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Massive pulmonary embolism: the predisposing and complicating factors, its current diagnostic approaches and critical importance of early diagnostic physical exam  [cached]
Filip A. Konecny
Journal of Research in Medical Sciences , 2006,
Abstract: Massive pulmonary embolism (MPE) often leads to circulation collapse, a form of shock. The process is set off by thrombus or multiple thrombi dislodgement followed by a rapid perfusion insufficiency of pulmonary arterial system. Patients experience severe hypotension with diastolic and systolic failure with an acute tricuspid regurgitation. On many occasions, release of an obstruction is unattainable and death is occurring frequently within one hour of presentation. A key reported source of MPE is its occurrence as a complication of deep vein thrombosis (DVT). While long-term immobilization and surgery are both directly associated with MPE, others such as previous DVT, malignancy, infectious lung and heart diseases, family thrombophilia, lower limb paralysis and pregnancy have to be considered as risk factors mainly due to its silent nature. Predisposing and complicating risks should be addressed by an early diagnostic physical exam. The clinician might offer a wide variety of diagnostic approaches, combining techniques into algorithms to better deal with the embolism severity. Multiple patient life-style changes and decisions to adhere to the proposed plan should be built up on patient-physician team effort. KEY WORDS: Massive pulmonary embolism, predisposing factors, current diagnostic approaches.
A Behcet’s Disease Patient with Right Ventricular Thrombus, Pulmonary Artery Aneurysms, and Deep Vein Thrombosis Complicating Recurrent Pulmonary Thromboembolism  [PDF]
Selvi A?ker,Müntecep A?ker,?zgür Gürsu,R?dvan Mercan,?zgür Bülent Timu?in
Case Reports in Pulmonology , 2013, DOI: 10.1155/2013/492321
Abstract: Intracardiac thrombus, pulmonary artery aneurysms, deep vein thrombosis, and pulmonary thromboembolism are rarely seen symptoms of Behcet’s disease. A 20-year-old female patient was admitted for complaints of cough, fever, palpitations, and chest pain. On the dynamic thorax computed tomograms (CT) obtained because of significantly enlarged hilar structures seen on chest radiograms, aneurysmal dilatation of the pulmonary artery segments bilaterally, chronic thrombus with collapse, and consolidation substances compatible with pulmonary embolism involving both lower lobes have been observed. It is learned that, four years ago, the patient had been diagnosed with Behcet’s disease and received colchicine treatment but not regularly. The patient was hospitalized. On the transthoracic echocardiogram, a thrombosis with a dimension of 4.2?×?1.6?cm was recognized in the right ventricle. On abdomen CT, aneurysmal iliac veins and deep vein thrombus on Doppler ultrasonograms were diagnosed. At the controls after three months of immunosuppressive and anticoagulant therapies, some clinical and radiological improvements were recognized. The patient suspended the treatment for a month and the thrombus recurred. We present our case in order to show the effectiveness of immunosuppressive and anticoagulant therapies and rarely seen pulmonary thromboembolism in recurrent Behcet’s disease. 1. Introduction Behcet’s disease (BD) is a multisystem disorder presenting with recurrent buccal aphthosis, genital ulcer, and uveitis with hypopyon [1]. Pulmonary involvement in Behcet’s disease is rare, occurring in 1 to 7.7% of the patients [2, 3]. Pulmonary artery aneurysms, arterial and venous thrombosis, pulmonary infarction, recurrent pneumonia, bronchiolitis obliterans organised pneumonia, and pleurisy are the main features of pulmonary involvement in Behcet’s disease [4]. Cardiac involvement causes coronary artery disease, recurrent pericarditis, myocardiopathy, and endocardiac abnormalities. Intracardiac thrombus formation is very uncommon [5]. We present a Behcet’s disease patient with intracardiac thrombus, pulmonary artery aneurysms, and deep vein thrombosis complicating recurrent pulmonary embolism. 2. Case Report A twenty-year-old woman was admitted to the hospital with complaints of cough, fever, palpitations, and chest pain. It was learned that, four years ago the patient had been diagnosed with Behcet’s disease and received irregular colchicine treatment. During interviews, we learned that, he had recurrent oral and genital ulcers. On examination, there was no
Infective Endocarditis in Tetralogy of Fallot Complicating Brain Abscess—A Case Report  [PDF]
Ramachandran Muthiah
Case Reports in Clinical Medicine (CRCM) , 2019, DOI: 10.4236/crcm.2019.85013
Abstract: Aim: To report a case of solitary, parietal lobe abscess in a boy, aged 16 years in Tetralogy of Fallot. Introduction: Infective endocarditis is a serious and fatal complication in congenital heart disease. Following bacterial endocarditis, ventricular septal defect (VSD) and Tetralogy of Fallot (TOF) have less morbidity and higher survival rate in children. Neurological complications were recognized in 20% of cases and brain abscess is a serious infection of brain parenchyma as a result of seeding of infective pathogens in the shunted blood from the right side of the heart. Case Report: A 16 year old boy had Tetralogy of Fallot, presented with altered sensorium of sudden onset. Echocardiography revealed a large vegetation, attached to the ventricular septum and a large VSD with overriding of aorta. CT brain revealed a large abscess cavity in the parietal lobe, which was evacuated by aspiration and treated with antibiotics. Conclusion: Any patient presented with altered sensorium in cyanotic congenital heart disease must be evaluated with CT scanning for brain abscess and also check hematocrit to rule out hyperviscosity syndrome. Lumbar puncture has been considered hazardous in patients with brain abscess and usually performed under a strong suspicion of meningitis or ventriculitis in the absence of increased intracranial pressure.
Update on pulmonary hypertension complicating chronic obstructive pulmonary disease
Soma Jyothula, Zeenat Safdar
International Journal of Chronic Obstructive Pulmonary Disease , 2009, DOI: http://dx.doi.org/10.2147/COPD.S5102
Abstract: ate on pulmonary hypertension complicating chronic obstructive pulmonary disease Review (7080) Total Article Views Authors: Soma Jyothula, Zeenat Safdar Published Date September 2009 Volume 2009:4 Pages 351 - 363 DOI: http://dx.doi.org/10.2147/COPD.S5102 Soma Jyothula, Zeenat Safdar Pulmonary-Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA Abstract: Pulmonary hypertension (PH) is the hemodynamic manifestation of various pathological processes that result in elevated pulmonary artery pressures (PAP). The National Institutes of Health Registry defined pulmonary arterial hypertension as the mean PAP of more than 25 mm Hg with a pulmonary capillary wedge pressure or left atrial pressure equal to or less than 15 mm Hg. This definition remains the currently accepted definition of PH that is used to define PH related to multiple clinical conditions including chronic obstructive pulmonary disease (COPD). The estimated US prevalence of COPD by the National Health Survey in 2002 in people aged >25 was 12.1 million. There is a lack of large population-based studies in COPD to document the correct prevalence of PH and outcome. The major cause of PH in COPD is hypoxemia leading to vascular remodeling. Echocardiogram is the initial screening tool of choice for PH. This simple noninvasive test can provide an estimate of right ventricular systolic and right atrial pressures. Right heart catheterization remains the gold standard to diagnose PH. It provides accurate measurement of mean PAP and pulmonary capillary wedge pressure. Oxygen therapy remains the cornerstone therapeutic for hypoxemia in COPD patients. Anecdotal reports suggest utility of PDE5-inhibitors and prostacyclin to treat COPD-related PH. Large randomized clinical trials are needed before the use of these drugs can be recommended.
Group B streptococcus endocarditis associated with multiple pulmonary septic emboli  [cached]
Carlos G. Teran,Ariel O. Antezana,Jerome Salvani,Deborah Abaitey
Clinics and Practice , 2011, DOI: 10.4081/cp.2011.e7
Abstract: Endocarditis is a rare presentation of group B streptococcal infection. Its association with pulmonary septic embolism was only barely studied and limited data is available up to date. Multiple septic emboli is a common complication of bacterial endocarditis, but only a few cases have been documented in relation to group B streptococcus. We present the case of an 87-year-old female patient with multiple underlying conditions that predisposed the development of bacterial endocarditis secondary to group B streptococcus and subsequently multiple pulmonary septic emboli. The patient was treated with ceftriaxone and azythromycin with good response and complete recovery without any further complications. In the event of a diagnosed case of group B streptococcus endocarditis, there should be a low threshold for the suspicion of septic pulmonary emboli especially in cases with right valves involvement.
Invasive pulmonary aspergillosis complicating chronic obstructive pulmonary disease in an immunocompetent patient.  [cached]
Ali Z,Ali A,Tempest M,Wiselka M
Journal of Postgraduate Medicine , 2003,
Abstract: Immunocompromised individuals are susceptible to pulmonary aspergillus infection, but invasive aspergillus infection is extremely rare in the presence of normal immunity. We report a case of invasive aspergillosis in an immunocompetent 63-year-old male with chronic obstructive pulmonary disease (COPD). Patients with COPD may be at risk for developing pulmonary aspergillus infection, which should be considered as a diagnostic possibility in patients with unresolving pulmonary infection.
Embolic Events And Neurological Complications In Infective Endocarditis  [PDF]
Vesna Suknjaja,Nemanja Popovic,Sanela Bozic,Jelena Milojkovic
Aktuelnosti iz Neurologije, Psihijatrije i Grani?nih Podru?ja , 2011,
Abstract: Infective endocarditis (IE) is an infection of the endocardial surface of the heart. The intracardiac effects of this infection include severe valvular insuffi ciency, which may lead to congestive heart failure and many complications. Valvular infections have entered the era of IE caused by increased usage of intravascular devices and medical procedures. Typically, the diagnosis is made relatively late, compared to the onset of valvular infection. Complications of infective endocarditis result from embolization, slowly progressive valvular destruction and various immunological mechanisms. Complications are very frequent in IE, complicating 20–60% of cases of IE. Th e risk of embolism is the highest during the first 2 weeks of antibiotic therapy and is clearly related to the size and mobility of the vegetation. Risk is increased with large vegetations (>10 mm) and particularly high with very mobile and even larger vegetations (>15 mm). Neurological complications develop in 20–40% of all patients with IE and are mainly the consequence of embolization. Rapid diagnosis and initiation of appropriate therapy especially antibiotics are of major importance to prevent a first or recurrent neurological complication.
Update on pulmonary hypertension complicating chronic obstructive pulmonary disease  [cached]
Soma Jyothula,Zeenat Safdar
International Journal of COPD , 2009,
Abstract: Soma Jyothula, Zeenat SafdarPulmonary-Critical Care Medicine, Baylor College of Medicine, Houston, TX, USAAbstract: Pulmonary hypertension (PH) is the hemodynamic manifestation of various pathological processes that result in elevated pulmonary artery pressures (PAP). The National Institutes of Health Registry defined pulmonary arterial hypertension as the mean PAP of more than 25 mm Hg with a pulmonary capillary wedge pressure or left atrial pressure equal to or less than 15 mm Hg. This definition remains the currently accepted definition of PH that is used to define PH related to multiple clinical conditions including chronic obstructive pulmonary disease (COPD). The estimated US prevalence of COPD by the National Health Survey in 2002 in people aged >25 was 12.1 million. There is a lack of large population-based studies in COPD to document the correct prevalence of PH and outcome. The major cause of PH in COPD is hypoxemia leading to vascular remodeling. Echocardiogram is the initial screening tool of choice for PH. This simple noninvasive test can provide an estimate of right ventricular systolic and right atrial pressures. Right heart catheterization remains the gold standard to diagnose PH. It provides accurate measurement of mean PAP and pulmonary capillary wedge pressure. Oxygen therapy remains the cornerstone therapeutic for hypoxemia in COPD patients. Anecdotal reports suggest utility of PDE5-inhibitors and prostacyclin to treat COPD-related PH. Large randomized clinical trials are needed before the use of these drugs can be recommended.Keywords: pulmonary arterial hypertension, airflow obstruction, vascular remodeling
Pneumomediastinum complicating pulmonary tuberculosis with diabetic ketoacidosis Pneumomediastinum complicating pulmonary tuberculosis with diabetic ketoacidosis  [cached]
Bruno Mendon?a Protásio,Jamile Rosário Kalil,Jo?o Gabriel Rosa Ramos,Eberth Alves Machado Neto
Autopsy and Case Reports , 2012,
Abstract: nulo We report a case of a 43-year-old man, previously healthy, with a three-month history of weight loss, dyspnea, cough, hemoptysis and chest pain, followed by polyuria and polydipsia during the last weeks. Clinical investigation disclosed diabetic ketoacidosis, pulmonary tuberculosis and pneumomediastinum. The patient’s outcome was favorable after clinical treatment and the pneumomediastinum resolved spontaneously without specific intervention.
Pulmonary Valve Infective Endocarditis in an Adult Patient with Severe Congenital Pulmonary Stenosis and Ostium Secundum Atrial Septal Defect  [PDF]
Juan Lacalzada,Cristina Enjuanes,Maria Manuela Izquierdo,Antonio Barragán Acea,Alejandro De La Rosa,Ignacio Laynez
Cardiology Research and Practice , 2010, DOI: 10.4061/2010/798956
Abstract: A hypertensive 76-year-old man with severe pulmonary valve stenosis (PVS) and recent initiation of haemodialysis was referred with fever, chills, and asthenia. One month prior, he had been admitted with similar symptoms. Transthoracic echocardiography (TTE) had shown a PVS and no valve vegetations were observed. Following discharge, he was readmitted with fever and blood cultures positive for Staphylococcus haemolyticus. A new TTE revealed two pulmonary valve vegetations and a previously undetected ostium secundum-type atrial septal defect (ASD), confirmed by transesophageal echocardiography. The clinical course was uneventful with intravenous antibiotic treatment and the patient was safely discharged. This is a case of pulmonary valve infective endocarditis (IE). The incidence of right-sided IE is on the rise due to the increased number of patients using central venous lines, pacing, haemodialysis and other intravascular devices. Pulmonary valve IE is extremely rare, especially in structurally normal hearts. The case reported here, presents a combination of predisposing factors, such as severe congenital PVS, the presence of a central venous catheter, and haemodialysis. The fact that it was an older patient with severe congenital PVS and associated with a previously undiagnosed ASD, is also an unusual feature of this case, making it even more interesting. 1. Case Report A hypertensive 76-year-old man with severe pulmonary valve stenosis (PVS) and recent initiation of haemodialysis for chronic kidney disease was referred to our hospital with fever, chills, and asthenia. One month prior, he had been admitted to another hospital with similar symptoms. He was found to have bacteraemia with serial blood cultures positive for Staphylococcus haemolyticus, appropriate antibiotic therapy was initiated, and a previously placed right internal yugular hemodialysis catheter was removed. Although transesophageal echocardiography (TEE) was not available in that facility, transthoracic echocardiography (TTE) examination had shown a thickened and calcified pulmonary valve with a reduced opening. Continuous wave Doppler measured a peak systolic gradient of 75?mmHg and mean systolic gradient of 42?mmHg across the pulmonary valve. No valve vegetations were observed. The patient was discharged in good condition 15 days later. Two weeks following discharge, he was readmitted with fever, blood cultures were positive for Staphylococcus haemolyticus, and the patient was subsequently referred to our institution. Physical examination on admission was unremarkable, however
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