Diagnosis of Pulmonary Embolism

Abstract

Case 1: A 77-year-old Caucasian woman with a probable diagnosis of ovarian cancer developed an acute onset of shortness of breath two days after being discharged for a workup of symptomatic ascites. Her medical history was signifi cant for hypertension and atrial fi brillation, and she was taking therapeutic doses of coumadin. She presented to the emergency department; was found to have a large, left pleural effusion; and was admitted to the hospital. A thoracentesis removed 2.1 L of fl uid. The patient's respiratory distress improved; however, she experienced a second episode of sudden onset shortness of breath prior to her anticipated discharge. She was afebrile, with a room air pulse oximetry of 80%, pulse of 121 beats per minute, and respiratory rate of 28. A chest x-ray (CXR) showed only a small pleural effusion remaining on the left. An electrocardiogram (EKG) showed atrial fi brillation. A chest computed tomography (CT) was performed and showed bilateral pulmonary emboli.Case 2: A 57-year-old, obese, African American woman with newly diagnosed endometrial cancer presented to clinic with a palpable left supraclavicular lymph node. A CXR revealed mediastinal adenopathy, and a chest CT was performed to further delineate the size of the mass and evaluate for metastases. The CT revealed a Hampton's hump and also was positive for pulmonary embolism (PE). The patient's vital signs were normal, and she did not have any respiratory symptoms. An ultrasound of her lower extremities was negative for deep vein thrombosis (DVT).Case 3: A 31-year-old Caucasian woman receiving chemoradiation for cervical cancer was admitted to the hospital with diffuse abdominal pain that occurred two days after completion of brachytherapy with after-loading tandem and ovoids, a treatment requiring complete bed rest for 48 hours. On admission, further review of systems was negative; however, the patient mentioned that she lived in a two-story house and had shortness of breath after climbing stairs-a symptom she attributed to her body habitus and anemia. Her height was 162.5 cm, and her weight was 135.9 kg. During the patient's hospitalization, she developed a rapid heart rate of 139 beats per minute. An EKG showed sinus tachycardia, and a CXR revealed atelectasis and diminished lung volumes. Laboratory evaluation revealed leukocytosis with a white blood cell count of 21.5/mm 3 , and a cardiac panel was negative. Her room air pulse oximetry was 100%. Following a diagnosis of pneumonia, the patient developed respiratory distress, was intubated, and was transported to the intensive care unit. Continued workup with a chest CT revealed bilateral pulmonary emboli and pulmonary metastases.Case 4 : A 58-year-old Caucasian woman with a history of cervical cancer underwent surgical debulking after an aborted pelvic exenteration. She developed a wound dehiscence and pelvic abscesses postoperatively. A pelvic drain was placed, and she was admitted to the hospital for IV antibiotic therapy. During her hospitalization, she developed a second surface ab...

Pulmonary thromboembolism

“…That is to say, blood gas values may be normal in cases of PTE, and the typical findings are nonspecific. The utility of arterial blood‐gas analysis in the diagnosis of PTE in humans is controversial 49,50 . Some authors have suggested that using the A‐a gradient may be more sensitive than solely looking for hypoxemia 23,51 .…”

“…The utility of arterial blood-gas analysis in the diagnosis of PTE in humans is controversial. 49,50 Some authors have suggested that using the A-a gradient may be more sensitive than solely looking for hypoxemia. 23,51 The A-a gradient is generally used for patients breathing room air and is calculated by subtracting the measured arterial oxygen partial pressure from the calculated alveolar partial pressure [A-a 5 fPAO 2 5 FiO 2 (Patm À PH 2 O) À (PaCO 2 /R)g À PaO 2 ], where normal is o10 mm Hg.…”

The Utilisation of Computed Tomography Pulmonary Angiography in a Regional Victorian Emergency Department

“…However, when considering confounding factors such as immobilization and female sex in the multivariate logistic regression analysis, the relationship between age and PE risk was attenuated. Nevertheless, increasing age has been traditionally considered a risk factor for PE [ 6 , 7 ], where the incidence rate rises exponentially [ 8 ].…”

Clinical presentation and patient management differences in confirmed and non-Confirmed pulmonary thromboembolism

“…Окончательное подтверждение диагноза ТЭЛА возможно после непосредственной визуализация тромбов в ветвях ЛА с помощью МСКТ или АПГ [3,6,11]. Эти методы в I группе были применены у 23 пациентов (35,4%), что и позволило исключить диагноз ТЭЛА.…”

“…Согласно статистическим данным, в структуре смерт-ности от сердечно-сосудистых заболеваний (ССЗ) ТЭЛА занимает третье место после инфаркта миокарда и ишемического инсульта [2]. ТЭЛА, особенно мас-сивная, -это всегда ситуация, требующая от врача принятия четких, быстрых решений и последующих действий в жестких рамках лимита времени, при этом достоверная диагностика данного патологического состояния невозможна без использования методов медицинской визуализации [3][4][5][6].…”