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Conrad TJ, Lau HX, Yerkovich ST, Alghamry A, Lee JC. Ventilation-perfusion scan for diagnosing pulmonary embolism: do chest x-rays matter? Nucl Med Commun 2024; 45:181-187. [PMID: 38247659 DOI: 10.1097/mnm.0000000000001802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Ventilation-perfusion (V/Q) scan coupled with single photon emission computed tomography (SPECT) is commonly used for the diagnosis of pulmonary embolism (PE). An abnormal chest x-ray (CXR) is deemed to hinder the interpretation of V/Q scan and therefore a normal CXR is recommended prior to V/Q scan. AIMS To determine if an abnormal CXR impacted on V/Q scan interpretation and subsequent management. METHODS A retrospective cohort analysis of all patients who underwent a V/Q scan for diagnosis of suspected acute PE between March 2016 and 2022 was performed. CXR reports were reviewed and classified as normal or abnormal. Low-dose computerised tomography was routinely performed in patients above the age of 70. Data regarding V/Q scan results and subsequent management including initiation of anticoagulation for PE or further diagnostic investigations were collected. RESULTS A total of 340 cases were evaluated. Of the positive V/Q scans (92/340), 98.3% of the normal CXR were anticoagulated compared to 100% of the abnormal CXR group. Of the negative V/Q scans (239/340), no cases were started on anticoagulation and no further investigations were performed across both normal and abnormal CXR groups. Indeterminate results occurred in only 9 cases with no significant difference in management between normal and abnormal CXR groups. CONCLUSION An abnormal CXR does not affect the reliability of V/Q scan interpretation in the diagnosis of PE when coupled with SPECT. Unless clinically indicated, the mandate by clinical society guidelines for a normal CXR prior to V/Q should be revisited.
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Affiliation(s)
- Thomas J Conrad
- Internal Medicine Services, The Prince Charles Hospital, Metro North Health, Brisbane
- Internal Medicine Services, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia
| | - Han X Lau
- Internal Medicine Services, The Prince Charles Hospital, Metro North Health, Brisbane
| | - Stephanie T Yerkovich
- Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology
| | - Alaa Alghamry
- Internal Medicine Services, The Prince Charles Hospital, Metro North Health, Brisbane
- Faculty of Medicine, The University of Queensland
| | - Joseph C Lee
- Faculty of Medicine, The University of Queensland
- Department of Medical Imaging, The Prince Charles Hospital, Metro North Health, Brisbane, Queensland, Australia
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Li DJ, Abele J, Sunner P, Varughese RA, Hirji AS, Weinkauf JG, Nagendran J, Weatherald JC, Lien DC, Halloran KM. Relative Lung Perfusion on Ventilation-Perfusion Scans After Double Lung Transplant. Transplantation 2023; 107:2262-2270. [PMID: 37291709 DOI: 10.1097/tp.0000000000004683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Pulmonary blood flow can be assessed on ventilation-perfusion (VQ) scan with relative lung perfusion, with a 55% to 45% (or 10%) right-to-left differential considered normal. We hypothesized that wide perfusion differential on routine VQ studies at 3 mo posttransplant would be associated with an increased risk of death or retransplantation, chronic lung allograft (CLAD), and baseline lung allograft dysfunction. METHODS We conducted a retrospective cohort study on all patients who underwent double-lung transplant in our program between 2005 and 2016, identifying patients with a wide perfusion differential of >10% on a 3-mo VQ scan. We used Kaplan-Meier estimates and proportional hazards models to assess the association between perfusion differential and time to death or retransplant and time to CLAD onset. We used correlation and linear regression to assess the relationship with lung function at time of scan and with baseline lung allograft dysfunction. RESULTS Of 340 patients who met inclusion criteria, 169 (49%) had a relative perfusion differential of ≥ 10% on a 3-mo VQ scan. Patients with increased perfusion differential had increased risk of death or retransplantation ( P = 0.011) and CLAD onset ( P = 0.012) after adjustment for other radiographic/endoscopic abnormalities. Increased perfusion differential was associated with lower lung function at time of scan. CONCLUSIONS Wide lung perfusion differential was common after lung transplant in our cohort and associated with increased risk of death, poor lung function, and CLAD onset. The nature of this abnormality and its use as a predictor of future risk warrant further investigation.
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Affiliation(s)
- David J Li
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jonathan Abele
- Department of Diagnostic Imaging and Radiology, University of Alberta, Edmonton, Canada
| | - Parveen Sunner
- Department of Diagnostic Imaging and Radiology, University of Alberta, Edmonton, Canada
| | | | - Alim S Hirji
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Jayan Nagendran
- Department of Surgery, University of Alberta, Edmonton, Canada
| | | | - Dale C Lien
- Department of Medicine, University of Alberta, Edmonton, Canada
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Karamian F, Sadeghi R, Askari E. Lung Ventilation-Perfusion Scan in COVID-19: Various Patterns of Perfusion Defects. Clin Nucl Med 2023; 48:e239-e243. [PMID: 36630708 PMCID: PMC10081924 DOI: 10.1097/rlu.0000000000004545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/15/2022] [Indexed: 01/13/2023]
Abstract
ABSTRACT Although COVID-19 infection is associated with the increased risk of pulmonary thromboembolism (PTE), COVID-19 pulmonary lesions cause ventilation-perfusion (V/Q) patterns other than PTE. Although extensive research has been done to address different anatomical patterns of COVID-19, there is a knowledge gap in terms of V/Q lung scintigraphy in these patients. The purpose of this study is to demonstrate these patterns and to show how important it is to use SPECT/CT in addition to planar images to differentiate between these patterns from PTE. In the current collection, we presented various patterns of V/Q SPECT/CT abnormalities in COVID-19 patients.
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Ulaner GA, Grigore C. False-Positive for Pulmonary Emboli on Ventilation/Perfusion Scan Due to Improper Patient Positioning During Tracer Administration. Clin Nucl Med 2023; 48:95-97. [PMID: 36127773 DOI: 10.1097/rlu.0000000000004391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT A 67-year-old woman presented with shortness of breath and a ventilation/perfusion scan was performed. Initial images demonstrated mismatched bilateral apical defects that would be classified as high probability for pulmonary emboli. However, it was unusual that the defects were only in the bilateral apices. Investigation discovered that 99m Tc-MAA was administered while the patient was in a seated position. Repeat scan the following day with the patient in the correct, supine, position during 99m Tc-MAA administration demonstrated no defects. In this case, incorrect patient positioning could have resulted in an incorrect diagnosis of pulmonary emboli and inappropriate treatment of the patient.
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Affiliation(s)
| | - Catalan Grigore
- Department of Radiology, Hoag Hospital Newport Beach, Newport Beach, CA
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Rabinowicz S, Nathan M, Pencharz D, Wagner T. Ventilation perfusion reporting: the utility of a prior chest radiograph in interpreting ventilation perfusion scans. Nucl Med Commun 2022; 43:1107-1108. [PMID: 35972344 DOI: 10.1097/mnm.0000000000001606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Bonnefoy PB, Bahloul A, Denizot B, Barres B, Moreau-Triby C, Girma A, Pallardy A, Ceyra Q, Sarda-Mantel L, Razzouk-Cadet M, Zsigmond R, Cachin F, Karcher G, Salaun PY, Le Roux PY. Functional Alterations Due to COVID-19 Lung Lesions-Lessons From a Multicenter V/Q Scan-Based Registry. Clin Nucl Med 2022; 47:e540-e547. [PMID: 35605049 PMCID: PMC9275799 DOI: 10.1097/rlu.0000000000004261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/06/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE In coronavirus disease 2019 (COVID-19) patients, clinical manifestations as well as chest CT lesions are variable. Lung scintigraphy allows to assess and compare the regional distribution of ventilation and perfusion throughout the lungs. Our main objective was to describe ventilation and perfusion injury by type of chest CT lesions of COVID-19 infection using V/Q SPECT/CT imaging. PATIENTS AND METHODS We explored a national registry including V/Q SPECT/CT performed during a proven acute SARS-CoV-2 infection. Chest CT findings of COVID-19 disease were classified in 3 elementary lesions: ground-glass opacities, crazy-paving (CP), and consolidation. For each type of chest CT lesions, a semiquantitative evaluation of ventilation and perfusion was visually performed using a 5-point scale score (0 = normal to 4 = absent function). RESULTS V/Q SPECT/CT was performed in 145 patients recruited in 9 nuclear medicine departments. Parenchymal lesions were visible in 126 patients (86.9%). Ground-glass opacities were visible in 33 patients (22.8%) and were responsible for minimal perfusion impairment (perfusion score [mean ± SD], 0.9 ± 0.6) and moderate ventilation impairment (ventilation score, 1.7 ± 1); CP was visible in 43 patients (29.7%) and caused moderate perfusion impairment (2.1 ± 1.1) and moderate-to-severe ventilation impairment (2.5 ± 1.1); consolidation was visible in 89 patients (61.4%) and was associated with moderate perfusion impairment (2.1 ± 1) and severe ventilation impairment (3.0 ± 0.9). CONCLUSIONS In COVID-19 patients assessed with V/Q SPECT/CT, a large proportion demonstrated parenchymal lung lesions on CT, responsible for ventilation and perfusion injury. COVID-19-related pulmonary lesions were, in order of frequency and functional impairment, consolidations, CP, and ground-glass opacity, with typically a reverse mismatched or matched pattern.
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Affiliation(s)
| | | | - Benoit Denizot
- Service de Médecine Nucléaire, Centre Hospitalier Alpes Léman, Contamine-sur-Arve
| | - Bertrand Barres
- Service de Médecine Nucléaire, Centre Jean Perrin, Clermont-Ferrand
| | | | - Astrid Girma
- Service de Médecine Nucléaire, Hôpital Foch, Suresnes
| | | | | | | | | | | | - Florent Cachin
- Service de Médecine Nucléaire, Centre Jean Perrin, Clermont-Ferrand
| | | | - Pierre-Yves Salaun
- Service de Médecine Nucléaire, Université Européenne de Bretagne, Université de Brest, EA3878 (GETBO) IFR 148, CHRU de Brest, Brest, France
| | - Pierre-Yves Le Roux
- Service de Médecine Nucléaire, Université Européenne de Bretagne, Université de Brest, EA3878 (GETBO) IFR 148, CHRU de Brest, Brest, France
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Borkowska E, Brudecki K, Kostkiewicz M, Gorzkiewicz K, Misiak R, Nalichowska E, Miszczyk J, Mróz T. 99mTc internal contaminations measurements among nuclear medicine medical personnel during ventilation - perfusion SPECT lung scans. Radiat Environ Biophys 2021; 60:389-394. [PMID: 33751179 PMCID: PMC8116248 DOI: 10.1007/s00411-021-00905-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
This paper presents results of measurements of 99mTc activity concentration in air and nuclear medical personnel blood during ventilation-perfusion SPECT lung scans. 99mTc activity measurements were conducted at the Nuclear Medicine Department, John Paul II Hospital, Krakow. Technicians and nurses who perform examinations were equipped with personal aspirators enabling air sampling to determine the radiation exposure at their workplaces. Measurements allowed to evaluate the concentration of 99mTc in 14 air samples and it ranged from 7800 ± 600 to 10,000 ± 1000 Bq m-3 for air samples collected by technicians and from 390 ± 30 to 600 ± 40 Bq m-3 for air samples collected by nurses. In addition 99mTc concentrations in blood of medical personnel were determined in 24 samples. For technicians the maximum 99mTc blood concentration levels reached 920 ± 70 Bq L-1 and 1300 ± 100 Bq L-1. In the case of nurses, the maximum estimated activity concentrations were about ten times lower, namely 71 ± 7 Bq L-1 and 39 ± 3 Bq L-1. Although the intakes appear to be relatively high, the resulting annual effective doses are about 34 µSv for technicians and only 2 µSv for nurses.
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Affiliation(s)
- E Borkowska
- Electroradiology Department, Faculty of Health Sciences, Institute of Physiotherapy, Jagiellonian University, Collegium Medicum, Michalowskiego 12, 31-126, Kraków, Poland
- Nuclear Medicine Department, John Paul II Hospital, Prądnicka 80, Kraków, Poland
| | - K Brudecki
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342, Kraków, Poland.
| | - M Kostkiewicz
- Heart and Vascular Diseases Department, Faculty of Medicine, Institute of Cardiology, Jagiellonian University, Collegium Medicum, Prądnicka 80, 31-202, Kraków, Poland
- Nuclear Medicine Department, John Paul II Hospital, Prądnicka 80, Kraków, Poland
| | - K Gorzkiewicz
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342, Kraków, Poland
| | - R Misiak
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342, Kraków, Poland
| | - E Nalichowska
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342, Kraków, Poland
| | - J Miszczyk
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342, Kraków, Poland
| | - T Mróz
- Institute of Physics, Jagiellonian University, Łojasiewicza 11, 30-348, Kraków, Poland
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Gühne F, Drescher R, Ndum F, Seifert P, Freesmeyer M. Complete Right-to-Left Shunt in Lung Perfusion Scintigraphy. Clin Nucl Med 2021; 46:e162-e164. [PMID: 32956119 DOI: 10.1097/rlu.0000000000003286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Lung scintigraphy was performed to rule out pulmonary embolism in a 37-year-old woman suffering from dyspnea and hypoxemia after routine diagnostics failed to find the underlying disease. Perfusion scans did not show tracer uptake within the lungs despite ventilation scans being unremarkable. Instead, the result suggested a complete right-to-left shunt, which was a conundrum. With the assistance of CT an uncommon congenital vessel aberration turned out to be the cause of this exceptional scintigraphy finding, as well as the yet unexplained hypoxemia.
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Affiliation(s)
- Falk Gühne
- From the Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
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9
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Sharma M, Surani S. Revisiting One of the Dreaded Outcomes of the Current Pandemic: Pulmonary Embolism in COVID-19. Medicina (Kaunas) 2020; 56:E670. [PMID: 33287199 PMCID: PMC7761739 DOI: 10.3390/medicina56120670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 02/05/2023]
Abstract
Pulmonary embolism (PE) is a commonly encountered clinical entity in patients with coronavirus disease 2019 (COVID-19). Up to 1/3 of patients have been found to have PE in the setting of COVID-19. Given the novelty of the virus causing this pandemic, it has not been easy to address diagnostic and management issues in PE. Ongoing research and publications of the scientific literature have helped in dealing with COVID-19 lately and this applies to PE as well. In this article, we attempt to succinctly yet comprehensively discuss PE in patients with COVID-19 with a review of the prevailing literature.
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Affiliation(s)
- Munish Sharma
- Corpus Christi Medical Center, Department of Pulmonary Medicine, Corpus Christi, TX 78412, USA;
| | - Salim Surani
- Department of Medicine, Texas A&M University, College Station, TX 77843, USA
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Robin P, Eddy M, Sikora L, Le Roux PY, Carrier M, Couturaud F, Planquette B, Pesavento R, Rodger M, Salaun PY, Le Gal G. Residual pulmonary vascular obstruction and recurrence after acute pulmonary embolism: protocol for a systematic review and meta-analysis of individual participant data. BMJ Open 2018; 8:e023939. [PMID: 30498046 PMCID: PMC6278780 DOI: 10.1136/bmjopen-2018-023939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In patients with a first, unprovoked venous thromboembolism (VTE), the optimal duration of anticoagulant therapy (AT) is controversial due to tightly balanced risks and benefits of indefinite anticoagulation. The objective of this study is to assess among patients with a first acute pulmonary embolism (PE) who received ≥3 months of AT and thereafter had a planar lung scan, whether residual pulmonary vascular obstruction (RPVO) is associated with VTE recurrence after discontinuation of AT. METHODS AND ANALYSIS We will conduct a systematic review with a meta-analysis of individual participant data of contemporary studies evaluating the prognostic significance of RPVO in patients with a first acute PE. We will search from inception to 24 January 2018, PubMed, Medline, Embase and Cochrane's Central Registry for Randomized Controlled Trials, CENTRAL for randomized controlled trials and prospective cohort studies. Two reviewers will conduct all screening and data collection independently. The methodological quality and risk of bias of eligible studies will be carefully and rigorously assessed using the Risk Of Bias In Non-randomised Studies of Interventions tool. The primary objective will be to assess the relationship between RPVO on ventilation-perfusion scan after completion of at least 3 months of AT after an acute PE event, and the risk of an objectively confirmed symptomatic recurrent VTE (including deep vein thrombosis or PE) or death due to PE. The secondary objectives will include the assessment of the optimal RPVO cut-off and the risk of recurrent VTE, as well as the relationship between the relative change in RPVO between PE diagnosis and at discontinuation of AT (≥3 months) and risk of recurrent VTE. ETHICS AND DISSEMINATION This study of secondary data does not require ethics approval. It will be presented internationally and published in the peer-reviewed literature. PROSPERO REGISTRATION NUMBER CRD42017081080.
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Affiliation(s)
- Philippe Robin
- Département de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France
- EA3878 (GETBO), Université de Brest, Brest, France
- Department of Medicine, Ottawa Hospital Research Institute, Thrombosis Research Group, University of Ottawa, Ottawa, Ontario, Canada
| | - Maggie Eddy
- Department of Medicine, Ottawa Hospital Research Institute, Thrombosis Research Group, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierre-Yves Le Roux
- Département de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France
- EA3878 (GETBO), Université de Brest, Brest, France
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, Thrombosis Research Group, University of Ottawa, Ottawa, Ontario, Canada
| | - Francis Couturaud
- EA3878 (GETBO), Université de Brest, Brest, France
- Département de Médecine Interne et Pneumologie, Centre Hospitalier Régional Universitaire de Brest, Brest, France
| | - Benjamin Planquette
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- UMR-S 1140, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Marc Rodger
- Department of Medicine, Ottawa Hospital Research Institute, Thrombosis Research Group, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierre-Yves Salaun
- Département de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France
- EA3878 (GETBO), Université de Brest, Brest, France
| | - Grégoire Le Gal
- EA3878 (GETBO), Université de Brest, Brest, France
- Department of Medicine, Ottawa Hospital Research Institute, Thrombosis Research Group, University of Ottawa, Ottawa, Ontario, Canada
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Mitchell N, Connell A, Kurth B. Venous thromboembolism leading to diagnosis of de novo malignancy in an organ transplant recipient. BMJ Case Rep 2018; 2018:bcr-2018-225125. [PMID: 30196255 DOI: 10.1136/bcr-2018-225125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a patient with remote orthotopic liver transplant who was ultimately diagnosed with Merkel cell carcinoma following admission for initial venous thromboembolism. Additionally, we review pertinent literature related to the risk of skin cancer in solid organ transplant recipients and discuss the importance of yearly skin exams in this patient population.
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Affiliation(s)
- Natalie Mitchell
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Alana Connell
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Benjamin Kurth
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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