1/34. Pulmonary bone marrow embolism in sickle cell disease.We report an unusual lethal complication of sickle cell anemia. The patient was admitted with a diagnosis of acute chest syndrome and died shortly after that of respiratory failure. autopsy revealed numerous deposits of bone marrow hematopoietic tissue occluding the microvascular circulation of the lung. Many causes of acute chest syndrome in sickle cell anemia have been identified, including bone marrow infarction leading to embolism of bone marrow fat. However, the release of bone marrow hematopoietic tissue leading to pulmonary vascular occlusion is not generally recognized premortem by treating physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/34. pulmonary embolism.Despite the difficulty in diagnosis and the detailed care necessary in both the acute and long-term management of the patient with pulmonary embolism, expertise in this area is requisite for the primary care physician who may expect to encounter this problem with moderate frequency among patients in his clinical practice.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/34. ED echocardiography for peripartum cardiomyopathy.Although peripartum cardiomyopathy is uncommon, emergency physicians should be knowledgeable of it because of its high morbidity and mortality. Emergency physicians should be alert to the fact that the clinical presentation of peripartum cardiomyopathy is nonspecific. Its clinical manifestations are found in other medical conditions that can present in the late prepartum or postpartum patient. We present a case of peripartum cardiomyopathy that illustrates how its nonspecific respiratory signs and symptoms led to an initial diagnosis of pulmonary embolism. The case also highlights the need for echocardiography in the evaluation of peripartum cardiomyopathy. We discuss the clinical presentation, diagnosis, and treatment of peripartum cardiomyopathy.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/34. thromboembolism associated with hiv infection: a case report and review of the literature.The array of the clinicopathologic spectrum related to hiv infection continues to increase and present new challenges to physicians caring for hiv-infected patients. Recent literature is encumbered with reports of various abnormalities consistent with a hypercoagulable state leading to thromboembolic complications. The coexistence of hiv/AIDS-related illnesses, such as malignancies, opportunistic infections, or autoimmune diseases, as well as drug therapy, may also predispose hiv-infected patients to thromboembolic disease. A case report of a 39-year-old man with Kaposi sarcoma who developed pulmonary embolism is presented, along with a review of the literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/34. Normal perfusion scintigraphy in pulmonary embolism. Causes and diagnostic alternatives.Diagnosing pulmonary embolism (PE) is a challenge for many physicians as it is a frequently occurring disease with nonspecific symptoms and signs. ventilation-perfusion (V/Q) scintigraphy is widely used as the first step in diagnosing PE since it is non-invasive and highly sensitive. With a normal perfusion scan, clinically relevant pulmonary thrombo-emboli are considered to be absent. In an ongoing study assessing the value of spiral CT in the diagnosis of PE, we encountered a patient who had a normal perfusion scan while a large partially occluding thrombus in the right lower lobe artery and its branches was depicted by spiral CT and pulmonary angiography. In this article, we discuss the significance of normal findings in perfusion scintigraphy, the causes of false-negative perfusion scans and the role of alternative techniques such as spiral CT and pulmonary angiography.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/34. Acute pleuritic chest pain.BACKGROUND: The differential diagnosis of acute pleuritic chest pain is large and includes a number of life threatening conditions. Clinical suspicion plays a major role in the choice of investigation and the interpretation of the results. OBJECTIVE: To outline the clinical features and diagnostic workup of three acute causes of pleuritic chest pain--acute pulmonary embolism, pneumothorax and acute pericarditis. DISCUSSION: The general practitioner plays an important role in the initiation of the investigative pathway for these conditions. Appropriate referral for ongoing assessment and care requires the primary care physician to be aware of the available investigations and their limitations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/34. pulmonary embolism presenting as disseminated intravascular coagulation.We report an unusual case of disseminated intravascular coagulation. Occult pulmonary embolism is a recognised cause of disseminated intravascular coagulation. Unexplained shock should prompt the physician to search for a thrombotic cause such as pulmonary thromboembolism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/34. Protected iliofemoral venous thrombectomy in a pregnant woman with pulmonary embolism and ischemic venous thrombosis.Although thromboembolism is uncommon during pregnancy and the postpartum period, physicians should be alert to the possibility because the complications, such as pulmonary embolism, are often life threatening. pregnant women who present with thromboembolic occlusion are particularly difficult to treat because thrombolysis is hazardous to the fetus and surgical intervention by any of several approaches is controversial. A 22-year-old woman, in her 11th week of gestation, experienced an episode of pulmonary embolism and severe ischemic venous thrombosis of the left lower extremity The cause was determined to be a severe protein s deficiency in combination with compression of the left iliac vein by the enlarged uterus. The patient underwent emergency insertion of a retrievable vena cava filter and surgical iliofemoral venous thrombectomy with concomitant creation of a temporary femoral arteriovenous fistula. The inferior vena cava filter was inserted before the venous thrombectomy to prevent pulmonary embolism from clots dislodged during thrombectomy When the filter was removed, medium-sized clots were found trapped in its coils, indicating the effectiveness of this approach. The operation resolved the severe ischemic venous thrombosis of the left leg, and the patency of the iliac vein was maintained throughout the pregnancy without embolic recurrence. At full term, the woman spontaneously delivered an 8-lb, 6-oz, healthy male infant.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/34. Fatal pulmonary artery embolism in a sickle cell patient: case report and literature review.This article reports a rare case of fatal saddle embolism to the pulmonary artery presenting as an acute chest syndrome (ACS) in a Sickle Cell patient. We present a review of the etiology, pathophysiology, clinical manifestation and management of ACS. Clinicians should be aware of the fact that a sickle cell crisis admission may represent a life-threatening process. Such awareness will help physicians to act promptly and execute proper therapeutic interventions. It is important for clinicians to be expectant of impending clinical deterioration and likewise be aware that ACS can develop in patients hospitalized for other medical or surgical conditions.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/34. Confirmation by spiral CT of a partially occlusive thrombus of the right pulmonary artery suggested by a V/Q lung scan.Findings on perfusion and ventilation imaging in a 24-year-old woman with anterior chest pain were consistent with pulmonary embolism involving the right lung. An astute physician raised the possibility of a thrombus occluding the right pulmonary artery, and subsequent spiral computed tomography confirmed the suspicion of an occluding thrombus at that site. Had spiral computed tomography been done first, the diagnosis would have been made much more rapidly.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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