Pulmonary embolus

BACKGROUND: Thrombosis associated with thrombocytopenia was a matter of concern post first and second doses of BNT162b2 and ChAdOx1 COVID-19 vaccines. Therefore, it is important to investigate the risk of thrombocytopenic, thromboembolic and haemorrhagic events following a second dose of BNT162b2 and ChAdOx1 COVID-19 vaccines. METHODS: We conducted a large-scale self-controlled case series analysis, using routine primary care data linked to hospital data, among 12...

Background COVID-19-related pulmonary complications have been explored extensively in the recent past. There is also a significant amount of literature on the neurological manifestations of COVID-19. However, there exists an unmet need to assess the impact of COVID-19 on patients with cerebrovascular diseases and its role in affecting mortality in such patients. Methods In this cross-sectional study, we analyzed 401,318 hospitalized patients with cerebrovascular diseases using the discharge data from the National Inpatient Sample 2020 to assess the association of COVID-19 with multiple clinical conditions, along with additional factors, such as length of stay in the hospital, total charges incurred, region and type of hospital, and primary insurance/payer in the United States of America...

BACKGROUND: Outpatient total shoulder arthroplasty (TSA) presents a safe alternative to inpatient arthroplasty, while helping meet the rapidly rising volume of shoulder arthroplasty needs and minimizing healthcare costs. Identifying the correct patient for outpatient surgery is critical to maintaining the safety standards with TSA. This study sought to update an ambulatory surgery center (ASC) TSA patient-selection algorithm previously published by our institution. METHODS: A retrospective chart review of TSAs performed in an ASC at a single institution was performed to collect patient demographics, perioperative risk factors, and postoperative outcomes with regards to reoperations, hospital admissions, and complications...

AIM: Extracorporeal membrane oxygenation (ECMO) may be beneficial in treatment of massive pulmonary embolus (PE), however the current evidence to guide its use is limited. We aimed to compare the incidence, characteristics, treatments, and outcomes of patients with massive PE by mode of ECMO from a large international registry. METHODS: Retrospective observational study of the Extracorporeal Life Support Organization (ELSO) database. RESULTS: A total of 821 patients underwent 833 ECMO episodes for PE...

Upper extremity deep venous thrombosis (UEDVT) is rare but carries significant morbidity. Primary UEDVT presents non-specifically and there are no clear diagnostic or management guidelines, which are essential for early treatment to prevent potentially devastating complications such as pulmonary embolus or post-thrombotic pain syndrome. A patient with left brachiocephalic vein UEDVT initially diagnosed radiographically as an acute aortic syndrome and referred to a cardiothoracic unit is presented. Computed tomography venogram confirmed the diagnosis of UEDVT and therapeutic anticoagulation was started...

Bone cement embolism is a known complication after a kyphoplasty operation. Cement embolisms without immediate fatal complication such as cardiac perforation or hypoxemia were often stable during observation. We report a case of a large volume bone cement embolism involving the right ventricle and the pulmonary artery system. The patient developed mild exertional shortness of breath and chest pain after a percutaneous kyphoplasty (PKP) operation 10 years ago. However, her mild symptoms were attributed to multiple myeloma, and no chest imaging was taken until the symptoms exacerbated after a COVID-19 infection 6 months ago...

IMPORTANCE: Approximately 8% of acute pulmonary emboli are confined to the subsegmental arteries. The 2016 and 2021 American College of Chest Physicians (CHEST) guidelines and expert panel reports suggest the use of structured surveillance without anticoagulation for select ambulatory patients with subsegmental pulmonary embolism who do not have active cancer, deep vein thrombosis, impaired cardiopulmonary reserve, marked symptoms, or increased risk of recurrent venous thromboembolism; however, guideline uptake in community practice is unknown, as is the proportion of outpatients eligible for surveillance...

Non-thrombotic pulmonary embolism (NTPE) challenges the medical community with its diverse etiologies and potential life-threatening implications. The classification section delves into the multifaceted nature of NTPE, which includes various embolic agents that traverse the vascular system. From air and fat emboli to tumor and amniotic fluid emboli, this exploration of diverse etiologies sheds light on the complexity of NTPE. Diagnostic methods play a crucial role in the effective management of NTPE. This article describes a range of traditional and cutting-edge diagnostic techniques, from computed tomography angiography (CTA) to novel biomarkers, enabling the accurate and timely identification of NTPE...

BACKGROUND: There is currently a lack of evidence-based guidelines regarding ideal management of a neonate, specifically a preterm, with thrombo-embolus. There are no clear guidelines as to the time-frame of spontaneous resolution of a thrombo-embolus. CASE SUMMARY: A large pedunculated right atrial mass was identified on a clinician-performed cardiac ultrasound in a preterm neonate. The mass was smaller than half of the atrial size and was not causing obstruction...

Patent foramen ovale (PFO) is a common congenital abnormality of high prevalence in adults. Its clinical significance is magnified in a right-to-left shunt, where paradoxical embolism can have catastrophic outcomes involving the brain, heart, mesenteric circulation, or extremities. Right-to-left shunting through a PFO is caused by increased right atrial pressure, as seen in the setting of pulmonary artery hypertension or pulmonary embolism. This case highlights the relevance of central venous catheter placement in the setting of a PFO...

We report a case of a pregnant woman who presented to the emergency department complaining of dyspnea and syncope and was ultimately diagnosed with pulmonary vein thrombosis and a saddle pulmonary embolus on computed tomography pulmonary angiography. Proper identification is critical for prompt management to avoid significant life-threatening sequela.

BACKGROUND: With the increased legalization of cannabis, a new unknown emerges for orthopaedic surgeons and their patients. This systematic review aimed to (1) evaluate complications of cannabis use; (2) determine the effects of cannabis on pain and opioid consumption; and (3) evaluate healthcare utilizations associated with cannabis use among patients undergoing total joint arthroplasty (TJA). METHODS: A systematic review was performed. A search of the literature was performed in 5 databases...

Venous thromboembolic disease presenting with acute pulmonary embolus (PE) can be treated in a variety of ways from anticoagulation as an outpatient to surgical embolectomy with many new interventional therapies being developed. Mortality in these patients can be as high as 50% and many of these treatments are also considered to be high risk. Early involvement of a multidisciplinary team and patient risk stratification can aid management decisions in these complex patients who can suddenly deteriorate.In this review we summarise the evidence behind new and developing interventional therapies in the treatment of high and intermediate-high risk PE including catheter directed thrombolysis, pharmacomechanical thrombolysis, thromboaspiration and the growing role of extracorporeal membrane oxygenation in the stabilisation and management of this cohort of patients...

OBJECTIVE: Implement and evaluate a quality assurance workflow that leverages NLP to rapidly resolve inadvertent discordance between radiologist and AI DSS in the interpretation of high acuity CTs when the radiologist does not engage with AI DSS output. METHODS: All consecutive high acuity adult CTs performed in our health system between March 1, 2020 through September 20, 2022 were interpreted alongside AI DSS (Aidoc, Tel Aviv, Israel) for intracranial hemorrhage (ICH), cervical spine fracture, and pulmonary embolus (PE)...

BACKGROUND: High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are well-recognized treatments to address varus and valgus malalignment, respectively, in the setting of symptomatic unicompartmental arthritis of the tibiofemoral joint. The existing literature is limited in its ability to characterize complications after HTO or DFO procedures. PURPOSE: The objective of this study was to determine the rate of early (≤90 days) postoperative complications and associated variables from the 15-year experience of a single academic institution...

Intracardiac thrombi such as pulmonary emboli represent a high risk of mortality. In this case study, we review two cases of intracardiac thrombi occurring within 24 h of one another and managed differently by the same cardiothoracic surgical team, highlighting the importance of an individualized approach as well as an understanding of current guidelines and contemporary management techniques.

No abstract text is available yet for this article.

IMPORTANCE: The ability to provide invasive mechanical ventilation (IMV) is a mainstay of modern intensive care; however, whether rates of IMV vary among countries is unclear. OBJECTIVE: To estimate the per capita rates of IMV in adults across 3 high-income countries with large variation in per capita intensive care unit (ICU) bed availability. DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined 2018 data of patients aged 20 years or older who received IMV in England, Canada, and the US...

Epithelioid hemangioendothelioma (EHE) is a very rare vascular neoplasm that is often asymptomatic. A 40-year-old woman presented to the emergency department for evaluation of a nonproductive cough, chest pain, and dyspnea. A chest computed tomography angiography (CTA) demonstrated necrotizing pneumonia, a loculated left-sided pleural effusion, and an acute pulmonary embolus. She was started on broad-spectrum intravenous antibiotics and heparin infusions, and a chest tube was placed. After minimal improvement in her pleural effusion following instillation of fibrinolytics, she underwent video-assisted thoracoscopic surgery with decortication, and a pleural biopsy was performed...

Background: Closure of a GE Healthcare Shanghai facility in 2022 disrupted iodinated contrast media supply. Technologic advances have addressed limitations in use of pulmonary MR angiography (MRA) for pulmonary embolus (PE) diagnosis. Objective: To describe a single institution's experience in use of pulmonary MRA as an alternative to CTA for PE diagnosis in the general population during the 2022 iodinated contrast media shortage. Methods: This retrospective single-center study included all CTA and MRA examinations performed to exclude PE, from April 1 through July 31 (18 weekly periods) in 2019 (before the COVID-19 pandemic and contrast media shortage), 2021 (during the pandemic, but before the shortage) and 2022 (during both the pandemic and the shortage)...