome was venous thromboembolism, defined as the composite of thrombotic PE, deep vein thrombosis, splanchnic vein thrombosis, or internal jugular vein thrombosis. RESULTS A total of 9571 cancer patients were included. In 1191 (12.4%; 95% confidence interval [CI], 11.8-13.1) patients, one or more PE events were observed at autopsy, of whom 1074 (90.2%) had a thrombotic embolism, 168 (14.1%) a tumor embolism, 9 (0.8%) a septic embolism, 7 (0.6%) a fat tissue embolism, and 3 (0.3%) a bone marrow embolism. Among patients with PE for whom the cause of death was specified in the autopsy report, death was considered PE-related in 642 patients (66.7%), which was 6.7% of the total study population. Venous thromboembolism was observed in 1223 (12.8%; 95% CI, 12.1-13.5) patients. CONCLUSION The proportion of PE in cancer patients at autopsy is substantial. Although the study population is not representative for the total cancer population, it suggests that PE is an important disease complication in cancer patients.
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Affiliation(s)
- Inge A. Gimbel
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Frits I. Mulder
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineTergooi HospitalHilversumThe Netherlands
| | - Floris T. M. Bosch
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineTergooi HospitalHilversumThe Netherlands
| | - Jan Erik Freund
- Department of PathologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Noori Guman
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineTergooi HospitalHilversumThe Netherlands
| | - Nick van Es
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Pieter W. Kamphuisen
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineTergooi HospitalHilversumThe Netherlands
| | - Harry R. Büller
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Saskia Middeldorp
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
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Abstract
Systemic arterial air embolism (SAAE) is a rare but potentially life-threatening condition that may occur when air enters into pulmonary veins or directly into the systemic circulation after pulmonary procedures (biopsy or resection) or penetrating trauma to the lung. While venous air embolism is commonly reported, arterial air embolism is rare. Even a minor injury to the chest along with positive-pressure ventilation can cause SAAE. Small amounts of air may cause neurological or cardiac symptoms depending on the affected arteries, while massive embolism can result in fatal cardiovascular collapse. We discuss the various causes of SAAE, including trauma, computed tomography-guided lung biopsy, and various intervention procedures such as mechanical circulatory support device implantation, coronary catheterization, and atrial fibrillation repair. SAAE diagnosis can be overlooked because its symptoms are not specific, and confirmation of the presence of air in the arterial system is difficult. Although computed tomography is the optimal imaging tool for diagnosis, patient instability and resuscitation often precludes its use. When imaging is performed, awareness of the causes of SAAE allows the radiologist to promptly diagnose the condition and relay findings to the clinicians so that treatment, namely hyperbaric oxygen therapy, may be started promptly.
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12
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Agbelele P, Van Maris F, Sanguina M, Zerkly B, Djebara AE, Girard P. Use of chest CT-scan images to differentiate between SARS-CoV-2 infection and fat embolism: A clinical case. Radiol Case Rep 2020; 15:2047-2050. [PMID: 32837669 PMCID: PMC7392099 DOI: 10.1016/j.radcr.2020.07.071] [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: 07/19/2020] [Revised: 07/25/2020] [Accepted: 07/25/2020] [Indexed: 11/24/2022] Open
Abstract
The authors present the case of a young man victim of a traffic accident during the SARS-CoV-2 confinement, having presented a fracture of the femoral shaft that was soon complicated by respiratory failure with oxygen desaturation. In this pandemic context, Covid-19 RT-PCR tests were carried out but returned negative. The CT images could suggest either a fatty embolism, a SARS-CoV-2 infection or both. The patient's condition improved significantly after going into intensive care and only symptomatic treatment. This case demonstrates the difficulty of differential interpretation of CT images between fatty embolism and SARS-CoV-2 infection.
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Affiliation(s)
- Penance Agbelele
- Orthopedic Surgery and Traumatology Department, South Oise Hospital Group, Creil, France
| | | | - Mario Sanguina
- Orthopedic Surgery and Traumatology Department, South Oise Hospital Group, Creil, France
| | - Bachar Zerkly
- Orthopedic Surgery and Traumatology Department, South Oise Hospital Group, Creil, France
| | - Az-Eddine Djebara
- Orthopedic Surgery and Traumatology Department, University Hospital of Amiens-Picardy 80480, Salouel, France
| | - Pierre Girard
- Orthopedic Surgery and Traumatology Department, South Oise Hospital Group, Creil, France
- Orthopedic Surgery and Traumatology Department, University Hospital of Amiens-Picardy 80480, Salouel, France
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Alpert M, Grigorian A, Scolaro J, Learned J, Dolich M, Kuza CM, Lekawa M, Nahmias J. Fat embolism syndrome in blunt trauma patients with extremity fractures. J Orthop 2020; 21:475-480. [PMID: 33716415 PMCID: PMC7923246 DOI: 10.1016/j.jor.2020.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/02/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study sought to provide a national, descriptive analysis to determine fat embolism syndrome (FES) risk factors, hypothesizing that femur fractures and multiple fractures are associated with an increased risk. METHODS The Trauma Quality Improvement Program was queried (2010-2016) for patients with extremity fractures. A multivariable logistic regression analysis model was used. RESULTS From 324,165 patients, 116 patients (0.04%) were diagnosed with FES. An age ≤30, closed femur fracture, and multiple long bone fractures were associated with an increased risk of FES. CONCLUSION Future research to validate these findings and develop a clinical risk stratification tool appears warranted.
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Affiliation(s)
- Miriam Alpert
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E. Second St, Pomona, CA, 91766, USA
| | - Areg Grigorian
- University of California, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, 333 the City Blvd West, Suite 1600, Orange, CA, 92868, USA
| | - John Scolaro
- University of California, Department of Orthopaedic Surgery, Division of Trauma, 101 the City Blvd South, Building 29A, Orange, CA, 92868, USA
| | - James Learned
- University of California, Department of Orthopaedic Surgery, Division of Trauma, 101 the City Blvd South, Building 29A, Orange, CA, 92868, USA
| | - Matthew Dolich
- University of California, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, 333 the City Blvd West, Suite 1600, Orange, CA, 92868, USA
| | - Catherine M. Kuza
- University of Southern California, Keck School of Medicine, Department of Anesthesiology, 1450 San Pablo St, Suite 3600, Los Angeles, CA, 90033, USA
| | - Michael Lekawa
- University of California, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, 333 the City Blvd West, Suite 1600, Orange, CA, 92868, USA
| | - Jeffry Nahmias
- University of California, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, 333 the City Blvd West, Suite 1600, Orange, CA, 92868, USA
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14
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Consider the 'Hole' Differential: Pulmonary Malignancy Presenting as a Cavitary Lesion. Am J Med 2020; 133:438-440. [PMID: 31525335 PMCID: PMC7076732 DOI: 10.1016/j.amjmed.2019.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/09/2019] [Indexed: 11/23/2022]
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15
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Approach to Abnormal Chest Computed Tomography Contrast Enhancement in the Hospitalized Patient. Radiol Clin North Am 2020; 58:93-103. [DOI: 10.1016/j.rcl.2019.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Jiang J, Liang QL, Liu LH, Cai SQ, Du ZY, Kong JL, Chen YQ. Septic pulmonary embolism in China: clinical features and analysis of prognostic factors for mortality in 98 cases. BMC Infect Dis 2019; 19:1082. [PMID: 31881849 PMCID: PMC6935238 DOI: 10.1186/s12879-019-4672-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To investigate the clinical features of septic pulmonary embolism (SPE) cases and prognostic factors for in-hospital mortality in China. METHODS A retrospective analysis was conducted of SPE patients hospitalized between January 2007 and June 2018 in the Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University. RESULTS A total of 98 patients with SPE were identified. All patients had bilateral multiple peripheral nodules on chest computed tomography. The most common pathogen found in blood culture was Staphylococcus aureus (10/33, 30.3%). Transthoracic echocardiography was performed in 39 patients and 20 showed vegetations. Bronchoscopy was performed in 24 patients. Bronchoalveolar lavage fluid (BALF) was obtained from 15 patients (62.5%) and showed predominantly polymorphonuclear cell infiltration (52%, range of 48%~ 63%). Four patients received transbronchial lung biopsy, and histopathological examinations revealed suppurative pneumonia and organizing pneumonia. The in-hospital mortality rate was 19.4%. Age (odds ratio [OR] 1.100; 95% confidence interval [CI] 1.035-1.169), hypotension (OR 7.260; 95% CI 1.126-46.804) and ineffective or delay of empirical antimicrobial therapy (OR 7.341; 95% CI 1.145-47.045) were found to be independent risk factors for in-hospital mortality, whereas drainage treatment was found to be a protective factor (OR 0.33; 95% CI 0.002-0.677). CONCLUSIONS SPE cases presented with nonspecific clinical manifestations and radiologic features. Blood cultures and bronchoscopy are important measures for early diagnosis and differential diagnosis. There is relationship between primary infection sites and the type of pathogen. Maintaining normal blood pressure and providing timely and appropriate initial antimicrobial therapy for effective control of the infection could improve prognosis.
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Affiliation(s)
- Jing Jiang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Qiu-li Liang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Li-hua Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Shuang-qi Cai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Zhong-ye Du
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Jin-liang Kong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
| | - Yi-qiang Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 People’s Republic of China No. 6 Shuangyong Road
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Zulkifle AM, Faisal M. Multiple asymptomatic vascular air embolisms following contrast-enhanced CT scan. BMJ Case Rep 2019; 12:12/8/e229169. [PMID: 31466969 DOI: 10.1136/bcr-2018-229169] [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: 11/04/2022] Open
Abstract
Vascular air embolism (VAE) is a known complication of contrast-enhanced CT (CECT) scan occurring in venous or arterial circulation with a wide spectrum of presentations. We report a case of a 44-year-old woman with endometrial adenocarcinoma stage IVB complicated with liver abscess and pulmonary embolism who developed VAE following a routine CECT scan after the sixth cycle of chemotherapy. This was an incidental finding and the patient remained asymptomatic throughout. As such, she was treated conservatively and gradually recovered. This case report serves as a reminder that VAE should be considered in patients presenting with unexplained symptoms following this procedure.
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Affiliation(s)
| | - Mohamed Faisal
- Respiratory Unit, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
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18
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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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19
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Dai L, Shi G, Li Y, Zhao B. Values of thoracic contrast-enhanced computed tomography in detecting incidental pulmonary thromboembolism in patients with malignant tumors. Oncol Lett 2019; 17:355-359. [PMID: 30655774 PMCID: PMC6313221 DOI: 10.3892/ol.2018.9578] [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: 04/02/2018] [Accepted: 10/04/2018] [Indexed: 11/20/2022] Open
Abstract
This study aimed to evaluate the values of thoracic multi-slice spiral computed tomography (CT) in the diagnosis of incidental pulmonary thromboembolism (IPTE) in patients with malignant tumors. The clinical data and imaging features of a total of 1,684 patients with malignant tumors, treated in the Fourth Hospital of Hebei Medical University, were analyzed retrospectively in order to investigate the types of malignancies, the patients' clinical features, and the emboli-preferred sites. Among the 1,684 patients, 60 patients had experienced IPTE (3.56%), 35 were females (58.33%), 25 were males (41.67%). Lung cancer had the highest incidence (n=22, 36.67%). The most common site of IPTE was the left lower lobe of pulmonary artery (n=46, 76.67%). The imaging results revealed that in 5 patients (8.33%) IPTE did not occur. Thoracic multi-slice spiral CT has a high detection rate of IPTE in patients with malignant tumors. Early diagnosis is helpful for early clinical treatment and has significant importance for patients' prognosis.
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Affiliation(s)
- Lijuan Dai
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Gaofeng Shi
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Yang Li
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Bo Zhao
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
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McCabe BE, Veselis CA, Goykhman I, Hochhold J, Eisenberg D, Son H. Beyond Pulmonary Embolism; Nonthrombotic Pulmonary Embolism as Diagnostic Challenges. Curr Probl Diagn Radiol 2018; 48:387-392. [PMID: 30232041 DOI: 10.1067/j.cpradiol.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 12/23/2022]
Abstract
Nonthrombotic pulmonary embolism (NTPE) is less well understood and is encountered less frequently than pulmonary embolism from venous thrombosis. NTPE results from embolization of nonthrombotic material to the pulmonary vasculature originating from many different cell types as well as nonbiologic or foreign materials. For many radiologists NTPE is a challenging diagnosis, presenting nonspecific or unusual imaging findings in the setting of few or unusual clinical signs. The aim of this paper is to review the pathophysiology of diverse causes of NTPE, which should aid radiologists to better understand and, more importantly, diagnose these infrequent events.
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Affiliation(s)
| | - Clinton A Veselis
- Temple University Hospital, Department of Radiology, Philadelphia, PA.
| | - Igor Goykhman
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - John Hochhold
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - Daniel Eisenberg
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - Hongju Son
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
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Abstract
The term nonthrombotic pulmonary embolism (NTPE) is defined as embolization of pulmonary arteries caused by foreign bodies (e. g. detached catheter fragments), biological substances (e. g. septic thrombus) or exogenous substances (e. g. gas). The frequency of NTPE is underestimated. Symptoms can cover the spectrum from undetectable to sudden death. In addition to mechanical obstruction of the pulmonary arteries, some NTPEs trigger an inflammatory cascade that causes deterioration of vascular, pulmonary and cardiac function. Radiological imaging in combination with the medical history of patients is sufficient to identify most NTPEs with certainty. The aim of this article is to make readers aware of the symptoms, frequency, relevance, classification, pathophysiology, laboratory findings and radiological findings of the most frequent forms of NTPE. The spectrum of forms presented here includes pulmonary embolisms due to foreign bodies (intravascular, intracorporeal and extracorporeal), amniotic fluid, endogenous tissue, fat, tumors, septic thrombi, hydatids, cement, metallic mercury, gas, silicone and particles.
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Affiliation(s)
- A G Bach
- Klinik für Diagnostische Radiologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
| | - D Schramm
- Klinik für Diagnostische Radiologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
| | - A Surov
- Klinik für Diagnostische Radiologie, Universität Leipzig, Leipzig, Deutschland
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24
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Fernando SM, Munene PM, Pena E. Iatrogenic pulmonary air embolism. CMAJ 2017; 189:E1069. [PMID: 28827438 DOI: 10.1503/cmaj.170265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Shannon M Fernando
- Department of Emergency Medicine (Fernando); Division of Critical Care (Fernando), Department of Medicine; Division of General Internal Medicine (Munene), Department of Medicine; Department of Radiology (Pena), University of Ottawa, Ottawa, Ont.
| | - Peter M Munene
- Department of Emergency Medicine (Fernando); Division of Critical Care (Fernando), Department of Medicine; Division of General Internal Medicine (Munene), Department of Medicine; Department of Radiology (Pena), University of Ottawa, Ottawa, Ont
| | - Elena Pena
- Department of Emergency Medicine (Fernando); Division of Critical Care (Fernando), Department of Medicine; Division of General Internal Medicine (Munene), Department of Medicine; Department of Radiology (Pena), University of Ottawa, Ottawa, Ont
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Moser J, Sheard S, Patel J, Sayer C, Madden B, Vlahos I. Iatrogenic peripheral pulmonary air embolism following intravenous contrast administration for CT pulmonary angiography: proposal of the “double bronchus sign”. BJR Case Rep 2017; 3:20160097. [PMID: 30363281 PMCID: PMC6159241 DOI: 10.1259/bjrcr.20160097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 12/03/2016] [Accepted: 12/18/2016] [Indexed: 11/21/2022] Open
Abstract
We present a case of iatrogenic extensive air embolism in the peripheral pulmonary arterial tree following intravenous contrast injection for a CT pulmonary angiogram performed to investigate chest pain in a 25-year-old female patient. Small volumes of iatrogenic air embolism following contrast injection are not infrequently encountered incidentally in the central vasculature (brachiocephalic veins, superior vena cava, right cardiac chambers and main pulmonary arteries). To our knowledge, however, this is the only case of extensive peripheral pulmonary arterial air embolism on CT that has been reported in the literature. Despite the extent of peripheral air, this potentially clinically significant complication was relatively inconspicuous at CT interpretation. A new radiological sign, the “double bronchus sign”, is proposed as a useful diagnostic tool. In addition to discussing the imaging features, important safety considerations and principles of immediate management, relevant to all radiologists, are addressed.
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Affiliation(s)
- Joanna Moser
- St George’s University Hospitals, NHS Foundation Trust and School of Medicine, London, UK
| | - Sarah Sheard
- St George’s University Hospitals, NHS Foundation Trust and School of Medicine, London, UK
| | - Jaymin Patel
- St George’s University Hospitals, NHS Foundation Trust and School of Medicine, London, UK
| | - Charlie Sayer
- St George’s University Hospitals, NHS Foundation Trust and School of Medicine, London, UK
| | - Brendan Madden
- St George’s University Hospitals, NHS Foundation Trust and School of Medicine, London, UK
| | - Ioannis Vlahos
- St George’s University Hospitals, NHS Foundation Trust and School of Medicine, London, UK
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Nonthrombotic Pulmonary Artery Embolism: Imaging Findings and Review of the Literature. AJR Am J Roentgenol 2017; 208:505-516. [DOI: 10.2214/ajr.16.17326] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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27
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Detection of incidental pulmonary embolism with multi-slice computed tomography in cancer patients. Clin Imaging 2017; 41:106-111. [DOI: 10.1016/j.clinimag.2016.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/16/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022]
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28
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Panigrahi MK, Vishnukanth G. Soft-tissue infection in an adult presenting as septic pulmonary embolism: A case report. Lung India 2016; 33:455-7. [PMID: 27578947 PMCID: PMC4948242 DOI: 10.4103/0970-2113.184933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Manoj Kumar Panigrahi
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. E-mail:
| | - Govindaraj Vishnukanth
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Alves UD, Lopes AJ, Maioli MCP, Soares AR, de Melo PL, Mogami R. Changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease. Radiol Bras 2016; 49:214-219. [PMID: 27777473 PMCID: PMC5073386 DOI: 10.1590/0100-3984.2015.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To describe and quantify the main changes seen on computed tomography of the chest in mildly symptomatic adult patients with sickle cell disease, as well as to evaluate the radiologist accuracy in determining the type of hemoglobinopathy. MATERIALS AND METHODS A prospective study involving 44 adult patients with sickle cell disease who underwent inspiration and expiration computed tomography of the chest. The frequency of tomography findings and the extent of involvement are reported. We also calculated radiologist accuracy in determining the type of hemoglobinopathy by analyzing the pulmonary alterations and morphology of the spleen. RESULTS The changes found on computed tomography scans, in descending order of frequency, were as follows: fibrotic opacities (81.8%); mosaic attenuation (56.8%); architectural distortion (31.8%); cardiomegaly (25.0%); lobar volume reduction (18.2%); and increased caliber of peripheral pulmonary arteries (9.1%). For most of the findings, the involvement was considered mild, five or fewer lung segments being affected. The accuracy in determining the type of hemoglobinopathy (HbSS group versus not HbSS group) was 72.7%. CONCLUSION In adult patients with sickle cell disease, the main tomography findings reflect fibrotic changes. In addition, computed tomography can be helpful in differentiating among hemoglobinopathies.
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Affiliation(s)
- Ursula David Alves
- MD, Radiologist at the Hospital Universitário Pedro Ernesto (HUPE), Student in the Graduate Program in Medical Sciences at the Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Agnaldo José Lopes
- PhD, Adjunct Professor of Pulmonology at the Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Maria Christina Paixão Maioli
- PhD, Adjunct Professor of Hematology at the Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Andrea Ribeiro Soares
- PhD, Adjunct Professor of Hematology at the Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Pedro Lopes de Melo
- PhD, Associate Professor, Head of the Biomedical Instrumentation Laboratory, Head of the Laboratory for Clinical and Experimental Research in Vascular Biology, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Roberto Mogami
- PhD, Adjunct Professor of Radiology at the Universidade do Estado do Rio de Janeiro (UERJ), Head of the Radiology Department of the Hospital Universitário Pedro Ernesto (HUPE), Rio de Janeiro, RJ, Brazil
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Oh HG, Cha SI, Shin KM, Lim JK, Kim HJ, Yoo SS, Lee J, Lee SY, Kim CH, Park JY. Risk factors for mortality in patients with septic pulmonary embolism. J Infect Chemother 2016; 22:553-8. [DOI: 10.1016/j.jiac.2016.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/18/2016] [Accepted: 05/30/2016] [Indexed: 12/15/2022]
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Fu J, Nguyen L, Nguyen E, Lau N, Ji P, French SW, Stringer WW. An interesting case of profound hypoxemia. Exp Mol Pathol 2016; 100:321-4. [PMID: 26939911 DOI: 10.1016/j.yexmp.2016.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
Abstract
A 58 year old male with a history of cirrhosis (hepatitis B and C), a long smoking history, and a recently diagnosed high-grade transitional cell carcinoma of the bladder wall presented three days after a biopsy procedure with abdominal pain, nausea, and new hypoxemia on room air. The chest radiograph was clear and the CT angiogram showed only a borderline large pulmonary artery, two small nodules (3mm and 4mm) in the right middle lobe of the lung, and emphysematous changes throughout the lung parenchyma. There was no evidence of pulmonary embolism. A wide range of diagnostic possibilities were entertained, including pneumonia (community or aspiration related to the procedure), COPD exacerbation, pulmonary emboli, porto-pulmonary syndrome, pulmonary hypertension with right to left shunt, tumor emboli, allergic reaction to a medication or chemotherapeutic agent, or lymphangitic/hematogenous spread of tumor to the lungs. The diagnosis was only established on a post mortem examination. The progressive hypoxia was due to diffuse spread of tumor within alveolar capillaries.
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Affiliation(s)
- Jennifer Fu
- Department of Internal Medicine, Harbor UCLA Medical Center, Torrance, CA, USA.
| | - Luan Nguyen
- Department of Pathology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Elise Nguyen
- Department of Pathology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Nick Lau
- Department of Pathology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ping Ji
- Department of Pathology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Samuel W French
- Department of Pathology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - William W Stringer
- Department of Internal Medicine, Harbor UCLA Medical Center, Torrance, CA, USA
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Newbigin K, Souza CA, Torres C, Marchiori E, Gupta A, Inacio J, Armstrong M, Peña E. Fat embolism syndrome: State-of-the-art review focused on pulmonary imaging findings. Respir Med 2016; 113:93-100. [PMID: 26895808 DOI: 10.1016/j.rmed.2016.01.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fat embolism syndrome (FES) is a rare but potentially fatal complication of trauma or orthopedic surgery, which presents predominantly with pulmonary symptoms. Modern intensive care has improved the mortality rates, however diagnosis remains difficult, relying predominantly on a combination of a classic triad of symptoms and non-specific, but characteristic radiological features. The aim of this review is to describe the main clinical and imaging aspects of FES, ranging from pathophysiology to treatment with emphasis on pulmonary involvement. METHODS We reviewed the currently published literature on the main characteristics of FES. RESULTS In a hypoxic patient with recent trauma or orthopedic surgery, the presence of diffuse, well-demarcated ground glass opacities or ill-defined centrilobular nodules on computed tomography (CT) of the chest are suggestive of FES. CONCLUSIONS Combination of the classic clinical syndrome in the appropriate clinical setting, together with the characteristic imaging findings on chest CT, can help to achieve the correct diagnosis. Management remains predominantly supportive care, and the benefit of medical therapies such as corticosteroids and heparin remains unclear.
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Affiliation(s)
| | | | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Joao Inacio
- The Ottawa Hospital, Ottawa, Ontario, Canada.
| | | | - Elena Peña
- The Ottawa Hospital, Ottawa, Ontario, Canada.
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Newbigin K, Souza CA, Armstrong M, Pena E, Inacio J, Gupta A, Rakhra K. Fat embolism syndrome: Do the CT findings correlate with clinical course and severity of symptoms? A clinical-radiological study. Eur J Radiol 2016; 85:422-7. [DOI: 10.1016/j.ejrad.2015.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
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Scaglione M, Linsenmaier U, Schueller G, Berger F, Wirth S. Infection. EMERGENCY RADIOLOGY OF THE CHEST AND CARDIOVASCULAR SYSTEM 2016. [PMCID: PMC7120007 DOI: 10.1007/174_2016_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Community-Acquired Pneumonia (CAP) is the first leading cause of death due to infection worldwide.Many gram-positive, gram-negative bacteria, funguses and viruses can cause the infectious pulmonary disease, and the severity of pneumonia depends on the balance between the microorganism charge, the body immunity defenses and the quality of the underlying pulmonary tissue. The microorganisms may reach the lower respiratory tract from inhaled air or from infected oropharyngeal secretions. The same organism may produce several different patterns that depend on the balance between the microorganism charge and the body immunity defenses.CAP is classified into three main groups: lobar pneumonia, bronchopneumonia and interstitial pneumonia.Lobar pneumonia is characterized by the filling of alveolar spaces by edema full of white and inflammatory cells. Necrotizing pneumonia consists of a fulminant process associated with focal areas of necrosis that results in abscesses. Bronchopneumonia or lobular pneumonia, is characterized by a peribronchiolar inflammation with thickening of peripheral bronchial wall, the diffusion of inflammation to the centrilobular alveolar spaces and development of nodules.The interstitial pneumonia represents with the destruction and esfoliation of the respiratory ciliated and mucous cells. The interstitial septa, the bronchial and bronchiolar walls become thickened for the inflammation process and lymphocytes interstitial infiltrates.Chest radiography represents an important initial examination in all patients suspected of having pulmonary infection and for monitoring response to therapy.Its role is to identify the pulmonary opacities, their internal characteristics and distribution, pleural effusion and presence of other complications as abscesses and pneumothorax.High spatial CT resolution allows accurate assessment of air space inflammation.The CT findings include nodules, interlobular septal thickening, intralobular reticular opacities, ground-glass opacities, tree-in-bud pattern, lobar-segmental consolidation, lobular consolidation, abscesses, pneumatocele, pleural effusion, pericardial effusion, mediastinal and hilar lymphoadenopaties, airway dilatation and emphysema.
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Affiliation(s)
- Mariano Scaglione
- Dept of Radiology, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | | | | | - Ferco Berger
- VU University Medical Center, Amsterdam, The Netherlands
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A Case of AcinetobacterSeptic Pulmonary Embolism in an Infant. Case Rep Infect Dis 2016; 2016:5241571. [PMID: 27529040 PMCID: PMC4977383 DOI: 10.1155/2016/5241571] [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: 02/02/2016] [Revised: 06/23/2016] [Accepted: 07/03/2016] [Indexed: 11/30/2022] Open
Abstract
Case Characteristics. An 11-month-old girl presented with fever and breathlessness for 5 days. Patient had respiratory distress with bilateral coarse crepitations. Chest radiograph revealed diffuse infiltrations in the right lung with thick walled cavities in mid and lower zone. Computed tomography showed multiple cystic spaces and emboli. Blood culture grew Acinetobacter species. Intervention. Patient was treated with Meropenem and Vancomycin. Outcome. Complete clinical and radiological recovery was seen in child. Message. Blood cultures and CT of the chest are invaluable in the evaluation of a patient with suspected septic pulmonary embolism. With early diagnosis and appropriate antimicrobial therapy, complete recovery can be expected in patients with septic pulmonary embolism.
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Sawyer CM, Potisek NM. Chest Pain in an Adolescent Male With a Leg Abscess. Clin Pediatr (Phila) 2015; 54:604-6. [PMID: 25525056 DOI: 10.1177/0009922814563275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sodhi KS, Saxena AK, Chandrashekhar G, Bhatia A, Singhi S, Agarwal R, Khandelwal N. Vascular air embolism after contrast administration on 64 row multiple detector computed tomography: A prospective analysis. Lung India 2015; 32:216-9. [PMID: 25983405 PMCID: PMC4429381 DOI: 10.4103/0970-2113.156216] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Vascular air embolism is being progressively reported as a nonfatal event with increase in use of computed tomography (CT) as a diagnostic modality. This study was undertaken to study the frequency and site of vascular air embolism in patients undergoing contrast-enhanced CT (CECT) and analyze CT parameters that influence its prevalence and final outcome. Materials and Methods: This was a prospective study approved by departmental ethics committee. Presence and location of air emboli in 200 patients who underwent CT scan of chest on a 64 detector scanner was recorded. We analyzed the role of various factors that could influence the prevalence of air embolism after injection of contrast in CECT scans. These factors included the amount of contrast injected, rate of flow of injection of contrast, site of injection of contrast, and size of intravenous access line. Results: Iatrogenic vascular air emboli were seen in 14 patients (7% of total). The locations of air emboli were main pulmonary artery in 12 (6% of total), left brachiocephalic vein in 3 (1.5% of total), right atrial appendage in 4 (2% of total), and superior vena cava (SVC) in 1 (0.5%) patient. There was no association between volume of contrast, flow rate, site and size of intravenous access, and presence of air emboli. Conclusion: Radiologists as well as referring physicians should be aware of vascular air embolism, which can occur after contrast injection in patients undergoing CT scan. Age, volume of contrast, flow rate of pressure injector, and site and size of venous cannula do not influence the likelihood or incidence of detection of venous air emboli on CT scans.
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Affiliation(s)
- Kushaljit S Sodhi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India
| | - Akshay K Saxena
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India
| | - Guruprasadh Chandrashekhar
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India
| | - Sunit Singhi
- Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India
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Li Q, Fan X, Huang XT, Luo TY, Chu ZG, Chen L, Zhang ZW, Li YQ, Wu JQ, Ouyang Y, Lv FJ, Ma CH. Tree-in-bud pattern in central lung cancer: CT findings and pathologic correlation. Lung Cancer 2015; 88:260-6. [PMID: 25843041 DOI: 10.1016/j.lungcan.2015.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/07/2015] [Accepted: 03/10/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Tree-in-bud (TIB) pattern can be found with central lung cancer on chest CT scans. However, few reports have described it so far. We aim to determine its incidence, CT findings and pathologic basis. MATERIALS AND METHODS 652 consecutive patients with confirmed central lung cancer were enrolled in our study. The incidence, CT findings and pathologic features of TIB pattern were analyzed retrospectively. RESULTS In total, TIB pattern was found in 22.5% (147/652) of patients. It was more common in patients with squamous cell carcinoma than those with non-squamous cell carcinoma (P=0.000). The most important associated CT finding was obstructive bronchial mucoid impaction distal to the cancer (100%, 147/147), followed by consolidation and ground-glass opacities (62.6%, 92/147). TIB pattern was confined to the areas of lung supplied by the involved bronchi (100%, 147/147) and had a focal distribution predominantly (94.6%, 139/147). Pathologically, it correlated with bronchiolectasis, bronchiolar lumen filled by mucus and inflammatory exudates, wall thickening with inflammatory cells infiltration. CONCLUSIONS TIB pattern is commonly detected in central lung squamous cell carcinoma on thoracic CT scan. It usually has a localized distribution with a predominant associated CT finding of obstructive bronchial mucoid impaction. This pattern corresponds to the mucoid impaction of bronchioles and bronchiolitis pathologically. A full understanding of TIB pattern in central lung cancer can be useful in preventing diagnostic errors.
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Affiliation(s)
- Qi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Xiao Fan
- Department of Radiology, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan Road Two, Yuzhong District, Chongqing, China
| | - Xing-Tao Huang
- Department of Radiology, The Fifth People's Hospital of Chongqing, No. 24 Renji Road, Nan'an District, Chongqing, China
| | - Tian-You Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China.
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Li Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Zhi-Wei Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Yan-Qing Li
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Jing-Quan Wu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Yu Ouyang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
| | - Chao-Hao Ma
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, China
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Yoshii Y, Kawabata Y, Takayanagi N, Araya J, Kuwano K, Sugita Y. Progressive diffuse pulmonary interstitial opacities due to complications of pulmonary tumor emboli: an autopsy case report. Intern Med 2015; 54:955-60. [PMID: 25876580 DOI: 10.2169/internalmedicine.54.3476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 76-year-old man complaining of exertional dyspnea was admitted to our hospital. Chest computed tomography revealed bilateral diffuse ground-glass opacities and small nodules. A transbronchial lung biopsy revealed tumor cell emboli in the pulmonary arteries. The patient was diagnosed with gastric adenocarcinoma using an endoscopic stomach biopsy; however, the interstitial opacities progressively worsened and he died of acute respiratory failure. An autopsy revealed extensive pulmonary tumor embolisms (PTE) with associated ischemic damages, e.g., infarctions, alveolar wall thickening with cuboidal metaplasia, hemorrhage, and diffuse alveolar damage. The ground-glass opacities in the chest computed tomography findings appear to correlate with the pathological ischemic changes associated with PTE.
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Affiliation(s)
- Yutaka Yoshii
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center; Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Japan.
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Affiliation(s)
- Imran Haider
- Department of Internal Medicine, Saint Luke's Hospital, Saint Louis, Missouri, United States of America E-mail:
| | - Raghav Gupta
- Department of Internal Medicine, Saint Luke's Hospital, Saint Louis, Missouri, United States of America E-mail:
| | - Shuang Song
- Department of Internal Medicine, Saint Luke's Hospital, Saint Louis, Missouri, United States of America E-mail:
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Hatani T, Takemura M, Inoue D, Takamatsu K, Ishitoko M, Itotani R, Suzuki S, Matsumoto M, Sakuramoto M, Fukui M. Septic pulmonary embolism due to periodontal disease. Respirology 2013; 18:308-12. [PMID: 23039239 DOI: 10.1111/j.1440-1843.2012.02278.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Septic pulmonary embolism due to periodontal disease (SPE-PD) is rarely reported and little is known about its clinical features. The purpose of this study was to evaluate the clinical and radiological features, as well as outcome, in SPE-PD. METHODS Patients' records were retrospectively reviewed and 12 patients with SPE-PD were identified (10 men, mean age 60.5 years). The patients' demographic features, laboratory data, physical and radiological findings, and clinical outcomes were evaluated. RESULTS All but one patient were smokers. Eight of the 12 patients had comorbidities including hypertension (58%) and/or diabetes mellitus (17%). Prevalent symptoms were fever (67%) and chest pain (58%). Only two patients fulfilled the criteria of systemic inflammatory response syndrome; most of the subjects were not clinically severely ill. Blood cultures were negative in all cases. Contrast-enhanced chest computed tomography (CT) showed multiple peripheral nodules in all 12 patients, wedge-shaped peripheral lesions abutting on the pleura in 10 (83%) and a feeding-vessel sign in 9 (75%). All patients recovered from their illness after antimicrobial therapy concomitant with tooth extraction or periodontal care. The median duration of antibiotic administration was 51 days. CONCLUSIONS Most patients with SPE-PD were not seriously ill. Contrast-enhanced chest CT appeared to be useful to diagnose SPE-PD.
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Affiliation(s)
- Takeshi Hatani
- Respiratory Disease Center, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Ohgimachi, Kita-ku, Osaka, Japan
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Stawicki SP, Firstenberg MS, Lyaker MR, Russell SB, Evans DC, Bergese SD, Papadimos TJ. Septic embolism in the intensive care unit. Int J Crit Illn Inj Sci 2013; 3:58-63. [PMID: 23724387 PMCID: PMC3665121 DOI: 10.4103/2229-5151.109423] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Septic embolism encompasses a wide range of presentations and clinical considerations. From asymptomatic, incidental finding on advanced imaging to devastating cardiovascular or cerebral events, this important clinico-pathologic entity continues to affect critically ill patients. Septic emboli are challenging because they represent two insults—the early embolic/ischemic insult due to vascular occlusion and the infectious insult from a deep-seated nidus of infection frequently not amenable to adequate source control. Mycotic aneurysms and intravascular or end-organ abscesses can occur. The diagnosis of septic embolism should be considered in any patient with certain risk factors including bacterial endocarditis or infected intravascular devices. Treatment consists of long-term antibiotics and source control when possible. This manuscript provides a much-needed synopsis of the different forms and clinical presentations of septic embolism, basic diagnostic considerations, general clinical approaches, and an overview of potential complications.
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Affiliation(s)
- Stanislaw P Stawicki
- Department of Surgery, Division of Trauma, Critical Care and Burns, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Bach AG, Restrepo CS, Abbas J, Villanueva A, Lorenzo Dus MJ, Schöpf R, Imanaka H, Lehmkuhl L, Tsang FHF, Saad FFA, Lau E, Alvarez JR, Battal B, Behrmann C, Spielmann RP, Surov A. Imaging of nonthrombotic pulmonary embolism: Biological materials, nonbiological materials, and foreign bodies. Eur J Radiol 2013; 82:e120-41. [DOI: 10.1016/j.ejrad.2012.09.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/06/2012] [Accepted: 09/12/2012] [Indexed: 12/21/2022]
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Park SM, Kim KH, Yoon NB, Jeong IH, Lee HW, Lee SK, Lee KN, Son C, Um SJ. Clinical Manifestations of 6 Cases of Septic Pulmonary Embolism at Increased Risk Recently. KOSIN MEDICAL JOURNAL 2012. [DOI: 10.7180/kmj.2012.27.2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives The aim of this study was to investigate the clinico-radiologic features and microbiologic data of patients with SPE in a tertiary care hospital in Busan. Methods We retrospectively analyzed clinical and radiologic features of 6 cases with septic pulmonary embolism that occurred from March 2009 to March 2011 in Dong-A university medical center. Results The mean age of the study population was 58 years, and two men and four women were included. Clinical symptoms included general weakness (5 patients), febrile sensation (4 patients) and pleuritic chest pain (2 patients). Underlying conditions were chemoport infection (4 patients), dental abscess (1 patients), and cellulitis of hip (1 patient). Chest computed tomography revealed bilateral multiple nodular opacities in most patients, and cavitation, central necrosis, feeding vessels were identified. All patients received parenteral antimicrobial therapy with or without central catheter removal, drainage of the extrapulmonary infection. Causative organisms were Pseudomonas aeruginosa (2 patients), Candida albicans (1 patient), Bacillus species (1 patient), and Klebsiella pneumonia (1 patient). Conclusions Clinical and radiologic features of septic pulmonary embolism were various and nonspecific. The diagnosis was usually suggested by the presence of a predisposing factor of septic pulmonary embolism and CT findings of bilateral multiple nodular opacities in patients with infectious signs and symptoms. Most important underlying condition was intravascular device infection.
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Pena E, Dennie C, Franquet T, Milroy C. Nonthrombotic Pulmonary Embolism: A Radiological Perspective. Semin Ultrasound CT MR 2012; 33:522-34. [DOI: 10.1053/j.sult.2012.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Shim H, Kim WS, Kim YW, Yang SS, Kim DK. Successful management of pulmonary and inferior vena cava tumor embolism from renal cell carcinoma. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 45:323-5. [PMID: 23130307 PMCID: PMC3487017 DOI: 10.5090/kjtcs.2012.45.5.323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 03/03/2012] [Accepted: 03/07/2012] [Indexed: 11/16/2022]
Abstract
Pulmonary tumor embolism can be a cause of respiratory failure in patients with cancer even though it occurs rarely. We describe a 56-year-old man who underwent a pulmonary tumor embolectomy using cardiopulmonary bypass on beating heart combined with inferior vena cava embolectomy and right radical nephrectomy. Aggressive surgical treatment in this severe case is necessary not only to reduce the fatal outcome of pulmonary embolism in the short run, but also to improve the oncological prognosis in the long term.
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Affiliation(s)
- Hunbo Shim
- Division of Cardiovascular Surgery, Department of Cardiothoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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Lee JW, Lee KH, Kim L, Yoon YH, Kim YJ, Kim YJ. Uncommon pulmonary metastasis presenting as pulmonary infarction with tumour emboli in two cases. J Med Imaging Radiat Oncol 2012; 56:192-4. [PMID: 22498193 DOI: 10.1111/j.1754-9485.2012.02352.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report two cases of pathologically proven pulmonary metastases presenting as pulmonary infarction with tumour emboli. In two cases, high-resolution CT showed multiple small subpleural consolidations in both lungs. The patients had breast cancer and uterine cervix cancer, respectively. Although various pulmonary diseases show subpleural consolidations on CT, pulmonary metastases by tumour emboli should be primarily considered in differential diagnosis especially when the patient has known malignancy.
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Affiliation(s)
- Ju Won Lee
- Departments of Radiology Pathology Thoracic Surgery, Inha University Hospital, Incheon, Korea
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Noël-Savina E, Paleiron N, Le Gal G, Descourt R. [Septic pulmonary embolism after removal of a venous access device for septic thrombophlebitis]. ACTA ACUST UNITED AC 2012; 37:146-9. [PMID: 22483563 DOI: 10.1016/j.jmv.2012.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 02/25/2012] [Indexed: 11/28/2022]
Abstract
Septic thrombophlebitis on a central venous access device (CVAD) is a rare and serious complication. According to current guidelines, the device should be removed and antibiotics be given. The risk of septic thrombophlebitis is related to the migration of septic emboli to the lung, a potentially fatal event, particularly in frail patients with lung cancer. We report a case observed in a 66-year-old man with multiple metastatic lung cancer who had a CVAD and who developed septic thrombophlebitis leading to coagulase-negative staphylococcal bacteriemia. After removal of the CVAD, the thrombophlebitis was complicated by pulmonary embolism affecting the entire network of the right lung.
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Affiliation(s)
- E Noël-Savina
- Service d'oncologie thoracique, CHU Morvan, CHU de Brest, 3, avenue Foch, 29200 Brest, France.
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Günalp M, Gürler S, Polat O, Demirkan A. Septic Pulmonary Embolism Associated with Renal Abscess: A Case Report. J Emerg Med 2012; 42:e51-3. [DOI: 10.1016/j.jemermed.2008.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 10/19/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
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