1/2236. pulmonary embolism during labor and the effect on the fetus monitored with oxycardiotocography. We report on a rare case of pulmonary embolism which we observed in the second stage of labor. For fetal surveillance we used oxycardiotocography (OCTG), an experimental system which combines internal CTG and pulse oximetry which enabled us to observe hemodynamic reactions of the unborn child and the effect on maternal-fetal gas exchange. It was possible to record marked fetal bradycardia simultaneously with decrease in oxygen saturation in the fetal arterial system during the acute event. ( info) |
2/2236. Pulmonary skin embolism: a case report. The incidental autopsy finding of an embolic fragment of skin partially occluding a pulmonary artery is described. It is suggested that the "graft" resulted from one of many needle punctures. ( info) |
| A 46-year-old woman presented with shortness of breath and frequent lower respiratory tract infections. A ventilation-perfusion scan showed markedly reduced perfusion of the right lung, and pulmonary arteriogram showed stenosis of the right pulmonary artery. A right pneumonectomy revealed dense white fibrous bands partially occluding the pulmonary artery branches and two large abscess cavities filled with pus in the upper and lower lobes. Microscopic examination revealed extensive necrosis of lung parenchyma, suppurative granulomatous inflammation with coccidioides immitis organisms and rare acid-fast bacilli. pulmonary artery fibrous bands were originally believed to be congenital; however, they are now known to be sequelae of thromboembolic phenomena. ( info) |
4/2236. Catheter-directed thrombolysis for thromboembolic disease during pregnancy: a viable option. Anticoagulation with intravenous heparin has been the standard treatment for the management of gestational thromboembolic complications. Catheter-directed thrombolysis is an encouraging approach for the treatment of thromboembolic disease and has not been previously reported during pregnancy. One gravid woman with pulmonary embolism, critically ill, and hemodynamically compromised, and two gravid women with iliofemoral venous thrombosis, who failed to respond to standard treatment with intravenous heparin, were treated with catheter-directed urokinase. All three patients experienced rapid resolution of symptoms and successful pregnancy outcomes. In our three patients, catheter-directed thrombolysis for thromboembolic disease during pregnancy allowed rapid resolution of hemodynamic abnormalities and/or resolution of thrombus. Catheter-directed thrombolysis offered a reasonably safe alternative to prolonged medical management in these young, otherwise healthy, patients. Long-term, it may prevent the postphlebitic syndrome. ( info) |
5/2236. Late massive haemoptyses from bronchopulmonary collaterals in infarcted segments following pulmonary embolism. Massive, recurrent haemoptyses requiring blood transfusions occurred in a patient who had been diagnosed as having pulmonary thromboembolism 3 months earlier. To the authors' knowledge this is the first case report of this kind, in which massive haemoptyses were proved to be caused by large bronchopulmonary collaterals that had developed in the infarcted lung segments affected by embolism. Selective embolization of the collaterals proved to be therapeutic and life saving. ( info) |
6/2236. 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. ( info) |
7/2236. 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. ( info) |
8/2236. Massive pulmonary hemorrhage: a rare complication of heparin therapy. A rare complication, massive pulmonary hemorrhage, occurred in two patients who were receiving heparin for pulmonary thromboembolic disease. The site of pulmonary hemorrhage was not found at autopsy. The occurrence of profuse hemoptysis in both patients prior to anticoagulation suggests that this finding may be of value in predicting the risk of pulmonary hemorrhage in a given patient. ( info) |
| Acute right ventricular dysfunction has been established both as a diagnostic and prognostic indicator in pulmonary embolism. This report illustrates the utility of thallium-201 scintigraphy as an adjunctive noninvasive test in the diagnosis of pulmonary embolism by demonstrating increases in regional right ventricular perfusion and its subsequent resolution with treatment presumably as a result of decreased pressure work. ( info) |
10/2236. 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. ( info) |