Beyond Pulmonary Embolism; Nonthrombotic Pulmonary Embolism as Diagnostic Challenges

McCabe, Bridgette E.; Veselis, Clinton A.; Goykhman, Igor; Hochhold, John; Eisenberg, Daniel A.; Son, Hong-Ju

doi:10.1067/j.cpradiol.2018.07.007

Cited by 18 publications

(16 citation statements)

References 48 publications

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“…The main differentiation was septic PE with bilateral, peripheral, pulmonary nodules that often manifest cavitary changes on a typical CT scan. 6 Our patient had only one extremely large cavity with no history of underlying infection or indwelling catheters, which is inconsistent with septic PE.…”

Section: Discussionmentioning

confidence: 68%

Non-surgical management of an abrupt cavitation and large oval-shaped lung abscess secondary to acute thromboembolic pulmonary infarction: a case report

Wang

Yan

et al. 2021

J Int Med Res

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Infected cavitating pulmonary infarction is a rare complication of pulmonary embolism with a high mortality rate. Surgical excision for this complication has been used in past decades. Abrupt cavitation and a large oval-shaped lung abscess caused by acute thromboembolic pulmonary infarction during anticoagulation are rare. We present a 70-year-old man who suffered from pleuritic pain and breathlessness, accompanied by nausea and vomiting for 1 day. A physical examination showed tachycardia and tachypnea with moist rales in the left upper chest. High D-dimer levels, leukocytosis, respiratory failure and left upper lobe consolidation were found on plain computed tomography (CT). CT pulmonary angiography was performed 2 days after the previous CT scan because pulmonary embolism was suspected. This scan showed emboli in the main, right upper, middle, lower and left upper pulmonary arteries with deteriorated left upper lobe consolidation and cavitation. Thromboembolic pulmonary infarction and an abscess were diagnosed. Enoxaparin 60 mg was administered every 12 hours for 10 days, followed by rivaroxaban, antibiotics and drainage of the hydrothorax. The patient improved after the strategy of non-surgical treatment and was discharged approximately 1 month later. The patient had an uneventful course during rivaroxaban 20 mg once daily for 1 year.

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Section: Discussionmentioning

confidence: 68%

Non-surgical management of an abrupt cavitation and large oval-shaped lung abscess secondary to acute thromboembolic pulmonary infarction: a case report

Wang

Yan

et al. 2021

J Int Med Res

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“…In addition, these lesions may be cavitated, although the prevalence of cavitation is dependent on the chronicity of the presentation, with a sensitivity ranging from 25 to 85%. 7 12 31 Indirect signs of vascular obstruction help distinguish SPE from simple abscesses, but they are insensitive. They include wedge-shaped opacities (reflecting pulmonary infarction), the “feeding vessel sign” (the identification of a single vessel leading to a nodular lesion and suggesting hematogenous origin), and the “halo sign” (a ground glass opacity surrounding a central nodule).…”

Section: Clinical Approach To Patients With Spementioning

confidence: 99%

Septic Pulmonary Embolism: A Contemporary Profile

Valerio

Baddour

2022

Semin Thromb Hemost

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Septic pulmonary embolism (SPE) is a rare clinical entity that is distinct from the classic and more common non-septic thrombotic pulmonary embolism. SPE should be suspected in patients with a systemic acute inflammatory reaction or sepsis who develop signs and symptoms of pulmonary involvement. The diagnosis of SPE depends on the specific radiologic finding of multiple, peripheral, nodular, possibly cavitated lesions. SPE should prompt an immediate search for the primary source of infection; typically, right-sided infective endocarditis, cardiac implantable electronic devices, and septic thrombophlebitis as a complication of bone, skin, and soft tissue infection including Lemierre's syndrome, indwelling catheters, or direct inoculation via injection drug use. Invasive treatment of the infection source may be necessary; in thrombophlebitis, the efficacy and safety of anticoagulation remain undefined. Blood cultures may be negative, particularly among patients with recent antibiotic exposure, and broad-spectrum antimicrobial therapy should be considered. The in-hospital mortality of SPE ranges up to 20% in published case series. While trends in the incidence of SPE are unknown, the opioid epidemic, the growing use of cardiac implantable electronic devices worldwide, and the reported increase in cases of septic thrombophlebitis may be leading to an escalation in SPE cases. We provide a contemporary profile of SPE and propose a clinical management algorithm in patients with suspected or confirmed SPE.

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“…Iatrogenic NTPE is a rare condition, with chest X-ray and CTPA being crucial in its diagnosis [2] . This case highlights the possibility of NTPE following the use of liquid embolization material in distant parts of the body.…”

Section: Discussionmentioning

confidence: 99%

“…Non–thrombotic pulmonary embolism (NTPE) can represent a significant diagnostic challenge due to its diverse clinical presentation and varied imaging features [1] . Radiology, in the form of chest X-ray and CT, are the mainstay of accurate and timely identification of this potentially fatal condition [2] . This case reports details an unusual case of iatrogenic NTPE with striking imaging features.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary migration of liquid embolization material: An unusual cause of pulmonary embolism

Yeomans

Sastry

Marin

2022

Radiology Case Reports

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Iatrogenic non–thrombotic pulmonary embolism is a rare cause of pulmonary embolism. This case demonstrates the unusual imaging findings associated with pulmonary migration of Precipitating Hydrophobic Injectable Liquid, a liquid embolization material most commonly used in interventional neuroradiological procedures. Chest X-ray and CT Pulmonary Angiogram images are shown. The case highlights the importance of a thorough clinical history, including past medical history, when interpreting radiological studies.

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Beyond Pulmonary Embolism; Nonthrombotic Pulmonary Embolism as Diagnostic Challenges

Cited by 18 publications

References 48 publications

Non-surgical management of an abrupt cavitation and large oval-shaped lung abscess secondary to acute thromboembolic pulmonary infarction: a case report

Non-surgical management of an abrupt cavitation and large oval-shaped lung abscess secondary to acute thromboembolic pulmonary infarction: a case report

Septic Pulmonary Embolism: A Contemporary Profile

Pulmonary migration of liquid embolization material: An unusual cause of pulmonary embolism

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