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Recurrent Pulmonary Embolism


Presentation

  • The present report describes a patient with deep venous thrombosis who had recurrent pulmonary embolism despite thrombolysis and anticoagulation.[ncbi.nlm.nih.gov]
  • CLINICAL PRESENTATION: A 30-year-old male, who was diagnosed as having nephrotic syndrome at 12, presented with general edema, ascites and hypoalbuminemia.[ncbi.nlm.nih.gov]
  • We describe an unusual presentation of mucoepidermoid carcinoma in a 19-year-old man with atypical pneumonia, deep vein thromboses and recurrent pulmonary embolism, which, to the best of our knowledge has not previously been reported.[ncbi.nlm.nih.gov]
  • Abstract Three patients with malignant mesothelioma of the pleura presented with unilateral pleural effusion and recurrent horizontal linear opacities on the chest radiograph.[ncbi.nlm.nih.gov]
  • Abstract Primary cardiac angiosarcoma is a rare tumor that may present with features mimicking venous thromboembolic disease, making the diagnosis particularly challenging.[ncbi.nlm.nih.gov]
Fever
  • The COPD patient presented fever and dyspnea, which are common symptoms in acute exacerbation and could be improved by appropriate therapy.[omicsonline.org]
  • Small to medium pulmonary embolism may present with the following signs: Tachypnoea, tachycardia, fever (if infarction has occurred). Crackles over involved area. Localised plural rub (with infarction).[myvmc.com]
  • Med. 55:307, 2010-JW): Dyspnea* Tachypnea* Tachycardia Pleuritic chest pain* Chest pain that is not substernal in location* Arterial oxygen saturation 92% on room air Low-grade fever (occasionally) Hemoptysis Pleural rub Clinical evidence of DVT III.[faculty.washington.edu]
  • A mildly raised temperature (fever). A fast heart rate (tachycardia). A massive PE or lots of clots (multiple emboli) may cause: Severe breathlessness.[patient.info]
Dyspnea
  • Abstract A 45-year-old woman with a history of recurrent pulmonary embolism was admitted to the emergency clinic with dyspnea, wheezing and tachypnea. Partial deep vein thrombosis of the popliteal vein was seen on Doppler sonography.[ncbi.nlm.nih.gov]
  • Dyspnea was the common symptom and signs of pulmonary hypertension were usual.[ncbi.nlm.nih.gov]
  • The COPD patient presented fever and dyspnea, which are common symptoms in acute exacerbation and could be improved by appropriate therapy.[omicsonline.org]
  • She was referred to the emergency ward 3 months later in May 2015 for acute dyspnea and chest discomfort lasting for 24 hours. At initial clinical examination, systolic blood pressure was 110 mmHg, and heart rate was 95 bpm.[escardio.org]
  • Recurrent symptoms of chest pain or dyspnea in patients on active anticoagulation cause understandable patient anxiety and result in ED visits to “rule out PE.”[epmonthly.com]
Hemoptysis
  • 2 (C) Wells CPR Clinical signs of DVT 3 Low Recent surgery or immobilization 1.5 Intermediate 2–6 High 6 Unlikely 0–4 Likely 4 Heart rate 100 bpm 1.5 Previous history of PE or DVT 1.5 Hemoptysis 1 Malignancy 1 Alternative diagnosis less likely than PE[onlinelibrary.wiley.com]
  • However, there are many key symptoms and signs of acute pulmonary embolism: Symptoms: Dyspnea, particularly abrupt in onset or abruptly worsening Pleuritic chest pain Cough Symptoms of deep venous thrombosis: calf/thigh pain and/or leg swelling Hemoptysis[clinicaladvisor.com]
  • A 43-year-old woman with a history of pulmonary embolism (PE) and antiphospholipid antibody syndrome taking rivaroxaban presented to the ED with shortness of breath, hemoptysis, and pleuritic chest pain. Chest CT demonstrated multiple PEs.[epmonthly.com]
  • Med. 55:307, 2010-JW): Dyspnea* Tachypnea* Tachycardia Pleuritic chest pain* Chest pain that is not substernal in location* Arterial oxygen saturation 92% on room air Low-grade fever (occasionally) Hemoptysis Pleural rub Clinical evidence of DVT III.[faculty.washington.edu]
Exertional Dyspnea
  • Case Report In January 2015, a 76-year-old ex-smoker was referred to our hospital with a 2-months history of increase in cough, purulent expectoration, exertional dyspnea and pyrexia.[omicsonline.org]
Painful Cough
  • However, there are many key symptoms and signs of acute pulmonary embolism: Symptoms: Dyspnea, particularly abrupt in onset or abruptly worsening Pleuritic chest pain Cough Symptoms of deep venous thrombosis: calf/thigh pain and/or leg swelling Hemoptysis[clinicaladvisor.com]
Chest Pain
  • We describe a 30-year-old woman with a history of recurrent pulmonary embolism who was admitted for investigation of pleuritic chest pain in whom transesophageal echocardiography played a critical role in the diagnosis and management.[ncbi.nlm.nih.gov]
  • Although an initial diagnosis of pulmonary embolism was made in all three patients and two received anticoagulants, it is more likely that the opacities represented plate atelectases due to restriction of basal lung expansion by severe chest pain.[ncbi.nlm.nih.gov]
  • Case Report A 57-year-old male presented with 3-day history of chest pain and shortness of breath. He had a history of recurrent PEs 1 year and 4 months before the current event, for which he had been receiving anticoagulation therapy.[arabjir.com]
  • Recurrent symptoms of chest pain or dyspnea in patients on active anticoagulation cause understandable patient anxiety and result in ED visits to “rule out PE.”[epmonthly.com]
  • Chest pain - with a large PE the pain may be felt in the centre of the chest behind the breastbone. Feeling faint, feeling unwell, or a collapse.[patient.info]
Cyanosis
  • Being short of breath, especially during exercise Feeling tired Feeling weak Feeling pain or pounding in the chest (the pounding is called palpitations) Swelling of the legs due to fluid retention ( edema ) Developing cyanosis (blue color to fingers and[my.clevelandclinic.org]
  • […] pleuritic chest pain apprehension cough haemotypsis leg pain collapse massive PE acute cardiovascular collapse Examination pale, mottled skin tachypnoea tachycardia signs of DVT hypotension altered LOC elevated JVP parasternal heave loud P2 central cyanosis[lifeinthefastlane.com]

Workup

  • Current guideline statements advocate administration of anticoagulant therapy during the diagnostic workup in the absence of contraindication or high risk for bleeding.[clinicaladvisor.com]
Right Axis Deviation
  • Focal oligemia, cardiomegaly and plump pulmonary arteries on chest X-ray films, right axis deviation, clockwise rotation, ST-segment depression and T-wave inversion on electrocardiograms, and dilatations of the pulmonary arterial trunk, the right ventricle[ncbi.nlm.nih.gov]
  • Review of EKGs showed a trend of increasing right axis deviation with recovery and recurrences during the previous 9 years and a current incomplete right bundle branch block with clockwise rotation and inverted T waves in V1-4.[ncbi.nlm.nih.gov]
  • axis deviation - s wave (I and aVL) 1.5mm - Q wave in III and aVF - p pulmonale - RBBB CXR: rules out other pathology, focal oligaemia, wedge density (pulmonary infarction) ABG: reduced PaO2 in keeping with size of PE, metabolic acidosis with circulatory[lifeinthefastlane.com]
Incomplete Right Bundle Branch Block
  • Review of EKGs showed a trend of increasing right axis deviation with recovery and recurrences during the previous 9 years and a current incomplete right bundle branch block with clockwise rotation and inverted T waves in V1-4.[ncbi.nlm.nih.gov]
P Pulmonale
  • pulmonale - RBBB CXR: rules out other pathology, focal oligaemia, wedge density (pulmonary infarction) ABG: reduced PaO2 in keeping with size of PE, metabolic acidosis with circulatory collapse, respiratory alkalosis D-Dimer: reassuring if negative to[lifeinthefastlane.com]

Treatment

  • Treatment with statins may be an attractive alternative for anticoagulant treatment in the long-term treatment of PE.[ncbi.nlm.nih.gov]
  • Abstract Right atrial and vena cava thrombus is a challenging clinical problem with limited treatment options for percutaneous extraction.[ncbi.nlm.nih.gov]
  • As a result, the outlook for most patients remains dismal even with aggressive multimodality treatment.[ncbi.nlm.nih.gov]
  • BACKGROUND: Maternal mortality may be reduced by prompt diagnosis and treatment of pulmonary embolism. CASE: A 25-year-old pregnant woman required a second Greenfield filter after developing a heparin allergy and recurrent pulmonary embolism.[ncbi.nlm.nih.gov]
  • Offers practical, clinically relevant material for the diagnosis and treatment of musculoskeletal conditions.[books.google.de]

Prognosis

  • The prognosis of such a disease is bad and the patient died at 1-year follow-up. Recurrent pulmonary embolism with well-conducted oral anticoagulant therapy requires further appropriate investigations, because of high suspicion of neoplastic process.[ncbi.nlm.nih.gov]
  • Notably, none of these tests has been unequivocally proven to improve the patients' prognosis when applied as primary tool to guide treatment decisions, nor are they recommend by recent guidelines [ 7 ].[erj.ersjournals.com]
  • Both these two conditions, when COPD is concomitant with IPA or PE, carry a poor prognosis. The coexistence of these three fatal diseases is rare.[omicsonline.org]
  • Prognosis of Pulmonary embolism (PE) How is Pulmonary embolism (PE) Treated? Pulmonary embolism (PE) References What is Pulmonary embolism (PE) Pulmonary embolism occurs in the lungs.[myvmc.com]
  • Finally, there is no real correlation between clot burden and prognosis. Patients may present with saddle pulmonary emboli and little symptoms or with relatively small clots and shock.[angiologist.com]

Etiology

  • The incidence of PVA is estimated 0.1%–0.2% with a slight female and left-sided preponderance as reported in patients presenting with various symptoms of venous disease. [2], [3], [4] PVA etiology is unknown, but congenital, (micro-) traumatic and inflammatory[arabjir.com]
  • In order to determine the duration of anticoagulation, know the rate of recurrence for VTE, which varies according to the etiology.[consultant360.com]

Epidemiology

  • The Worcester Venous Thromboembolism study: a population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med. 2006;21:722-727. 3.Sanchez O, Planquette B, Meyer G. Update on acute pulmonary embolism.[consultant360.com]
Sex distribution
Age distribution

Pathophysiology

  • ., Asherson, R.A. and Cervera, R. (2008) Morbidity and mortality in the catastrophic antiphospholipid syndrome: Pathophysiology, causes of death, and prognostic factors.[scirp.org]
  • Although this study does not change our current practice, the results of this study are nevertheless important and provide unique new insight into the pathophysiology of CTEPH after PE.[erj.ersjournals.com]
  • […] defined as acute PE with obstructive shock or SBP submassive PE is acute PE without systemic hypotension (SBP 90 mm Hg) but with either RV dysfunction or myocardial necrosis those with none of the above severe features are non-massive or low risk PEs PATHOPHYSIOLOGY[lifeinthefastlane.com]

Prevention

  • To prevent recurrent pulmonary emboli, a Greenfield inferior vena cava filter was implanted in April 2002. No further pulmonary embolism events occurred after interventional filter deployment.[ncbi.nlm.nih.gov]
  • Surgical resection may be necessary to prevent potential thrombosis and life-threatening pulmonary embolism.[ncbi.nlm.nih.gov]
  • It is suggested that anticoagulants will not prevent all recurrent pulmonary emboli, and that phlebography, and if necessary surgery, should be part of the routine investigation and treatment of all patients after their first pulmonary embolus.[ncbi.nlm.nih.gov]
  • To learn more about how we use cookies, please see our cookies policy Close Intended for healthcare professionals Research Prevention of...[bmj.com]
  • Surgical treatment is indicated above a 2.5 cm diameter to prevent complications, notably deep venous thrombosis and pulmonary embolism (PE).[ncbi.nlm.nih.gov]

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