scholarly journals An Unusual Presentation of a Massive Pulmonary Embolism with Misleading Investigation Results Treated with Tenecteplase

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
David Migneault ◽  
Zachary Levine ◽  
François de Champlain
Keyword(s):  
Pulmonary Embolism ◽  
Case Reports ◽  
Massive Pulmonary Embolism ◽  
Unusual Presentation ◽  
Test Results ◽  
Diagnostic Challenge ◽  
Bedside Echocardiography ◽  
The Face ◽  
Contrast Angiography ◽  
Atypical Presentations

Background. There is no foolproof strategy to identify a pulmonary embolism (PE) in the emergency department, and atypical presentations are common. Negative test results may mislead physicians away from the diagnosis of PE.Objectives. The current report aims to raise awareness of an unusual presentation of massive PE and its diagnosis and management, in the face of limited evidence in the scientific literature.Case Reports. We report the case of a patient with a negative D-Dimer and a negative Computed Tomography contrast angiography of the chest who was diagnosed twenty-seven hours later with a massive PE, as suggested by a bedside echocardiography. The patient was successfully treated with tenecteplase (TNK).Conclusions/Summary. Pulmonary embolism frequently presents atypically and is often a diagnostic challenge. There is limited literature about the treatment of massive PE. Further research on bedside echocardiography for diagnosing PE in unstable patients is warranted. In addition, further study into new thrombolytic agents like tenecteplase in the context of massive and submassive PE is warranted.

scholarly journals Double Bolus Alteplase Therapy during Cardiopulmonary Resuscitation for Cardiac Arrest due to Massive Pulmonary Embolism Guided by Focused Bedside Echocardiography

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hafiz B. Mahboob ◽  
Bruce W. Denney
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Case Reports ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Excellent Outcome ◽  
Hemodynamic Compromise ◽  
Bedside Echocardiography ◽  
Resuscitation Guidelines

Massive pulmonary embolism (PE) frequently leads to cardiac arrest (CA) which carries an extremely high mortality rate. Although available, randomized trials have not shown survival benefits from thrombolytic use. Thrombolytics however have been used successfully during resuscitation in clinical practice in multiple case reports and in retrospective studies. Recent resuscitation guidelines recommend using alteplase for PE related CA; however they do not offer a standardized treatment regimen. The most consistently applied approach is an intravenous bolus of 50 mg tissue plasminogen activator (t-PA) early during cardiopulmonary resuscitation (CPR). There is no consensus on the subsequent dosing. We present a case in which two 50 mg boluses of t-PA were administered 20 minutes apart during CPR due to persistent hemodynamic compromise guided by bedside echocardiogram. The patient had an excellent outcome with normalization of cardiac function and no neurologic sequela. This case demonstrates the benefit of utilizing bedside echocardiography to guide administration of a second bolus of alteplase when there is persistent hemodynamic compromise despite achieving return of spontaneous circulation after the initial bolus, and there is evidence of persistent right ventricle dysfunction. Future trials are warranted to help establish guidelines for thrombolytic use in cardiac arrest to maximize safety and efficacy.

Herpes myelitis after thoracic spine surgery

2013 ◽  
Vol 18 (5) ◽  
pp. 519-523 ◽  
Author(s):  
Mark Daniel Anderson ◽  
Sudhakar Tummala
Keyword(s):  
Herpes Zoster ◽  
Herpes Simplex ◽  
Spine Surgery ◽  
Case Reports ◽  
Delayed Treatment ◽  
Vesicular Rash ◽  
Poor Neurological Outcome ◽  
The Face ◽  
Pubmed Search ◽  
Atypical Presentations

Herpes simplex or herpes zoster reactivation after spinal surgery is rarely reported. This case report and review of the literature describes patients in whom this reactivation occurs to clarify the diagnosis and management. In addition to reporting their case, the authors reviewed case reports and series published between 1980 and 2012 found through a PubMed search. Herpes reactivation is generally confined to a vesicular rash that can be treated with acyclovir. However, occasional dissemination has occurred and has led to myelitis or encephalitis. Atypical presentations led to delays in diagnosis, delayed treatment, and poor neurological outcome. While rare, herpes simplex or herpes zoster reactivation is a complication of spine surgery that must be considered in the face of new-onset focal neurological symptoms in a dermatome pattern without a structural cause, even without a rash.

Plantar Molluscum Contagiosum in an Adult Patient

2016 ◽  
Vol 106 (3) ◽  
pp. 235-236 ◽  
Author(s):  
Anıl Gülsel Bahalı ◽  
Ozlem Su ◽  
Dilek Bıyık Ozkaya ◽  
Kadriye Sallahoglu ◽  
Pelin Yıldız ◽  
...  
Keyword(s):  
Viral Infection ◽  
Adult Patient ◽  
Skin Surface ◽  
Molluscum Contagiosum ◽  
Unusual Presentation ◽  
Genital Region ◽  
The Face ◽  
Atypical Presentations ◽  
Plantar Area ◽  
Immunocompetent Patients

Molluscum contagiosum is a viral infection of the skin. It may occur anywhere on the skin surface but is most common in skinfolds, on the face, and in the genital region. Atypical presentations are usually seen in conditions with altered immunity, but they may occur in immunocompetent patients as well. We present a case of an unusual presentation of molluscum contagiosum lesions (multiple normal and one giant) on the plantar area of the foot in an adult.

scholarly journals Pulmonary Embolism and Cardiac Tamponade in Critical Care Patients with COVID-19; Telemedicine’s Role in Developing Countries: Case Reports and Literature Review

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Islam Mohammed Sheata ◽  
Scott Richard Smith ◽  
Heba Kamel ◽  
Giustino Varrassi ◽  
Farnad Imani ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Developing Countries ◽  
Intensive Care ◽  
Cardiac Tamponade ◽  
Case Reports ◽  
Chronic Hypertension ◽  
Case Presentation ◽  
Bedside Echocardiography ◽  
Telemedicine Technology ◽  
Echocardiographic Findings

Introduction: In this study, two cases that demonstrate the importance of bedside echocardiography and hands-off telemedicine technology for diagnosis and intervention in patients with coronavirus disease 2019 (COVID-19) are discussed. Case Presentation: We report two cases of cardiac emergency associated with COVID-19. Case 1 is a 50-year-old female patient with chronic hypertension and chronic renal failure. Case 2 is a 64-year-old female with atrial fibrillation and recent stroke. Both were admitted to an isolation intensive care unit that was designated specifically to patients with COVID-19. Conclusions: During admission, both patients had sudden deterioration characterized by oxygen desaturation and hypotension necessitating inotropic support. As a result, for both patients, bedside echocardiography was performed by the attending intensivist. Echocardiographic findings showed cardiac tamponade and acute pulmonary embolism, respectively, which were confirmed by a cardiologist through telemedicine technology. Proper emergency management was initiated, and both patients recovered well. Limited bedside transthoracic echocardiography had a front-line impact on the treatment and outcome of the two patients with COVID-19. By implementing telemedicine technology, the lives of two patients were saved, demonstrating the significance of telemedicine in isolation intensive care units in the developing countries during the COVID-19 pandemic.

scholarly journals Percutaneous Thrombectomy for the Treatment of Acute Massive Pulmonary Embolism: Two Case Reports

2020 ◽  
Author(s):  
Kinley Sangay Dorji ◽  
Sorracha Rookkapan ◽  
Wiwatana Tanomkiat ◽  
Keerati Hongsakul
Keyword(s):  
Pulmonary Embolism ◽  
Case Reports ◽  
Hemodynamic Instability ◽  
Massive Pulmonary Embolism ◽  
High Efficacy ◽  
Endovascular Technique ◽  
Systemic Thrombolysis ◽  
The Third ◽  
Surgical Thrombectomy ◽  
Percutaneous Thrombectomy

Pulmonary embolism (PE) is the third commonest cause of death in hospitalized patients after myocardial infarction and stroke. Surgical thrombectomy is a standard option in cases of a clinical massive PE with hemodynamic instability and in patients in whom systemic thrombolysis is contra-indicated. Percutaneous thrombectomy is a new minimally invasive alternative treatment for clinical massive PE, and it has a high efficacy, with fewer complications. We report two patients with acute massive PE that were treated successfully using the endovascular technique with suction thrombectomy.

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