Pulmonary embolism imaging

Sudden onset of shortness of breath and chest pain as well as a decreased oxygen level in the blood can be signs that a patient is experiencing a pulmonary embolic episode; however, a great many other conditions also can cause these signs and symptoms. If left undiagnosed and untreated, pulmonary embolism can be potentially fatal. This article describes types of medical imaging used to evaluate possible pulmonary embolism, including conventional chest radiographs, spiral computed tomography, magnetic resonance imaging and nuclear medicine lung ventilation and perfusion imaging.     

Pulmonary embolism after hip arthroscopy

A case of pulmonary embolus after elective hip arthroscopy is reported. The incidence of thromboembolic events after such procedures is currently unknown, and the decision regarding whether to provide prophylaxis rests on anecdotal evidence.     

Pulmonary air embolism: Case report

The authors encountered a patient with an indwelling central venous catheter who presented with pulmonary edema after the catheter hub was disconnected. Pulmonary arteriography demonstrated diffuse peripheral vasoconstriction, decreased arterial-to-venous transit time, and arterial occlusions. The former two findings allowed the authors to prospectively suggest the diagnosis of pulmonary air embolism.     

Pulmonary imaging in fat embolism syndrome

Ventilation/perfusion lung scanning can be used to effectively detect fat embolism following skeletal trauma. Typical ventilation/perfusion findings may be present when the chest radiograph is normal, and clinical findings are equivocal.     

Pulmonary embolism demonstrated by computerized tomography

We describe a case of pulmonary embolism diagnosed by computerized tomography. Scanning by CT in pulmonary embolism shows promise as an alternative to pulmonary angiography for definitive diagnosis. It is especially valuable for patients who are considered as high risk for pulmonary angiography and for serial follow-up of pulmonary embolism.     

Pulmonary embolism: prognostic CT findings

PURPOSE: To retrospectively determine whether three computed tomographic (CT) findings-ventricular septal bowing (VSB), ratio between the diameters of right ventricle (RV) and left ventricle (LV), and embolic burden-are associated with short-term death, defined as in-hospital death or death within 30 days of CT, whichever was longer, due to acute pulmonary embolism (PE). MATERIALS AND METHODS: Institutional Review Board approval was obtained, and patient information was reviewed in compliance with HIPAA regulations. A total of 1193 patients with CT scans positive for PE from January 1, 1997, to December 31, 2002, who had given authorization for retrospective research were included. Scans were independently reviewed by two observers. CT findings were compared with risk of death by using univariate analysis (chi(2) statistic) and multivariate logistic regression. Interobserver variability (kappa statistic or intraclass correlation coefficient), sensitivity, and specificity of CT findings for predicting death were calculated. A third observer reviewed discrepant cases post hoc. RESULTS: Fifty-four percent of patients were women and 46% were men (mean age, 63 years +/- 16). For observer 1, VSB was associated with death in univariate (odds ratio [OR], 1.98; P = .04) and multivariate modeling (OR, 1.97; P = .05). Interobserver variability was only fair (kappa = 0.54) for VSB, and observer 2 found no association with death (OR, 1.52; P = .22). For both observers, VSB had low sensitivity (21% and 18%) and high specificity (88% and 87%) for predicting death. Neither RV/LV diameter ratio nor embolic burden was associated with increased risk of death. For observer 3, VSB was associated with death in univariate (OR, 2.10; P = .05) and multivariate analyses (OR, 2.18; P = .05). CONCLUSION: CT-depicted VSB is predictive of death due to PE, but with low sensitivity and high interobserver variability. RV/LV diameter ratio and embolic burden are not associated with short-term death due to PE.     

肺栓塞23例

肺栓塞(Pulmonary embolism,PE)是指内源性或外源性栓子堵塞肺动脉引起肺循环障碍的临床和病理生理综合征.发病率、病死率及误诊率均较高,是国内外重要的医疗保健问题之一.在临床上易误诊和漏诊,临床医师对肺栓塞的警惕性不高,正确诊断率低,漏诊率高达80%以上.笔者回顾分析了近5年来我院收治的肺栓塞患者23例,对该病的临床特点、诊断和治疗进行探讨.     

Pulmonary needle embolism from intravenous drug abuse

Although the embolization of catheters and other foreign bodies in blood vessels is a well-known happening, needle embolization has rarely been reported. We describe here an instance in which a hypodermic needle broke in a man's skin during cocaine injection. The needle fragment was observed to migrate within a short time to the periphery of the left lung. The patient did not develop complications. The limited literature available indicates that such peripheral embolization usually follows a benign course.     

Pulmonary embolism as an indicator of occult malignancy

A case that demonstrates the relationship between malignancy and pulmonary throboembolic disease is presented. Pulmonary embolism, which was diagnosed on a ventilation-perfusion lung scan, initiated a search for the etiology of this condition. Normal examination of the deep venous system of the legs prompted further investigation, which ultimately led to the endoscopic diagnosis of poorly differentiated gastric carcinoma.     

Pulmonary embolism in pregnancy: a diagnostic dilemma

The diagnosis of PE in pregnancy poses a challenge due to pregnancy-related physiological changes. Missing the PE or wrongly treating a pregnant woman for PE has serious clinical consequences. There has been concern over the use of radiation-based imaging modalities due to risk of teratogenicity and oncogenicity. This review is focused on various diagnostic options and risks of radiation to the fetus and mother from radiation-based procedures.