1/235. Pulmonary bone marrow embolism in sickle cell disease.We report an unusual lethal complication of sickle cell anemia. The patient was admitted with a diagnosis of acute chest syndrome and died shortly after that of respiratory failure. autopsy revealed numerous deposits of bone marrow hematopoietic tissue occluding the microvascular circulation of the lung. Many causes of acute chest syndrome in sickle cell anemia have been identified, including bone marrow infarction leading to embolism of bone marrow fat. However, the release of bone marrow hematopoietic tissue leading to pulmonary vascular occlusion is not generally recognized premortem by treating physicians.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/235. Sudden unexpected death from pulmonary thromboembolism--examination of antemortem chest X-ray.An autopsy case of a woman who died suddenly from undiagnosed and untreated pulmonary thromboembolism (PTE) on her way home from the hospital is described in this report. She had complained of chest pain and dyspnea on exertion when she visited the hospital and a chest X-ray taken at that time showed remarkable manifestation of right heart failure and PTE, compared with former x-rays taken during previous visits to the hospital. In this report we present the findings of four chest x-rays of this patient, which had been taken both before and after the development of PTE.- - - - - - - - - - ranking = 7.576857227995keywords = chest pain, chest (Clic here for more details about this article) |
3/235. Microvascular pulmonary emboli secondary to precipitated crystals in a patient receiving total parenteral nutrition: a case report and description of the high-resolution CT findings.A patient with a history of a small-bowel transplant that was subsequently resected required total parenteral nutrition for nutritional supplementation. While receiving therapy, he developed chest tightness, shortness of breath, and fever. The chest radiograph showed bilateral reticulonodular opacities, and the high-resolution CT scan demonstrated diffuse, poorly marginated micronodular opacities in a miliary pattern. pathology specimens obtained by transbronchial biopsy revealed amorphous material obstructing the pulmonary microvasculature. Microvascular emboli secondary to precipitated crystals is a potential complication of total parenteral nutrition. An awareness of the factors that influence crystal solubility may prevent adverse interactions in patients who require parenteral nutrition.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/235. Primary right atrial angiosarcoma mimicking acute pericarditis, pulmonary embolism, and tricuspid stenosis.A 29 year old white man presented to the emergency room with new onset pleuritic chest pain and shortness of breath. He was initially diagnosed as having viral pericarditis and was treated with non-steroidal anti-inflammatory drugs. A few weeks later he developed recurrent chest pain with cough and haemoptysis. Chest radiography, cardiac examination, transthoracic and transoesophageal echocardiography pointed to a mass that arose from the posterior wall of the right atrium, not attached to the interatrial septum, which protruded into the lumen of the right atrium causing intermittent obstruction of inflow across the tricuspid valve. Contrast computed tomography of the chest showed a right atrial mass extending to the anterior chest wall. The lung fields were studded with numerous pulmonary nodules suggestive of metastases. A fine needle aspiration of the pulmonary nodule revealed histopathology consistent with spindle cell sarcoma thought to originate in the right atrium. Immunohistochemical stains confirmed that this was an angiosarcoma. There was no evidence of extracardiac origin of the tumour. The patient was treated with chemotherapy and radiation. This case highlights the clinical presentation, rapid and aggressive course of cardiac angiosarcomas, and the diagnostic modalities available for accurate diagnosis.- - - - - - - - - - ranking = 10.15371445599keywords = chest pain, chest (Clic here for more details about this article) |
5/235. Treatment of may-thurner syndrome with catheter-directed thrombolysis and stent placement, complicated by heparin-induced thrombocytopenia.may-thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, resulting in left iliofemoral deep vein thrombosis and severe leg edema. We report the case of a 41-year-old female who presented with severe left leg edema present for 1 day. One week earlier she had experienced acute shortness of breath and pleuritic chest pain. Duplex ultrasound revealed a left iliofemoral deep vein thrombosis. A computed tomography (CT) scan performed for abdominal pain revealed thrombosis of the entire left common and external iliac veins. A ventilation-perfusion scan diagnosed a pulmonary embolism. The patient was treated with systemic intravenous heparin and catheter-directed thrombolysis of the iliofemoral deep vein thrombosis. Complete thrombolysis and iliofemoral vein patency was achieved over 5 days. A persistent stenosis in the left common iliac vein consistent with may-thurner syndrome was alleviated with percutaneous balloon angioplasty and placement of a Wallstent. heparin therapy was terminated at the time of stenting because of suspected heparin-induced thrombocytopenia. The patient was started on a continuous infusion of 10% dextran 40, and warfarin therapy was initiated. heparin-induced antibodies were confirmed by a C-14 serotonin release assay. The endovascular reconstruction remains patent 4 months later. heparin-induced thrombocytopenia complicating endovascular reconstruction of the iliofemoral venous system in a patient with may-thurner syndrome is an uncommon occurrence. This case and a review of the literature are discussed.- - - - - - - - - - ranking = 4.576857227995keywords = chest pain, chest (Clic here for more details about this article) |
6/235. Acute massive pulmonary embolism following high ligation combined with compression sclerotherapy for varicose veins report of a case.A case of acute pulmonary embolism following high ligation and compression sclerotherapy for varicose veins is reported. A 54-year-old women developed superficial varicosities and stasis pigmentation on her left leg 1 year prior to her first visit to hospital. No deep vein thrombosis was detected by ascending phlebography performed 3 months prior to operation. High ligation combined with compression sclerotherapy was performed for the varicose veins. One day after treatment, the patient complained of chest pain and discomfort, and then collapsed. perfusion scintigraphy revealed multiple embolisms in the bilateral lungs. The patient recovered after aggressive anticoagulant and thrombolytic therapy. Although pulmonary embolism is a rare complication of sclerotherapy, it is potentially one of the most serious.- - - - - - - - - - ranking = 4.576857227995keywords = chest pain, chest (Clic here for more details about this article) |
7/235. Massive pulmonary embolus in a 14 year old boy.Pulmonary embolus in children is rare. A case of massive pulmonary embolus, after surgery, in a child of 14 years is described. Accident and emergency doctors should be aware that pulmonary embolus can occur in children and exercise a high index of suspicion for the diagnosis in those patients with risk factors for the condition who present acutely with typical symptoms such as dyspnoea, chest pain, haemoptysis, or collapse.- - - - - - - - - - ranking = 4.576857227995keywords = chest pain, chest (Clic here for more details about this article) |
8/235. Neovascularity related to mural thrombus in endomyocardial fibrosis.We report a 30-year old, previously healthy, Ghanese woman admitted with sudden onset of dyspnoe, hemoptoe and right-sided chest pain due to endomyocardial fibrosis with secondary pulmonary emboli coronary angiography revealed a myocardial "blush". This finding may focus attention to the presence of mural thrombus that may have diagnostic and therapeutic consequences.- - - - - - - - - - ranking = 4.576857227995keywords = chest pain, chest (Clic here for more details about this article) |
9/235. pulmonary embolism presenting as syncope: case report and review of the literature.syncope as an initial presentation of pulmonary embolism occurs in about 10% of patients. A 68-year-old woman was admitted to the hospital with syncope. A right lower lobe infiltrate was found on a chest x-ray film, and results of a ventilation-perfusion scan were interpreted to mean that a high probability of pulmonary embolism existed. Other causes of syncope were excluded. A Doppler scan of the lower extremities revealed deep venous thrombosis. Intravenous heparin was administered, and then an inferior vena cava filter was placed to prevent pulmonary embolism from recurring. The patient has been well for 16 months since that episode. A review of 20 case reports in the literature of 10 women and 10 men with pulmonary embolism presenting as syncope revealed that female patients were younger than male patients and that the outcome was fatal in 40% of all cases. syncope as a presenting symptom of pulmonary embolism is difficult to diagnose. physicians must be vigilant with patients who have syncope, because this symptom may be the "forgotten sign" of life-threatening pulmonary embolism. The need for prompt diagnosis is clear, because with appropriate treatment the majority of patients may survive.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
10/235. False positive perfusion lung scintiscans in tetraplegic patients: a case series.An accurate diagnosis of pulmonary embolism is essential to prevent excessive morbidity and mortality from either inappropriate therapy or failure to institute anticoagulation. The diagnosis of pulmonary embolism in tetraplegic spinal cord injury patients is complicated by frequent inability to perform the ventilation portion of the ventilation-perfusion scintiscan (V/Q scan) and by controversy regarding classification of defects on perfusion-only scans, as well as by coexisting pulmonary disease, systemic illness, related injuries, and the tendency for tetraplegic patients to have unexplained fever. This report describes three tetraplegic ventilator-dependent patients with hypoxic respiratory failure and normal chest radiographs who had large defects on perfusion-only lung scans. ventilation scintiscans were not performed because the patients were ventilator-dependent with tracheostomies. Pulmonary angiography findings were normal in all patients, and all three responded to aggressive pulmonary toilet. Even large defects on perfusion-only scans despite normal chest radiographs should not be used to establish a diagnosis of pulmonary embolism in tetraplegic patients, and further diagnostic imaging is warranted.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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