Comparison of clinical and postmortem diagnosis of pulmonary embolism.

Karwinski, B.; Svendsen, Einar

doi:10.1136/jcp.42.2.135

Cited by 164 publications

(56 citation statements)

References 13 publications

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“…Sub-massive PE is surprisingly prevalent but difficult to diagnose [21] because presenting signs and symptoms are non-specific and screening tests are not always sensitive enough to detect disease in asymptomatic patients. The condition is often overlooked in patients with comorbid disease, and it appears that up to 70 per cent of PE is only detected at autopsy [21][22][23][24].…”

Section: Pathophysiology Of Pulmonary Embolismmentioning

confidence: 99%

Pulmonary embolism: predicting disease severity

Burrowes

Clark

Marcinkowski

et al. 2011

Phil. Trans. R. Soc. A.

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Pulmonary embolism (PE) is the most common cause of acute pulmonary hypertension, yet it is commonly undiagnosed, with risk of death if not recognized promptly and managed accordingly. Patients typically present with hypoxemia and hypocapnia, although the presentation varies greatly, being confounded by co-mordidities such as preexisting cardio-respiratory disease. Previous studies have demonstrated variable patient outcomes in spite of similar extent and distribution of pulmonary vascular occlusion, but the pathophysiological determinants of outcome remain unclear. Computational models enable exact control over many of the compounding factors leading to functional outcomes and therefore provide a useful tool to understand and assess these mechanisms. We review the current state of pulmonary blood flow models. We present a pilot study within 10 patients presenting with acute PE, where patient-derived vascular occlusions are imposed onto an existing model of the pulmonary circulation enabling predictions of resultant haemodynamics after embolus occlusion. Results show that mechanical obstruction alone is not sufficient to cause pulmonary arterial hypertension, even when up to 65 per cent of lung tissue is occluded. Blood flow is found to preferentially redistribute to the gravitationally non-dependent regions. The presence of an additional downstream occlusion is found to significantly increase pressures.

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Section: Pathophysiology Of Pulmonary Embolismmentioning

confidence: 99%

Pulmonary embolism: predicting disease severity

Burrowes

Clark

Marcinkowski

et al. 2011

Phil. Trans. R. Soc. A.

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“…In contrast with former beliefs, however, most pulmonary thromboemboli are not cleared from the microcirculation. Autopsy studies show the residue of chronic, partially recanalized thrombi in virtually all individuals who have had prior pulmonary emboli [4]. However, it remains an exception that pulmonary hypertension due to chronic large vessel pulmonary thrombi or extensive microvascular obstruction (CTEPH) ensues [5].…”

Section: Discussionmentioning

confidence: 99%

Chronic thromboembolic pulmonary hypertension and vascular transformation of the lymph node sinuses

Meysman

Diltoer²,

Raeve³

et al. 1997

Eur Respir J

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease often not recognized until it is far advanced. Medical management does not reverse the effects of the disease, nor does it prevent its progression. Pulmonary thromboendarterectomy is the preferred treatment.We present the case of a patient in whom CTEPH was mistaken for an interstitial lung disease with mediastinal lymph node enlargement. The mediastinal lymph node enlargement was due to vascular transformation of the lymph node sinuses (VTS). This is an unusual case of chronic thromboembolic pulmonary hypertension with vascular transformation of the lymph node sinuses. Eur Respir J 1997; 10: 1191-1193 Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but potentially treatable cause of pulmonary hypertension. Unfortunately, there is often a delay in the diagnosis due to the fact that signs and symptoms are nonspecific in the majority of these patients. For this reason, CTEPH is frequently mistaken for other entities, such as chronic obstructive pulmonary disease, coronary artery disease, interstitial lung disease, congestive heart failure, or psychosomatic dyspnoea [1].We present the case of a patient in whom enlarged mediastinal lymph nodes and a mosaic pattern of lung attenuation on chest computed tomography (CT) scan were mistaken for interstitial lung disease. At autopsy, CTEPH and vascular transformation of the lymph node sinuses (VTS) were found. Case reportA 32 year old male was transferred to our institution because of respiratory distress and haemoptysis after transbronchial biopsy. Since the age of 10 yrs, the patient had been treated with inhaled β 2 -mimetics on demand, for allergic asthma. He had a smoking history of 15 pack-years but had ceased smoking 3 yrs before admission. Varicectomy of the lower limbs had been performed 2 yrs earlier.The patient was examined at another hospital a few months before admission because of worsening exertional dyspnoea and wheezing. Inhaled corticosteroids, budesonide 400 mg·day -1 , were added to his treatment, without any improvement in his symptoms. Spirometry performed at that time showed moderate obstructive pulmonary disease, with significant bronchial hypersensitivity at histamine provocation testing (provocative dose causing a 20% fall in forced expiratory volume in one second (PD20) 0.8 mg·mL -1 ). A chest radiograph was reported to show cardiac enlargement and pulmonary hyperinflation. An electrocardiogram revealed sinus rhythm with inverted T-waves in the precordial leads, and an echocardiogram demonstrated considerable enlargement of the right atrium and ventricle. Mean pulmonary artery pressure by Doppler evaluation of the tricuspid regurgitant envelope was estimated at 42 mmHg. A CT scan of the chest ( fig. 1a and b) revealed mediastinal lymph node enlargement and a mosaic pattern of lung attenuation, suggesting interstitial lung disease.Bronchoscopy and transbronchial biopsy were performed but haemoptysis and respiratory distress developed soon afterwards. The ...

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“…Tedavi edilmeyen olgularda üç aylık mortalite yaklaşık %25-30 arasında bildirilmiştir [2][3][4]. Doğru tanı ve tedavi ile bu oran yaklaşık olarak %3-8'e kadar düşebilmektedir [5][6][7].…”

Section: Introductionunclassified

Anatomic Localization of Thrombi in Our Cases of Pulmonary Thromboembolism

Tasci¹

2013

JCAM

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Anahtar KelimelerAnatomik Dağılım; Pulmoner Tromboemboli; Trombüs Abstract Aim: Pulmonary thromboembolism (PTE), known to be diagnosed with the disease requiring immediate treatment. Pulmonary angiography as the gold standard among the methods being used in the diagnosis of pulmonary CT angiography, ventilation perfusion scan, is located within the lower extremity venous Doppler ultrasound diagnostic algorithms. Scintigraphy and CT angiography in the diagnosis of PTE according to the conditions of the hospital may gain priority. In recent years, close to the accuracy of CT angiography results were obtained with the invasive angiography. Radiologists subsegment branches of pulmonary artery thrombus, a fact that they are looking forced. CT angiographic images of patients with pulmonary thromboembolism with thrombus in our study by examining the distribution profile were revealed. Radiologists and clinicians aimed to give information on this issue. Material and Method: Within one year period at our outpatient clinic of Chest Diseases and pulmonary CT angiography images of 37 patients diagnosed with PTE were reviewed retrospectively. Results: Determined the distribution and frequency of thrombi. Thrombus in the pulmonaryarteries are most commonly seen in all the branches to the lower lobes. The thrombus inthe left upper lobe was the least anatomical localisation. Discussion: Today, close to the results seen that BTPA invasive pulmonary angiography. Thrombioften seen as places for Clinicians and radiologists believe that information about the donor.

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Comparison of clinical and postmortem diagnosis of pulmonary embolism.

Cited by 164 publications

References 13 publications

Pulmonary embolism: predicting disease severity

Pulmonary embolism: predicting disease severity

Chronic thromboembolic pulmonary hypertension and vascular transformation of the lymph node sinuses

Anatomic Localization of Thrombi in Our Cases of Pulmonary Thromboembolism

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