Pulmonary embolism and acute pancreatitis: Case series and review

Abstract

Reports of pulmonary embolism in the setting of acute pancreatitis are rare. We present three cases of acute pancreatitis associated with pulmonary embolism and review the literature. Two of the three patients had severe acute pancreatitis with bilateral pulmonary emboli, and to our knowledge, these cases represent the first report of pulmonary embolism occurring in the setting of pancreatic ascites and pleural effusion. All patients experienced abdominal pain, though in one patient, symptoms suggestive of a pulmonary embolism were lacking. All three patients were successfully treated with unfractionated heparin and conservative management. Pulmonary thrombosis may occur in the setting of severe acute pancreatitis as the result of systemic inflammatory response. We review the literature and provide microvascular explanations for the occurrence of pulmonary complications and thrombosis in the setting of acute pancreatitis. We also review prior cases of pulmonary embolism in acute pancreatitis. Our experience suggests that pulmonary embolism may be an under-recognized complication of severe acute pancreatitis. Keywords: Pulmonary embolism, pancreatitis, ascites, pleural effusion, thrombosis INTRODUCTIONSevere acute pancreatitis can provoke a systemic inflammatory response which may lead to a number of vascular and pulmonary complications. Pulmonary embolism is a rarely reported complication of acute pancreatitis (1-3). Here we present three cases of acute pancreatitis associated with pulmonary embolism, and propose that pulmonary vascular thrombosis may be an underrecognized complication of severe acute pancreatitis. To our knowledge, two of the three cases represent the first reports of pulmonary embolism occurring in the setting of pancreatic ascites and pleural effusion. CASE PRESENTATIONSCase 1 A 28 year old woman presented with six weeks of abdominal pain along with nausea and vomiting. The patient had a history of alcoholic pancreatitis but denied recent alcohol consumption. She reported no chest pain or shortness of breath. Initial vital signs included a temperature of 98.7 F, blood pressure of 122/87 mmHg, and she was tachycardic with a heart rate of 132 beats/ min. Oxygen saturation was 95% on room air. Physical examination was remarkable for epigastric tenderness and abdominal distention consistent with ascites. Lipase was 1,453 IU/L, and liver enzymes were normal. Ascitic fluid analysis showed an amylase of 43,400 IU/L. CT scan of the abdomen and pelvis showed ascites and evidence of prior cholecystectomy. Incidental, multiple pulmonary emboli were seen in bilateral lower lobes, along with a right-sided pleural effusion and lower lobe consolidation with abnormal enhancement, consistent with pulmonary infarct (Figure 1). The pancreas appeared normal.The patient was started on unfractionated heparin along with intravenous hydration and bowel rest. Her abdominal pain and nausea quickly improved, and she tolerated an oral diet within three days. She was discharged with low-molecular weight heparin a...

Development and validation of a prediction model for deep vein thrombosis in older non-mild acute pancreatitis patients

“…NMAP usually requires a long hospital stay. The systemic inflammatory and hypercoagulable state of NMAP patients may contribute to the development of venous thromboembolism[ 9 - 11 ]. Deep vein thrombosis (DVT), a kind of venous thromboembolism, commonly develops in the lower extremities.…”

Association of multiple splanchnic venous thrombosis and left renal venous thrombosis, a rare complication of pancreatitis: a case report

“…Extrasplanchnic thrombotic complications have been described in the literature. They involve both venous and arterial circulations: pulmonary circulation [5], inferior vena cava (IVC) and renal veins [6, 7], right atrium [8], coeliac axis [9], and renal arteries [10].…”

Imaging Assessment of Etiology and Severity of Acute Pancreatitis

“…Finally, multiple pulmonary complications may be seen during the course of severe acute pancreatitis that includes the presence of pleural effusions, pulmonary infiltrates, pulmonary emboli and associated infarction, and, more rarely, pulmonary empyema and pneumothorax (28,83).…”