scholarly journals A rare case of deep vein and right atrial thrombosis in a patient with chronic heart failure and pulmonary embolism

2020 ◽  
Vol 90 (1) ◽  
Author(s):  
Akhmetzhan Sugraliyev ◽  
Shynar Aktayeva ◽  
Gulnur Tanbayeva ◽  
Almat Kodasbayev ◽  
Plinio Cirillo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Embolism ◽  
Chronic Heart Failure ◽  
Rare Case ◽  
Present Report ◽  
Correct Diagnosis ◽  
Right Atrial ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
Acute Pe

Deep vein thrombosis (DVT) is frequently observed in patients with chronic heart failure (CHF), increasing the risk of pulmonary embolism (PE). Clinical evaluation of CHF patients with suspected acute PE is challenging since these diseases share several symptoms and signs such as dyspnea. Thus, it is intuitive that correct and fast diagnosis of PE in these patients might be able to significantly change their clinical outcome. In the present report, we describe a rare case of a patient with CHF and PE due to a huge thrombosis of deep veins and of right atrium in whom echo evaluation permitted the correct diagnosis and therapy.

Venous Thrombo-Embolism in Childhood

1975 ◽  
Author(s):  
I. M. G. Macintyre ◽  
D. R. B. Jones ◽  
G. V. Ruckley
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Umbilical Vein ◽  
Correct Diagnosis ◽  
Renal Vein Thrombosis ◽  
Axillary Vein ◽  
Vein Thrombosis ◽  
Axillary Vein Thrombosis ◽  
Atrial Shunt ◽  
Deep Vein

Venous thrombo-embolism has been considered to be rare in infancy and childhood. Hospital in-patient statistics in Scotland over a 4-year period were examined. Forty-nine patients aged 15 years or less had been coded as venous thrombosis. After computer and clinical errors had been removed 36 cases remained. Renal vein thrombosis accounted for 12 of these, caval thrombosis following ventriculo-atrial shunt 4, cerebral thrombophlebitis 3, umbilical vein thrombosis 2, pulmonary thrombosis in infancy 2, axillary vein thrombosis 2 and jugular venous thrombosis 1. There were 10 cases of deep vein thrombosis of the lower limb and a clinical study of these is the subject of this paper. Two patients also had pulmonary embolism and two others developed chronic venous insufficiency. Children at high risk are those with sepsis or trauma. Venous thrombosis may simulate osteomyelitis and pulmonary embolism may be misdiagnosed as bronchopneumonia. Clinicians must be aware of the possibility of thrombo-embolism in childhood if correct diagnosis and treatment is to be instituted.

scholarly journals Pulmonary Tuberculosis With Saddle Pulmonary Embolism and Deep Vein Thrombosis: A Rare Case Report

Cureus ◽  
2021 ◽  
Author(s):  
Eihab A Subahi ◽  
Mouhammad J Alawad ◽  
Elabbass A Abdelmahmuod ◽  
Dalal Sibira ◽  
Ijaz Kamal
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Case Report ◽  
Pulmonary Tuberculosis ◽  
Rare Case ◽  
Vein Thrombosis ◽  
Rare Case Report ◽  
Deep Vein

scholarly journals A Rare Silent Killer: Right Atrial Metastasis of Thyroid Hürthle Cell Carcinoma

2015 ◽  
Vol 8 (2) ◽  
pp. 233-237 ◽  
Author(s):  
Hongxiu Luo ◽  
Sunil Tulpule ◽  
Mahmood Alam ◽  
Reema Patel ◽  
Shuvendu Sen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Cell Carcinoma ◽  
Right Atrial ◽  
Vein Thrombosis ◽  
Hürthle Cell ◽  
Hürthle Cell Carcinoma ◽  
Cardiac Metastases ◽  
Hurthle Cell Carcinoma ◽  
Deep Vein

Hürthle cell carcinoma (HCC) is a variant of a follicular carcinoma with a tendency to higher frequency of metastases and a lower survival rate. However, intracavitary cardiac metastases from thyroid HCC are extremely rare. We describe the case of a 57-year-old female with thyroid HCC, 5 years after total thyroidectomy, who presented with dyspnea associated with hypoxia and hypotension. The computed tomography angiogram showed extensive pulmonary embolism and a 6-cm right atrial mass while the lower-extremity deep vein thrombosis studies were negative. This patient received a cardiac thrombectomy using cardiopulmonary bypass support. However, intraoperatively, we found out that the mass was from the mediastinum, directly extending into the heart and clearly unresectable since it effaced at least 1/3 of the right atrial wall. The core biopsy of the mass confirmed that it was metastatic poorly differentiated HCC of thyroidal origin. The patient eventually died of respiratory failure due to a massive pulmonary embolism. For cancer patients with unexplained dyspnea, cardiac metastases should be considered regardless of anticoagulation prophylaxis, especially when there is no deep vein thrombosis in the lower limbs. Early recognition of intracavitary cardiac metastases may help in providing prompt treatment and improving the prognosis.

scholarly journals Negative Baseline Imaging Does not Exclude Acute Pulmonary Embolism in Patients with Recurrent Syncopal Episodes and Cardiac Biomarker Elevation

2020 ◽  
Author(s):  
Umut Kocabaş ◽  
Hakan Altay ◽  
Flora Özkalaycı ◽  
Seçkin Pehlivanoğlu
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Cardiac Biomarker ◽  
Mortality And Morbidity ◽  
Vein Thrombosis ◽  
Doppler Ultrasound Imaging ◽  
Uncommon Presentation ◽  
Echocardiographic Examination ◽  
Deep Vein ◽  
Acute Pe

Acute pulmonary embolism (PE) is an important vascular disease with high mortality and morbidity and syncope is an uncommon presentation sign of acute PE. This report presents two cases illustrating acute PE as a cause of recurrent syncopal episodes with elevated cardiac troponin and N-terminal pro-brain natriuretic peptide levels despite normal initial trans-thoracic echocardiographic examination and negative Doppler ultrasound imaging for detection of deep vein thrombosis.

A 6-Year Epidemiological Study of Pulmonary Embolism in an Emergency Department

2005 ◽  
Vol 12 (4) ◽  
pp. 206-214 ◽  
Author(s):  
CC Cheng ◽  
CH Chung
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Hong Kong ◽  
Clinical Features ◽  
Correct Diagnosis ◽  
Final Diagnosis ◽  
Vein Thrombosis ◽  
Chest X Ray ◽  
Deep Vein

Objective To identify the epidemiology and early clinical features of patients with pulmonary embolism with a view to facilitate making the correct diagnosis. Methodology A retrospective study of patients admitted through the emergency department with a discharge diagnosis of pulmonary embolism in the computerised Clinical Management System from 1st January 1999 to 31st December 2004 in a public emergency general hospital in Hong Kong. Results Twenty-two patients were newly diagnosed to have pulmonary embolism and included in the study. The patients' clinical features and investigation findings were analysed. Old age and immobilisation were the most common risk factors identified. Nine patients were found to have deep vein thrombosis but none of them complained of calf pain during consultation in the emergency department. Most patients had symptoms of shortness of breath and chest pain on presentation. Fourteen patients had type 1 respiratory failure. The electrocardiogram and chest X-ray findings were non-specific. All the patients with D-dimer done showed positive results. CT scans were used in all patients to make the final diagnosis. Nineteen patients received low molecular weight heparin followed by warfarin and three patients had thrombolytic therapy. Conclusion Pulmonary embolism is not a commonly diagnosed disease in Hong Kong. The symptoms are non-specific and it is difficult to make the correct diagnosis in the emergency department.

scholarly journals Fever is associated with higher morbidity and clot burden in patients with acute pulmonary embolism

2018 ◽  
Vol 5 (1) ◽  
pp. e000327 ◽  
Author(s):  
Muhammad Saad ◽  
Danial H Shaikh ◽  
Nikhitha Mantri ◽  
Ahmed Alemam ◽  
Aiyi Zhang ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Intensive Care Admission ◽  
Vein Thrombosis ◽  
Clot Burden ◽  
Deep Vein ◽  
Acute Pe

BackgroundFever is considered as a presenting symptom of pulmonary embolism (PE). We aim to evaluate the association between PE and fever, its clinical characteristics, outcomes and role in prognosis.MethodsA retrospective chart review of patients who were hospitalised with the diagnosis of acute PE was conducted. Patients in whom underlying fever could also be attributable to an underlying infection were also excluded.ResultsA total of 241 patients met the study criteria. 63 patients (25.7%) had fever within 1 week of diagnosis of PE of which four patients had fever that could be due to underlying infection and were excluded. Patients in PE with fever group were younger compared with PE without fever group (52.52 vs 58.68, p=0.012) and had higher incidence of smoking (44.1% vs 20.9%, p<0.001). Patients in PE with fever group were more likely to require intensive care admission (69.5% vs 35.7%, p<0.001), had a longer hospital length of stay (19.80 vs 12.20, p<0.001) and higher requirement of mechanical ventilation (30.5% vs 6.6%, p<0.001) compared with those without fever. PE with fever group were more likely to have massive and submassive PE (55.9% vs 36.8%, p=0.015) and had higher incidence of deep vein thrombosis (33.3% vs 17.4%, p=0.0347) compared with PE without fever. In a univariate model, there was higher likelihood of in-hospital mortality in PE with fever group compared with PE without fever (22.0% vs 10.4%, p=0.039).ConclusionPatients with acute PE and fever have higher morbidity and clot burden.

Safe Treatment of Pulmonary Embolism on An Outpatient Basis.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1979-1979
Author(s):  
Michael J. Kovacs ◽  
Jeffrey D.E. Hawel ◽  
Janelle F. Rekman ◽  
Alejandro Lazo-Langner
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Hospital Admission ◽  
Major Hemorrhage ◽  
Vein Thrombosis ◽  
The Mean ◽  
Risk For Bleeding ◽  
Deep Vein ◽  
Acute Pe

Abstract Background: Acute pulmonary embolism (PE) is a common medical problem in outpatient clinics and emergency rooms. Treatment with heparin and warfarin is well established and effective. In some centres (such as ours) eligible patients with PE are treated as outpatients, however many centres remain reluctant to do so. We review our experience with outpatient treatment of acute PE. Methods: We reviewed hospital charts for all inpatients and thrombosis clinic charts for all outpatients with a diagnosis of acute PE that was made prior to a decision on hospital admission from January 1, 2003 to January 30, 2008. All diagnoses were objectively proven by high probability V/Q scan or non-diagnostic V/Q scan with positive compression U/S or segmental or greater perfusion defect on CTPA. Patients were eligible to be treated as outpatients if they were hemodynamically stable, not high risk for bleeding, not requiring oxygen therapy, not requiring unfractionated heparin due to renal failure, and not having another indication for hospital admission. Most patients were treated with low molecular weight heparin (LMWH) for 5–7 days together with warfarin except for cancer patients who were treated with LMWH alone. All patients were instructed to call the thrombosis service or to go the emergency room if they developed symptoms of new PE or bleeding. Outpatients were seen in follow-up at 1, 4, and 12 weeks in the thrombosis clinic. Inpatient charts were reviewed for demographics and reason for hospital admission. For outpatients, in addition to demographics, charts were reviewed for the three month outcomes of major bleeding, recurrent venous thromboembolism and death. Results: There were a total of 633 patients with PE. 319 were admitted to the hospital whereas 314 (49.7%) were managed entirely as outpatients. The mean age for inpatients was 64 years. Inpatients were admitted for the following reasons: 125 (39%) for concomitant illness, 84 (26%) for hypoxia, 21 (7%) for hemodynamic instability, 14 (4%) for pain control, 1 (0.3%) for thrombolysis, 24 (7%) for other investigations, and 50 (16%) for other or unlcear reasons. For the 314 outpatients the mean age was 55 years and 184 (59%) were female. Eight (2.8%) patients were lost to follow-up. There were 195 (62%) idiopathic PE, 62 (20%) had PE secondary to cancer and 57(18%) to other transient risk factors. There were 247 (79%) patients who were managed with LMWH and warfarin, 51 (16%) managed with LMWH alone and 16 (5%) patients had experimental treatment. At 3 months of follow up there were 3 (1%) patients who developed major hemorrhage (GI bleed, hemoptysis, hemarthrosis), 3 (1%) patients who had objectively documented recurrent thrombosis (1 deep vein thrombosis, 2 PE), and 9 (2.9%) patients died, all of them from cancer progression. None of these events occurred within the first 7 days after diagnosis. Conclusions: To our knowledge this is the largest report of outpatient PE management. In our hospital 50% of ambulatory patients who have a diagnosis of PE are managed entirely as outpatients with a low risk for bleeding or thrombosis recurrence. For those admitted the majority was due to a concomitant illness that required admission itself. Many centres remain hesitant to treat patients with PE in this fashion but will treat patients with deep vein thrombosis as outpatients. Both conditions are at risk of recurrent PE and bleeding but it is not clear how a hospital admission would prevent that from happening. Our findings suggest that uncomplicated PE is not an indication for hospital admission per se. Outpatient management of PE deserves further consideration.

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