11/2236. Thrombolysis with resolution of pulmonary hypertension in a heart transplant candidate. We report a patient with idiopathic cardiomyopathy and high pulmonary resistance due to pulmonary emboli of unknown age. Successful thrombolytic therapy returned his pulmonary resistance to normal, allowing orthotopic cardiac transplantation. This case underscores the need to aggressively diagnose and treat pulmonary emboli in potential transplant candidates. ( info) |
12/2236. Pacemaker-related endocarditis. Report of 7 cases and review of the literature. We report on 7 patients with pacemaker endocarditis diagnosed during the workup of long-standing fever. Persistent positive blood cultures and echocardiography led to the diagnosis in 6 patients whereas autopsy was diagnostic in another. Causative microorganisms were staphylococcus epidermidis (3), staphylococcus lugdunensis (1), pseudomonas aeruginosa (1), streptococcus bovis (1), and streptococcus mitis-streptococcus sanguis (1). pulmonary embolism was present in nearly 50% of the cases, a figure clearly higher than previously reported. In all but 1 case the initial medical approach was not successful, and thus the pacing system was finally removed. None of the cases relapsed after the removal. We have reviewed the literature regarding pacemaker endocarditis, particularly with respect to treatment. ( info) |
13/2236. Primary venous aneurysms--case reports. Venous aneurysms are rare lesions that may be the source of pulmonary emboli and can result in death. The authors have recently treated several patients who had venous aneurysms of the upper extremity, lower extremity, and jugular system. Venous aneurysms usually appear to have a safe natural history in these locations, although all of the reported patients required surgery after the development of symptoms owing to complaints of pain, and/or cosmetic appearance, and/or a diagnosis of thrombosis. These cases are presented, along with a review of venous aneurysms occurring at other sites and their causes. ( info) |
14/2236. Thrombotic risk in thalassemic patients. Hemostatic parameters of 495 beta-thalassemic patients (421 with thalassemia major and 74 with thalassemia intermedia) were analyzed, to assess their association with the described thrombophilic condition and to verify the role of additional risk factors (e.g. persistent postsplenectomy thrombocytosis, insulin dependent diabetes mellitus, estrogen-progestin treatment and atrial fibrillation). The prevalence of thromboembolic accidents was 5.2% and in four patients (15.3%) inherited or acquired predisposing defects were recognized. The incidence of thromboembolic events and the associated relative risk due to hemocoagulative abnormalities in these patients are discussed. ( info) |
15/2236. Visualization of functional improvement by 123I-IMP lung SPET after thromboendarterectomy for chronic pulmonary embolism. We report on six patients with chronic pulmonary embolism who underwent 123I-IMP and 99Tcm-MAA lung SPET before and after thromboendarterectomy. 123I-IMP lung SPET can assess the viability of lung parenchyma, because it is a non-particulate agent that accumulates in the endothelial membranes of pulmonary capillaries. Chronic pulmonary thromboembolism accompanied by pulmonary hypertension has a poor prognosis that may be improved only by thromboendarterectomy. We compared 123I-IMP and 99Tcm-MAA lung SPET in terms of functional improvement after such surgery. After thromboendarterectomy, all six patients were functionally improved, according to the criteria of the new york heart association. The pre- and post-surgery percentage of vascular obstruction did not differ significantly with 99Tcm-MAA lung SPET (44.8 /- 11.2% and 32.5 /- 15.6% pre- and post-surgery, respectively). In contrast, 123I-IMP lung SPET revealed a significant pre- versus post-surgery difference (15.5 /- 9.5% and 3.3 /- 5.9% pre- and post-surgery, respectively). 123I-IMP lung SPET could be useful for evaluating thromboendarterectomy because pulmonary parenchymal viability owing to arterial microvasculature can be estimated. ( info) |
16/2236. diagnosis of main-stem pulmonary thromboemboli by transesophageal echocardiography. The aim of this report is to describe the usefulness of transesophageal echocardiography in the diagnosis of pulmonary emboli. A biplane transesophageal probe was used to examine the pulmonary artery in multiple views in three patients with suspected pulmonary emboli. The diagnosis of pulmonary emboli was made by transesophageal echocardiography in each of three patients when an echodense, circular or linear mass was seen in more than one view of the main or right pulmonary artery. In conclusion, our findings, coupled with previous case reports, suggest that transesophageal echocardiography should be considered in all critically ill patients with suspected pulmonary emboli. ( info) |
| In two patients with massive pulmonary embolism and cardiogenic shock requiring mechanical ventilation and prolonged external cardiac massage, occluded pulmonary arteries were recanalized by primary mechanical fragmentation of thrombi using a percutaneously inserted catheter followed by fibrinolytic therapy. The hemodynamic and respiratory parameters rapidly and greatly improved. Pulmonary angiography before discharge revealed normal results in both patients. No central neurological abnormalities were detected. It is concluded that patients with cardiogenic shock due to massive pulmonary embolism may benefit from immediate mechanical thrombus fragmentation followed by fibrinolysis when thrombolysis or surgical embolectomy are strictly contraindicated or not available. ( info) |
18/2236. Flitting radiographic shadows: an unusual presentation of cancer in the lungs. Tumour involvement of pulmonary blood vessels occurs frequently in advanced lung cancer and occasionally may cause pulmonary infarction. A case is reported of diffuse obstruction of pulmonary arteries by cancer in which no primary tumour was found, and which presented as flitting radiographic opacities due to pulmonary infarction. ( info) |
19/2236. Interventricular septal shift due to massive pulmonary embolism shown by CT pulmonary angiography: an old sign revisited. The computed tomographic (CT) pulmonary angiogram appearances of acute right ventricular dysfunction due to massive pulmonary embolus in a patient are described. Abnormal findings comprised right ventricular dilatation, interventricular septal shift, and compression of the left ventricle. These changes resolved following thrombolysis. Use of CT pulmonary angiography to diagnose pulmonary emboli is increasing. Secondary cardiac effects are established diagnostic features shown by echocardiography. These have not been previously described but are important to recognise as they may carry important prognostic and therapeutic implications. ( info) |
20/2236. Pulmonary vein obstruction by bronchogenic carcinoma. Two patients with obstruction of the pulmonary veins by bronchogenic carcinoma, an unusual cause, are presented. These and other cases reported have had features suggestive of mitral stenosis. The differential diagnosis is discussed. ( info) |