ObjectiveTo investigate therapeutic strategy of acute pulmonary embolism. MethodsClinical data of 48 patients with acute pulmonary embolism who were treated in Affiliated Hospital of North Sichuan Medical College form January 2009 to May 2014 were analyzed retrospectively. ResultsOf the 48 cases, 14 cases of low risk (low risk group) were treated with anticoagulation, 24 cases of middle risk (middle risk group) were treated with anticoagulation and systematic thrombolysis or interventional therapy (local thrombolysis after thrombus fragmentation or thrombolytic catheter placement in pulmonary artery), 10 cases of high risk (high risk group) were treated with anticoagulation and interventional therapy. In low risk group, 12 cases (85.7%) were cured and 2 cases (14.3%) were markedly effective, and total effective rate was 100%. In middle risk group, 16 cases (66.7%) were cured and 8 cases (33.3%) were markedly effective, and total effective rate was 100%. In high risk group, 1 case died, 3 cases were cured, 2 cases were markedly effective, and 4 cases were better, and the total effective ratio was 9/10. All cases suffered from no complication such as hemorrhage of cerebral and digestive system. Forty-eight cases were followed up for 3-12 months, with a median time of 8 months. During the follow-up period, there was no complication occurred such as dyspnea, pulmonary embolism, placement change of filter net, and thrombosis. ConclusionsCorresponding therapeutic strategy would be taken according to risk stratification of the acute pulmonary embolism.
Objective To explore the clinical manifestations, computed tomography features, management and prognosis of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism. Methods The clinical data of patients with Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism admitted to Dongnan Hospital of Xiamen University from January 2012 to January 2017 were retrospectively analyzed. Results There were 8 patients who had Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism. Fever occurred in all patients, respiratory symptoms were noted in 5 patients, abdominal pain occurred in 2 patients, endophthalmitis coexisted in 1 patient, and diabetes mellitus coexisted in 7 patients, with no chest pain or hemoptysis. In biochemical indexes, procalcitonin increased most obviously. Microbiological studies revealed Klebsiella pneumoniae in 8 patients. Chest CT showed peripheral nodules with or without cavities, peripheral wedge-shaped opacities, a feeding vessel sign, pleural effusion, and infiltrative shadow. One patient finally deteriorated to acute respiratory failure, and died due to acute respiratory distress syndrome and/or septic shock. There was one case of spontaneous discharge. A total of 6 patients were improved and cured. Conclusions The clinical manifestation of Klebsiella pneumoniae liver abscess complicated with septic pulmonary embolism is unspecific and misdiagnosis rate is relatively high. The major characteristics of chest CT scan include peripheral nodules with or without cavities, peripheral wedge-shaped opacities and a feeding vessel sign. Diagnosis and differential diagnosis can be made based on these features combined with clinical data and primary disease (liver abscess).
Aortic intramural hematoma and pulmonary embolism are two rapidly progressive and life-threatening diseases. A 65-year-old male patient with descending aortic intramural hematoma and pulmonary embolism underwent pulmonary embolectomy and descending aortic stent-graft placement, with good postoperative results.
ObjectiveTo explore the diagnostic value of the bedside echocardiogram for different risk stratification of patients with suspected pulmonary embolism. MethodsPatients with suspected pulmonary embolism in the emergency department of the Second Afflicted Hospital Xi'an Jiaotong University between July 2013 to December 2015 were included. According the Wells scores, they were divided into a low risk group (0-2 points), a intermediate risk group (3-6 points) and a high risk group (>6 points). All patients were underwent the bedside echocardiogram diagnosis, and the diagnostic value of the echocardiography for pulmonary embolism, the characteristics of different risk stratification of patients were analyzed by SPSS 18.0 software. Results115 patients with suspected pulmonary embolism were included, of which 20 were in the low risk group, 73 were in the medium risk group, and 22 were in the high risk group. The incidence of pulmonary embolism among the three groups was significantly different (high-risk vs. medium risk vs. low-risk: 90.9% vs. 76.7% vs. 15.0%, P<0.05), and the higher Wells scores gets, the greater possibility of having the pulmonary embolism. For the intermediate-risk group, the incidence of pulmonary embolism was significantly higher in patients with positive ultrasonic results than those with the negative ultrasonic results (87.3% vs. 44.4%, P<0.05). The predication of the ultrasonic positive and the negative in the low and high risk groups had no statistical differences (P>0.05). The result of echocardiogram showed that the right ventricular end-diastolic diameter, right ventricular end-diastolic transverse diameter, right atrial end-diastolic transverse diameter, RV/LV, RA/LA in the high risk group and the intermediate risk group were significantly higher than those in the low risk group (all P values <0.05). The right ventricular anterior wall activity in the low risk group was higher than that in the high risk group (P<0.05), but this difference was not found between the high risk group and the intermediate risk group. ConclusionBedside echocardiogram can be used as the diagnosis and differential diagnosis methods of suspected pulmonary embolism, and it has relatively higher diagnostic value for intermediate to high risk patients predicted by the Wells scores than low risk ones.
Objective To analyze the clinical features of rickettsial infection complicated with pulmonary embolism and to improve clinicians’ knowledge of rickettsial infection complicated by thromboembolism events. Methods We retrospectively analyzed the clinical data of a patient with pulmonary thromboembolism complicated by Rickettsial felis infection and conducted a review of the relevant literature. The search terms "Rickettsia/Scrub typhus, thrombosis" or "Rickettsia/ Scrub typhus, embolism" were used to search the Wanfang ,VIP ,Chinese National Knowledge Infrastructure and PubMed databases from January 1985 to May 2023, respectively. Results The 81-year-old male patient was admitted to the hospital on June 1, 2021 due to "dizziness, sore throat for 11 days, fever for 7 days, and shortness of breath for 3 days". Physical examination revealed a eschar-like rash behind the left ear, venous thrombosis in both lower limbs was detected by color ultrasound, computed tomographic pulmonary angiography indicated multiple pulmonary embolism in both lungs, and positive rickettsiae on peripheral blood next-generation sequencing, confirming the diagnosis of Rickettsial felis infection complicated by venous thromboembolism (VTE) in both lower limbs and pulmonary embolism. Twenty manuscripts, including 20 cases, were retrieved from databases. Among them, Rickettsial felis infection combined with thromboembolism event was not found. With the addition of our case, a total of 21 cases were analyzed in detail. Six of the 21 cases were complicated with VTE, 10 with pulmonary embolism, 5 with intracranial venous thrombosis, 6 with thrombosis at other sites (jugular venous thrombosis, mesenteric thrombosis, aortic thrombosis, etc), and 8 of which had concurrently involved systemic thrombosis. Of the 4 deaths, 2 cases had mesenteric embolism, 1 case had cerebral infarction, and 1 case had systemic multiple thrombus. Conclusions Rickettsial infection symptoms and signs are often atypical, can be complicated with lower limb VTE or pulmonary embolism. Early identification, diagnosis and treatment are very important, especially for patients with dyspnea, chest pain and other related symptoms.
ObjectiveTo investigate the difference in fibrinogen and D-dimer (D-D) level among pulmonary embolism patients with different risk stratification. MethodsSixty pulmonary embolism patients admitted during January 2013 and January 2014 in our hospital were retrospectively analyzed.The general clinical data were gathered, and the patients were divided into a high-risk group (n=19), a moderate-risk group (n=21), and a low-risk group (n=20) according to the 2008 ESC Guidelines on the diagnosis and management of acute pulmonary embolism.Fourteen patients admitted simultaneously with dyspnea and chest pain without pulmonary embolism were randomly recruited as a control group.The plasma levels of fibrinogen and D-D were detected and compared between these groups. ResultsIn the pulmonary embolism patients, there were no significant statistical differences in general data between the patients with different risk degree.With the risk degree increased, the level of fibrinogen decreased and the level of D-D increased (P < 0.05).Compared with the pulmonary embolism patients, the level of fibrinogen was higher and the level of D-D was lower in the control group(P < 0.05).The level of fibrinogen was negatively correlated with the level of D-D with a correlation coefficient of-0.805. ConclusionsElevated fibrinogen is one of high risk factors of the pulmonary embolism. With the occurrence of pulmonary embolism, the level of fibrinogen becomes lower, suggesting the potential of fibrinogen as a indicator for pulmonary embolism diagnosis and risk stratification.
ObjectiveTo explore the early predictive value of Wells score and D-dimer for acute pulmonary embolism. MethodsEighty-two cases with acute pulmonary embolism comfirmed by computed tomography pulmonary angiography and (or) lung ventilation/perfusion scan were retrospectively studied from October 2013 to October 2014 in our hospital. Another 82 cases without acute pulmonary embolism in the chest pain center simultaneously were selected as control group. The data on admission were analyzed including Wells score, D-dimer, pH, PCO2, PO2, P(A-a)O2, brain natriuretic peptide, troponin I of two groups of patients. Relevant variables were selected by multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was made by sensitivity as the ordinate and 1 minus specificity as abscissa. The area under ROC curve (AUC) for relevant variables was calculated and the variable with higher AUC was selected. The best threshold, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were achieved from the ROC curves. ResultsThe multivariate logistic regression analysis showed that Wells score (OR=8.114, 95%CI 1.894-34.761, P=0.005) and D-dimer (OR=1.009, 95%CI 1.001-1.017, P=0.021) could predict APE early. The AUC, sensitivity, specificity, PPV, NPV of Wells score for the early prediction of patients with acute pulmonary embolism were 0.990, 50.0%, 100.0%, 100.0%, 66.7%, respectively. The AUC, sensitivity, specificity, PPV, NPV of D-dimer for the early prediction of patients with acute pulmonary embolism were 0.986, 95.1%, 97.6%, 97.5%, 95.2%, respectively. ConclusionWells score and D-dimer have high predictive value in patients with acute pulmonary embolism, and can be used in preliminary screening of acute pulmonary embolism in the emergency department.
ObjectiveTo discuss the implantation and conversion technology of convertible inferior vena cava filter and the experience of management.MethodsThe clinical data of 115 patients with convertible inferior vena cava filter implantation admitted to our vascular surgery center from January 2018 to December 2018 was retrospectively analyzed.ResultsAmong the 115 patients with convertible inferior vena cava filter implantation, 74 were males and 41 were females. The ages ranged from 22 to 87 years, with median age 54 years. The successful rate of filter implantation was 100% without any surgical related complications. After implantation surgery, patients were followed up from 4 to 455 days with a median of 90 days and the recurrence rate of adverse events was 7.8% (9/115). The recurrence time were 16 to 104 days after conversion, with a median of 42 days. Twenty-three patients (20.0%) received filter conversion, one of them failed and all the others succeeded. The technical successful rate was 95.7% (22/23). The conversion operative time was 22.8 to 51.4 min, with median time 27.4 min. The intervals between implantation and conversion were from 4 to 455 days, with median time 159 days. Accessory techniques were used in 20 of 22 successful filter conversions and the application rate of accessory technique was 90.9%. The patients were followed-up from 30 to 180 days after conversion with a median time of 90 days and no adverse event was reported.ConclusionConvertible inferior vena cava filter is a significant choice for patients application of inferior vena cava filter due to its high safety of conversion surgery, technical success rate and possibility of conversion after long-term indwelling.
Objective To investigate the clinical characteristics and diagnosis and treatment of fungal pulmonary embolism, and to improve the understanding of this disease. Methods The diagnosis and treatment of two patients with fungal main pulmonary embolism in the First Affiliated Hospital of Guangzhou Medical University were summarized and analyzed. Literatures were retrieved from Wanfang database, China national knowledge internet database and Pubmed database with search terms of “pulmonary embolism AND mucor”, “pulmonary embolism AND aspergillus”, “pulmonary embolism AND fungi”, “pulmonary embolism AND Candida”, “pulmonary embolism AND cryptococcus”. Results Case 1, a 53-year-old female was referred, with cough, high fever, breathlessness for 2 years, chest pain for 1 year. The patient had rheumatoid arthritis and systemic lupus erythematosus history with long term prednisone treatment. Finally, the patient was diagnosed main pulmonary artery embolism (aspergillus) and disseminated aspergillosis. Although treatment with voriconazole, amphotericin B, and caspofungin were given for more than 1 year, the patient died with uncontrolled aspergillus infection. Case 2, a 67-year-old female was referred with cough, chest distress, chest pain for 8 months, breathlessness for 6 months. The patient had a history of chronic viral hepatitis C. Finally the patient was diagnosed as main pulmonary artery embolism and pulmonary valve endocarditis (aspergillus, mucor). The patient underwent pulmonary artery lesion resection and tricuspid valvuloplasty (DeVega method). After surgery, the patient was delivered with amphotericin B and posaconazole for 3 months. During the follow-up period of 1 year, the patient recovered almost totally without relapse signs. A total of 42 cases of fungal pulmonary embolism from 1980 to 2021 were retrieved (including 2 cases in this article), and 6 of these cases were main pulmonary artery embolism. Of all the cases, the median age was 49 years and 22 (54.3%) were males. 20 cases were immunocompromised. The infection pathogens included: Aspergillus (21, 50%), Candida (11, 26.2%), Mucor (7, 16.7%), and Aspergillus combined with Mucor (1, 2.5%), Coccidioides spp (1, 2.5%), and Cryptococcus (1, 2.5%). Fifteen cases were complicated with infection other than cardiopulmonary. Twenty-two cases were treated with surgery combined with antifungal medicine, and 9 cases with antifungal medicine alone. Twenty-two cases were dead and the overall mortality rate was 52.4%. There were statistically significant differences in the effects of fungal species, dissemination of other organs other than the heart and lung, and surgical treatment on the survival rate. The survival rate of different fungal species was significantly different. Dissemination to organs other than the heart and lungs reduces survival, whereas surgical treatment improves survival. Conclusions Fungal pulmonary embolism, a disease with high mortality, rarely involves the main pulmonary artery. The possibility of fungal pulmonary embolism should be considered when the cause of pulmonary thrombosis is unknown and the anticoagulant effect is poor. Although there is no unified treatment at present, early surgical combined with standard antifungal treatment may improve the prognosis of patients.
Objective To explorer the application value of the inferior vena cava filter (IVCF) implantation in the prevention of recurrent pulmonary embolism (PE). Methods Clinical data of 265 inpatients with PE admitted from November 2014 to November 2016 were retrospectively analyzed. The patients were divided into an IVCF treatment group (55 cases) and an anticoagulant therapy group (210 cases) according to treatment measure. All patients were followed up for 3 months to 2 years through regular review. The one-year PE and deep vein thrombosis (DVT) recurrence rates, one-year mortality and two-year mortality were compared between two groups. Results The PE and DVT recurrence rates were 9.1% and 21.8% in the IVCF treatment group, and were 18.6% and 11.0% in the anticoagulant therapy group, respectively. The PE recurrence rate was lower and the DVT recurrence rate was higher in the IVCF treatment group compared with the anticoagulant therapy group, the differences were statistically significant (P<0.05). The one-year mortality (29.1% vs. 12.9%) and two-year mortality (34.5% vs. 14.8%) were significantly higher in the IVCF treatment group than those in the anticoagulant therapy group (P<0.05). Conclusions IVCF without anticoagulation can reduce incidence of pulmonary embolism caused by the lower extremity DVT, but will increase DVT recurrence rate. It may be an alternative option for prevention of PE in patients with contraindications to anticoagulant therapy or recurrent PE patients after regular anticoagulant therapy.