1/103. Utility of thallium-201 scintigraphy in detecting right ventricular dysfunction in pulmonary embolism.Acute right ventricular dysfunction has been established both as a diagnostic and prognostic indicator in pulmonary embolism. This report illustrates the utility of thallium-201 scintigraphy as an adjunctive noninvasive test in the diagnosis of pulmonary embolism by demonstrating increases in regional right ventricular perfusion and its subsequent resolution with treatment presumably as a result of decreased pressure work.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/103. Postoperative acute pulmonary thromboembolism in patients with acute necrotizing pancreatitis with special reference to apheresis therapy.Eight patients with pancreatic abscesses secondary to acute necrotizing pancreatitis underwent drainage of their abscesses under laparotomy. Two of them died of acute pulmonary thromboembolism (PTE) within 1 week. autopsy revealed a large thrombus at the main trunk of the pulmonary artery and in the left common iliac vein. Femoral catheter insertion/indwelling, immobilization, surgery, increased trypsin/kinin/kallikrein, increased endotoxin, and decreased antithrombin-III (AT-III) were present following drainage of the pancreatic abscesses. With respect to the bedside diagnosis of acute PTE, alveolar-arterial oxygen gradients obtained by blood gas analysis and mean pulmonary artery pressure estimated by pulsed Doppler echocardiography are very useful. In terms of the treatment, attention should be paid to the following to prevent deep venous thrombosis: prophylactic administration of low molecular weight heparin and administration of AT-III (AT-III > or = 80%), use of the subclavian vein whenever possible as blood access for apheresis therapy, as short a compression time as possible after removing the blood access catheter (< or =6 h), and application of intermittent pneumatic compression devices or elastic compression stockings on the lower extremities.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/103. pulmonary artery leiomyosarcoma.pulmonary artery leiomyosarcoma is a rare but highly lethal disease, and can be mistaken for pulmonary thromboembolism. We report a case of pulmonary artery leiomyosarcoma managed with surgical resection, chemotherapy, and radiotherapy. A 57-year-old woman was admitted with complaints of aggravated dyspnea. She was initially treated with oxygen therapy and heparinization for a suspected pulmonary embolism. echocardiography revealed a dilated right atrium and ventricle and severe tricuspid regurgitation, with an estimated systolic right ventricular pressure of 95 mm Hg; a shadow of a mass in the main pulmonary artery was also noted. Right ventriculography revealed a filling defect, and to-and-fro motion of the mass in the main pulmonary artery. The left pulmonary artery was almost totally occluded by the mass. The patient's condition improved dramatically after palliative excision of the mass and patch reconstruction of the outflow tract of the right ventricle with a bicuspid xenograft. Pathologic examination of the mass revealed leiomyosarcoma. Chemotherapy and radiotherapy were subsequently administered and follow-up imaging studies 3 months postoperatively revealed no recurrence of the tumor. The patient remains well, more than 1 year after treatment. This report emphasises that pulmonary artery sarcoma should be considered in the differential diagnosis in cases of suspected pulmonary thromboembolism.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/103. Transient right-to-left shunt in massive pulmonary embolism.A 56-yr-old man, two months after an operation for an acoustic neurinoma, gradually developed dyspnea. Massive pulmonary embolism (MPE), with a significant right-to-left (R-L) shunt, was seen in a perfusion scan of the lungs with Tc-99m MAA. radioactivity was noted in the thyroid, spleen, kidneys and brain. A cardiac ultrasound study did not reveal intracardiac shunting. A few days later, when the patient's condition improved, another perfusion scan of the lungs did not show the shunt, whereas a subsequent digital subtraction angiographic study confirmed the diagnosis of MPE but failed to reveal the cause of the shunt. In the absence of any possible pathophysiological mechanism, to explain the observed R-L shunt, we deduce that the particles of Tc-99m MAA might have passed through the precapillary pulmonary arteriovenous anastomoses and/or through dilated pulmonary capillaries, as a result of highly increased pulmonary vascular pressure due to MPE.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/103. Combined hepatocellular-cholangiocarcinoma presented with massive pulmonary embolism.A 30-year-old HBsAg-positive woman was admitted to the hospital because of 6 days of progressive shortness of breath. She was in severe respiratory distress with circulatory collapse. She had an enlarged liver but no stigmata of chronic liver disease or signs of cirrhosis. She had rapidly developed respiratory arrest and was transferred to intensive care unit. heart ultrasonography and Doppler scan showed right heart straining and high pulmonary artery pressure. Despite cardiovascular and respiratory support she died a few hours after admission. autopsy revealed combined hepatocellular-cholangiocarcinoma infiltrating the entire liver, metastatic invasion of lung blood vessels and absence of right ventricular hypertrophy. The incidence of hepatocellular-cholangiocarcinoma, a variant of hepatocellular carcinoma, is roughly 2-3% and the presenting symptoms are abdominal pain, weight loss, jaundice, fever or decompensation of liver disease. Associated HBsAg positivity and cirrhosis are reported in 20-30% and 60% of patients, respectively. Metastases to lungs are relatively frequent but this is the first report of hepatocellular-cholangiocarcinoma presented with acute respiratory distress due to massive pulmonary embolism.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/103. Pulmonary venous air embolism in hyaline membrane disease.A newborn infant with the respiratory distress syndrome in whom pulmonary venous air embolism (PVAE) developed as a complication of positive pressure therapy is reported. The underlying pathophysiology in this disorder is probably the development of alveolar-capillary fistulae secondary to unduly high intrabronchial pressures. An increased awareness by radiologists and clinicians of PVAE as a potential complication of aggressive respiratory therapy will result in more frequent recognition of this uncommon but lethal disorder.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
7/103. Respiratory failure after liver transplantation.A rapidly growing haemangioendothelial sarcoma of the liver in a twenty-two year old woman was treated by liver transplantation. disseminated intravascular coagulation resulted in massive blood loss during surgery, and contributed to the death of the patient from respiratory failure on the fourth post-operative day, despite continuous post-operative intermittent positive-pressure ventilation. Other factors leading to her respiratory failure are discussed. There was no evidence of dysfunction in the transplanted liver.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/103. Hemodynamic applications of capnography.The measurement of the pressure of exhaled carbon dioxide (PetCO2) via capnography has several useful hemodynamic applications. This article discusses integrating PetCO2 values with hemodynamic assessment. capnography can be applied to hemodynamic assessment in three key ways: (1) identification of end-expiration during pulmonary artery and central venous pressure measurements, (2) assessment of pulmonary perfusion and alveolar deadspace, (3) assessment of cardiopulmonary resuscitative efforts. The article presents research, sample waveforms for end-expiration identification, and case examples.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
9/103. cardiac tamponade masking pulmonary embolism.This report describes a patient admitted with shortness of breath due to cardiac tamponade, which masked concomitant pulmonary embolism that was diagnosed only after right heart pressures failed to decrease after successful pericardiocentesis. The patient was found to have widely metastatic adenocarcinoma of colon (with metastases to pericardium) and a paraneoplastic syndrome of deep vein thrombosis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/103. Severe pulmonary hypertension in a patient with systemic lupus erythematosus and minimal lupus activity.Pulmonary hypertension (PH) sometimes occurs in patients with systemic lupus erythematosus (SLE). We report a case of 51-year-old-woman with PH associated with SLE. She had been diagnosed as SLE on the basis of pericardial effusion, hematological disorder, positive antinuclear antibody, and hypocomplementemia. Despite minimal lupus activity, she had marked elevation of pulmonary arterial pressure (101/53 mmHg) and decreased cardiac index (1.5 l/min/m2). Symptoms related to PH were progressive under treatment with oral corticosteroids, oxygen, calcium antagonists, and warfarin. After 17 months of epoprostenol treatment, she died of pulmonary infarction. SLE-associated PH is often severe and progressive even in association with minimal activity.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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