Early bilateral pulmonary embolism following a moderate blunt chest trauma: A case report

Post-traumatic pulmonary embolism (PE) remains a major problem in cardio-pulmonary diseases and represent the third most common cause of death in trauma patients. Traditional PE occur most commonly between the fifth and the seventh day after a major trauma and are rare before the fourth day. Here, we report a case of acute pulmonary embolism developing 1 day after a moderate thoracic injury in a previously well young man. The diagnosis was made by non-invasive methods and the patient was given anticoagulation therapy with good outcome. The circumstances and the early occurrence of PE in this case is at odds with what is generally reported after trauma.     

Radiological features of pulmonary venous hypertension in pulmonary emphysema.

In pulmonary emphysema, the normal features of pulmonary venous hypertension are often disturbed due to destruction of pulmonary tissue. The abnormal features are described.     

Pulmonary fat embolism after pelvic and long bone fractures in a trauma patient

Fat embolism is a common complication of pelvic and long bone fractures. Macroscopic fat emboli in the pulmonary arteries on computed tomography have been reported postoperatively after fixation of long bone fractures for trauma, however the quantification of attenuation values of fat emboli have been infrequently reported in the literature. We present a case of pulmonary fat embolism in a 52-year-old female after acute bony trauma sustained during a motor vehicle accident. To the authors' knowledge however, pulmonary fat embolism has not been described on the initial trauma CT scan.     

Catheter-directed thrombolysis with the Endowave system in the treatment of acute massive pulmonary embolism: a retrospective multicenter case series

PURPOSE: To evaluate the efficacy of thrombolysis with the EndoWave peripheral infusion system in the treatment of patients with massive pulmonary embolism (PE) as compared to patients treated with catheter-directed thrombolysis. MATERIALS AND METHODS: Ten patients (five men and five women; age range, 31-85 years; mean age, 54.20 years) with massive acute PE (17 lesions) were treated with ultrasonography (US)-assisted catheter-directed thrombolysis with the Endowave system. All patients had hypoxia and dyspnea. No patient had contraindication for thrombolysis. Angiographic findings, duration of lysis, dose of thrombolytics used, and procedural complications were recorded. Thrombolytics used were urokinase, tissue-type plasminogen activator (tPA), and Reteplase. RESULTS: Complete thrombus removal was achieved in 13 of the 17 lesions (76%), near complete thrombolysis was achieved in three lesions (18%), and partial thrombolysis was achieved in one lesion (6%). The mean time of thrombolysis was 24.76 hours +/- 8.44 (median, 24 hours). The mean dose of tPA used for the Endowave group was 0.88 mg/h +/- 0.19 (13 lesions). CONCLUSIONS: US-assisted catheter-directed thrombolysis is an effective method for treating massive thrombolysis. It has the potential to shorten the time of lysis and lower the dose of thrombolytics.     

Radiological emergency management of multiple trauma patients

In recent years there has been major improvement in the management of patients with serious injuries. The initial imaging technique for multiple trauma patients is also undergoing change. In addition, other innovations including specialisation in training (casualty surgery), preclinical services (emergency medical care/ambulance system), optimisation of early clinical procedures (guidelines for action) and modification of clinical treatment strategies (conservative/operative/interventional) have altered the management of these patients. Conventional X-ray diagnosis, which has played a major role to date, is now increasingly giving way to modern cross-sectional imaging, in particular CT. This tendency has been seen in Germany particularly since the introduction of spiral CT. However, to minimise any risk to critically injured patients, standards must be defined with regard to physical structure, emergency room equipment and quality. The basic principles, the current situation and suggestions for improvement with regard to the emergency management of multiple trauma patients are put forward and discussed from the radiologic point of view.     

Lower leg mass in pulmonary embolism: a case of popliteal vein aneurysm

Emergency Radiology - Popliteal vein aneurysms (PVAs) are rare entities, with less than 300 hundred cases reported in the global literature. Despite their rarity, they have immense consequences,...     

Pulmonary fat embolism syndrome: CT findings in six patients

PURPOSE: Our purpose is to describe the CT findings in pulmonary fat embolism syndrome (FES). METHOD: Chest radiographs and CT scans of six patients with pulmonary FES were reviewed. Initial and follow-up CT findings were noted, and the extent of CT abnormalities was correlated with partial pressure of arterial oxygen (PaO2). RESULTS: Focal areas of consolidation or ground-glass opacity and nodules were seen in all patients, predominantly in the upper lobes of the lungs. Association between these opacities and pulmonary vessels was indicated in three patients. In the lower lobes of all patients, gravity-dependent opacities predominated. Diffuse ground-glass opacity was noted in five patients. Follow-up CT scans showed rapid improvement in three patients, but the gravity-dependent opacity progressed. The extent of CT abnormalities correlated positively with PaO2 (r = 0.8, p < 0.05). CONCLUSION: CT findings reflect the pathophysiology of this syndrome, which differs from that of simple capillary permeability pulmonary edema.     

Unusual finding in a water-logged corpse —hyperchylomicronemia or pulmonary fat embolism?

Summary During excavation work at the bank of the River Inn the corpse of a 32-year-old alcoholic male was recovered. Head injuries suggested a crime of violence. Postmortem examination demonstrated conspicuous milky turbidity of the blood, which was found by laboratory testing to be due to hyperchylomicronemia. The findings are interpreted and their relevance to the determination of postmortal head injuries is discussed. The inadequacy of double-edged knife specimens and frozen-section biopsies for the estimation of pulmonary fat embolism as a vital reaction is considered.     

Interstitial lung abnormalities and pulmonary fibrosis in COVID-19 patients: a short-term follow-up case series

Fibrotic lung changes are well-known complications of SARS, MERS, and ARDS from other causes and are anticipated in recovered COVID patients. However, there is limited data so far showing a temporal relationship between lung changes on imaging in the acute phase and follow-up imaging after recovery from the infection. We present 12 patients who demonstrate the development of interstitial lung changes and pulmonary fibrosis in the same distribution and pattern as the acute phase findings, up to 6 months after the acute infection, demonstrating a direct relationship between these changes and COVID-19 pneumonia.     

Radiological features of neonatal mucolipidosis II (I-cell disease): a case report

A case of mucolipidosis II (I-cell disease) in the early neonatal period is reported. The infant showed severe skeletal changes including diffuse periosteal new bone formation of long bones and ribs, marked osteopenia, resorption of scapula, clavicula, and mandible, and irregular demineralization of metaphyses of long tubular bones. Early skeletal manifestation of mucolipidosis II is not well known and differentiation from congenital syphilis or congenital hyperparathyroidism may be difficult. In such cases, a radiologist should assist in the diagnosis, and the list of differential diagnoses should include mucolipidosis II.     

Experimental pulmonary fat embolism induced by injection of triolein in rats

The relationship between the volume of fat flowing in the bloodstream and the degree of pulmonary fat embolism has remained unclear. In this study, in order to examine whether the volume of fat particles in the bloodstream could be estimated from the degree of pulmonary fat embolism, 0.05, 0.1, 0.15, 0.2 and 0.25 ml of triolein were injected into male rats weighing 300-320 g, through the caudal vein. Consequently, it was noted that the severity of pulmonary fat embolism tended to gradually increase in proportion to the volume of injected triolein, with the severity of pulmonary fat embolism being significantly augmented by the injection of 0.2 and 0.25 ml of triolein, based on morphometric analysis. In application to human cases, about 60 ml of fat particles was estimated to flow into the bloodstream after the occurrence of a pelvic fracture. Moreover, the results of this study led to the hypothesis that the prognosis of pulmonary fat embolism is affected by the severity of preceding conditions which have caused fat embolism.     

Detection of pulmonary fat embolism with dual-energy CT: an experimental study in rabbits

Objectives

To evaluate the use of dual-energy CT imaging of the lung perfused blood volume (PBV) for the detection of pulmonary fat embolism (PFE).

Methods

Dual-energy CT was performed in 24 rabbits before and 1 hour, 1 day, 4 days and 7 days after artificial induction of PFE via the right ear vein. CT pulmonary angiography (CTPA) and lung PBV images were evaluated by two radiologists, who recorded the presence, number, and location of PFE on a per-lobe basis. Sensitivity, specificity, and accuracy of CTPA and lung PBV for detecting PFE were calculated using histopathological evaluation as the reference standard.

Results

A total of 144 lung lobes in 24 rabbits were evaluated and 70 fat emboli were detected on histopathological analysis. The overall sensitivity, specificity and accuracy were 25.4 %, 98.6 %, and 62.5 % for CTPA, and 82.6 %, 76.0 %, and 79.2 % for lung PBV. Higher sensitivity (p?<?0.001) and accuracy (p?<?0.01), but lower specificity (p?<?0.001), were found for lung PBV compared with CTPA. Dual-energy CT can detect PFE earlier than CTPA (all p?<?0.01).

Conclusion

Dual-energy CT provided higher sensitivity and accuracy in the detection of PFE as well as earlier detection compared with conventional CTPA in this animal model study.

Key points

? Fat embolism occurs commonly in patients with traumatic bone injury.? Dual-energy CT improves diagnostic performance for pulmonary fat embolism detection.? Dual-energy CT can detect pulmonary fat embolism earlier than CTPA.