Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previousl...Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.展开更多
This study explored the therapeutic targets and molecular mechanisms of Huangqi Guizhi Decoction (HGD) in alleviatingpulmonary embolism (PE) by employing network pharmacology and molecular docking techniques. Firstly,...This study explored the therapeutic targets and molecular mechanisms of Huangqi Guizhi Decoction (HGD) in alleviatingpulmonary embolism (PE) by employing network pharmacology and molecular docking techniques. Firstly, the effective activecomponents of the Chinese herbs in HGD were retrieved from the Traditional Chinese Medicine Systems Pharmacology Database(TCMSP), and their potential therapeutic targets were predicted using the Swiss Target Prediction platform. Subsequently, PErelatedtarget genes were obtained from the Online Mendelian Inheritance in Man (OMIM) database and GeneCards database.Then, the Wei Sheng Xin tool was used to generate a Venn diagram for identifying the common targets between the herb-relatedtargets and PE-related targets. After screening these common targets, a “drug-component-target network” and a protein-proteininteraction (PPI) network were constructed. Furthermore, Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia ofGenes and Genomes (KEGG) enrichment analysis were conducted on the intersecting targets, and molecular docking verificationwas performed using AutoDockTools and PyMol software. Finally, 20 active components were screened from Astragali Radix, 7from Cinnamomi Ramulus, 13 from Paeoniae Radix Alba, 5 from Zingiberis Rhizoma Recens, and 29 from Jujubae Fructus, witha total of 983 therapeutic targets. Among these targets, 134 were associated with PE, and protein kinase B1 (AKT1), mitogenactivatedprotein kinase 1 (MAPK1), and transformation-related protein 53 (TP53) served as the core targets. The results of GOand KEGG enrichment analyses indicated that the alleviation of PE by HGD is mainly related to pathways including immuneresponse, regulation of gene expression, atherosclerosis, and tumorigenesis. Molecular docking results showed that the keyactive components in HGD could bind to the core targets spontaneously and stably. This study revealed that HGD may alleviatesymptoms in PE patients by regulating signaling pathways, modulating platelet function to exert anticoagulant effects, andregulating the expression of anti-inflammatory genes, which provided a direction for subsequent experimental research.展开更多
Pulmonary and cerebral lipiodol embolism after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma is rare. To our knowledge, only 7 cases have been reported in the literature. We present a cas...Pulmonary and cerebral lipiodol embolism after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma is rare. To our knowledge, only 7 cases have been reported in the literature. We present a case of pulmonary and cerebral lipiodol embolism, and analyzed retrospectively the imaging and clinical data of the patient and conclude the most probable mechanism of pulmonary and cerebral lipiodol embolism, which is different from that of the cases reported previously.展开更多
To study the clinical characteristics and treatment of pulmonary embolism （PE） after transcatheter arterial chemoembolization （TACE） for hepatocellular carcinoma （HCC）. Methods： The clinical records of 13 512 p...To study the clinical characteristics and treatment of pulmonary embolism （PE） after transcatheter arterial chemoembolization （TACE） for hepatocellular carcinoma （HCC）. Methods： The clinical records of 13 512 patients diagnosed with HCC and received TACE from January 2000 to December 2009 were reviewed. Among these patients, 5 031 were allocated into group A who had one or more disorders like diabetes, hypertension, coronary heart disease, obesity or varicose vein of lower limb, while the other 8 481 patients who did not have such disorders were in group B. Results： A total of 39 185 TACE procedures were performed for the 13 512 patients. Five （0.01%） patients in group A developed PE after TACE, of whom two recovered 4 and 5 d later with early anticoagulant therapy while the hypertension, coronary heart disease, obesity or varicose vein of lower limb are possibly more likely to develop PE other 3 died of respiratory failure within 5 h. The mortality of PE was 60% （3/5）. Conelusion： HCC patients with diabetes, after TACE than those without such disorders. Patients who have such disorders should be more carefully observed after TACE and early treatment with heparin should be applied once PE develops.展开更多
BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic thera...BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.展开更多
Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequen...Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.展开更多
Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis...Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis and treatment modalities.Unfavorable prognosis may be attributed to the increasing incidence of the disease and pitfalls in risk stratification using the established risk stratification tools that fail to recognize patients with intermediate-high risk PE at normotensive shock in order to prevent further deterioration.In this light,research has been focused to identify novel risk stratification tools,based on the hemodynamic impact of PE on right ventricular function.Furthermore,a growing body of evidence has demonstrated that novel interventional treatments for PE,including catheter directed thrombolysis,mechanical thrombectomy and computer-assisted aspiration,are promising solutions in terms of efficacy and safety,when targeted at specific populations of the intermediate-high-and high-risk spectrum.Various therapeutic protocols have been suggested worldwide,regarding the indications and proper timing for interventional strategies.A STelevation myocardial infarction-like timing approach has been suggested in highrisk PE with contraindications for fibrinolysis,while optimal timing of the procedure in intermediate-high risk patients is still a matter of debate;however,early interventions,within 24-48 hours of presentation,are associated with more favorable outcomes.展开更多
Objective:To investigate the differential effects of different rivaroxaban dosing regimens on symptom relief,fluctuations in laboratory parameters,and medication safety in patients with stable pulmonary embolism(PE).M...Objective:To investigate the differential effects of different rivaroxaban dosing regimens on symptom relief,fluctuations in laboratory parameters,and medication safety in patients with stable pulmonary embolism(PE).Methods:This study enrolled 100 patients in the maintenance phase of PE who were treated at our hospital between January 2022 and December 2023.They were randomly divided into a control group and an observation group using a random number table,with 50 subjects in each group.The treatment period was uniformly set at 6 months.The control group received oral rivaroxaban 10 mg once daily,while the observation group received oral rivaroxaban 5 mg once daily.The study focused on comparing the two groups regarding the degree of clinical symptom relief,coagulation function parameters(including D-dimer levels,PT,and APTT),cardiac function markers(NT-proBNP),and drug-related adverse events.All data were processed using SPSS 26.0 statistical software.Measurement data are presented as mean±standard deviation,intergroup differences were verified by t-test,categorical variables were analyzed by chi-square test,and the statistical significance level was set at P<0.05.Results:After six months of treatment intervention,there was no significant difference in the overall relief of core clinical symptoms such as dyspnea and chest pain between the two groups.Regarding laboratory indicators,post-treatment D-dimer levels,prothrombin time,activated partial thromboplastin time,and NT-proBNP values were significantly optimized compared to baseline in both groups(P<0.05),but intergroup comparisons did not reach statistical significance.Notably,the overall incidence of bleeding events in the observation group was significantly lower than that in the control group(P<0.05),while there were no significant differences in the incidence rates of other adverse events between the two groups.Conclusion:In the maintenance phase treatment of pulmonary embolism,rivaroxaban 5 mg and 10 mg doses are equivalent in efficacy regarding improvement of clinical symptoms and blood indicators.However,the 5 mg dose significantly reduces the risk of bleeding,offers better safety,and is more suitable for long-term anticoagulation management in some high-risk populations.展开更多
BACKGROUND Pulmonary embolism(PE)is a leading cause of cardiovascular mortality.Although anticoagulation is the cornerstone of treatment,aspirin’s potential to modulate thromboinflammation and improve outcomes in non...BACKGROUND Pulmonary embolism(PE)is a leading cause of cardiovascular mortality.Although anticoagulation is the cornerstone of treatment,aspirin’s potential to modulate thromboinflammation and improve outcomes in non-surgical PE patients remains underexplored.AIM To assess whether prehospital aspirin use is associated with improved outcomes in patients hospitalized with acute PE.METHODS We conducted a retrospective case-control study of 323 adult patients admitted with computed tomography-confirmed acute PE from January 2020 to December 2023.Patients were stratified according to documented daily aspirin use for≥7 days prior to hospital admission.Primary outcomes included right ventricular strain,intensive care admission,shock,mechanical ventilation,and in-hospital mortality.Univariate logistic regression was used.A P value<0.05 was considered significant.RESULTS Total of 323 patients,90(27.9%)used aspirin prehospital.Aspirin users were older(74.2±14.3 years vs 66.9±16.7 years,P<0.001)and had more coronary artery disease.Aspirin use was associated with significantly lower rates of right ventricular strain on computed tomography[22.2% vs 34.8%,odds ratio(OR)=0.536,95%confidence interval(CI):0.305-0.944,P=0.029],Intensive care admission(16.7%vs 28.8%,OR=0.496,95% CI:0.266-0.924,P=0.025),shock(2.2%vs 9.9%,OR=0.208,95% CI:0.048-0.899,P=0.021),and in-hospital mortality(3.3% vs 11.6%,OR=0.260,95% CI:0.080-0.889,P=0.022).CONCLUSION Prehospital aspirin use is associated with reduced severity and mortality in acute PE.These findings support a potential protective role for aspirin and warrant validation in prospective,multicenter trials.展开更多
Pulmonary embolism(PE)can range from minor,asymptomatic blood clots to life-threatening emboli capable of obstructing pulmonary arteries,potentially leading to cardiac arrest and fatal outcomes.Due to this significant...Pulmonary embolism(PE)can range from minor,asymptomatic blood clots to life-threatening emboli capable of obstructing pulmonary arteries,potentially leading to cardiac arrest and fatal outcomes.Due to this significant mortality risk,risk stratification is essential following PE diagnosis to guide appropriate therapeutic intervention.This study proposes a machine learning-based methodology for PE risk stratification,utilizing clinical data from a cohort of 139 patients.The predictive framework integrates an enhanced binary Honey Badger Algorithm(BCCHBA)with the K-Nearest Neighbor(KNN)classifier.To comprehensively evaluate the performance of the core optimization algorithm(CCHBA),a series of benchmark function tests were conducted.Furthermore,diagnostic validation tests were performed using real-world PE patient data collected from medical facilities,demonstrating the clinical significance and practical utility of the BCCHBA-KNN system.Analysis revealed the critical importance of specific indicators,including neutrophil percentage(NEUT%),systolic blood pressure(SBP),oxygen saturation(SaO2%),white blood cell count(WBC),and syncope.The classification results demonstrated exceptional performance,with the prediction model achieving 100%sensitivity and 99.09%accuracy.This approach holds promise as a novel and accurate method for assessing PE severity.展开更多
BACKGROUND Coronary heart disease(CHD)and pulmonary embolism(PE)are thrombotic diseases.Patients with CHD and PE are common in clinical practice.However,the clinical diagnosis of PE is challenging due to overlapping p...BACKGROUND Coronary heart disease(CHD)and pulmonary embolism(PE)are thrombotic diseases.Patients with CHD and PE are common in clinical practice.However,the clinical diagnosis of PE is challenging due to overlapping primary symptoms,such as chest tightness and dyspnea.This confluence frequently leads to the misdiagnosis of PE,thus precipitating treatment delays and compromising patient outcomes.Herein,we report the case of a patient with both diseases who under-went surgery and medication therapy.CASE SUMMARY A 51-year-old man with a history of hypertension for 2 years visited a local hospital because of paroxysmal chest tightness for 1 d and was diagnosed with CHD.However,he refused hospitalization.He visited our hospital for the treatment of recurring symptoms.A comprehensive examination after admission revealed elevated D-dimer levels,and computed tomography pulmonary angio-graphy was performed to confirm the diagnosis of PE.The patient successfully underwent coronary artery bypass grafting with anticoagulant and antiplatelet drugs and had a prognosis.CONCLUSION D-dimer is useful in screening for PE,whereas computed tomography pulmonary angiography is important for diagnosis.For patients with CHD and PE,coronary artery bypass grafting combined with anticoagulant and antiplatelet therapy is feasible.展开更多
Intravenous leiomyomatosis(IVL)is a rare,histologically benign uterine smooth muscle tumor with malignant biological behavior due to its propensity for intravascular extension.[1]While gynecological in origin,its most...Intravenous leiomyomatosis(IVL)is a rare,histologically benign uterine smooth muscle tumor with malignant biological behavior due to its propensity for intravascular extension.[1]While gynecological in origin,its most severe manifestations are cardiovascular,arising from tumor propagation through the venous system into the inferior vena cava(IVC),right heart,and pulmonary arteries,mimicking thromboembolic disease.[2,3]This can lead to pulmonary embolism(PE),right heart obstruction,and even sudden cardiac death.[4]Diagnosis is challenging,often delayed by misdiagnosis as conventional PE.We present two cases of IVL initially presenting with PE,highlighting the critical cardiovascular implications and diagnostic pitfalls.展开更多
Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions t...Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow.While intermediate–HR(IHR)individuals remain hemodynamically stable,they face a significant chance of clinical decline and thus need close and continuous observation.Effective risk assessment,mortality prediction,and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies.Catheter-directed therapy(CDT)has emerged as a promising option,offering the ability to alleviate clot burden and reduce strain on the right ventricle,all while posing a lower risk of major bleeding compared to systemic thrombolysis.The growing adoption of CDT reflects its increasing relevance in PE treatment,especially when managed by specialized PE response teams that ensure individualized,multidisciplinary care.As clinical practices evolve,further studies and robust clinical trials are necessary to clearly define CDT’s role in lowering the risks of complications and death among IHR PE patients.This article explores the current understanding and future direction of managing PE,focusing in the role of catheter-based interventions.展开更多
The aim of this study is to analyze the risk factors and clinical characteristics of pulmonary embolism in northern Shaanxi.In this study,162 patients with venous thrombosis admitted between June 2023 and June 2024 un...The aim of this study is to analyze the risk factors and clinical characteristics of pulmonary embolism in northern Shaanxi.In this study,162 patients with venous thrombosis admitted between June 2023 and June 2024 underwent CT pulmonary angiography to investigate the risk factors and clinical characteristics of pulmonary embolism(PE)in northern Shaanxi.The patients were divided into a control group(no PE,n=98)and a study group(PE,n=64)based on the presence or absence of PE.Data were collected using a Case Report Form,and statistical analyses were conducted to summarize clinical features and risk factors,followed by three months of targeted therapy.Significant differences were observed between the two groups in clinical manifestations such as pleural pain,dyspnea,and hemoptysis,as well as in past medical histories(including malignant tumor history and right ventricular dysfunction),physical signs like lung rales,and laboratory parameters such as hemoglobin,albumin,white blood cell count,D-dimer,blood oxygen saturation,total cholesterol,triglycerides,and high-density lipoprotein cholesterol(all P<0.05).Multivariate logistic regression analysis identified pleural pain,dyspnea,malignancy,right ventricular dysfunction,lung rales,D-dimer,white blood cell levels,and blood oxygen saturation as risk factors for PE in patients with venous thrombosis.Following targeted therapy,the proportions of patients with pleural pain,dyspnea,and lung rales decreased significantly,with concurrent reductions in right ventricular end-diastolic inner diameter(RVD),D-dimer,and white blood cell levels,and a significant increase in blood oxygen saturation.These findings suggest that early prevention and intervention based on these risk factors can effectively reduce the incidence of PE in northern Shaanxi.展开更多
Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracrani...Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracranial aneurysm rupture and hemorrhage and developed pulmonary embolism after clipping surgery,was selected as the research subject.Through multidisciplinary collaboration,standardized assessment and dynamic condition observation,various risks were identified early.Combined with the patient’s individual characteristics,a personalized nursing plan was formulated.During the treatment process,emphasis was placed on strengthening the patient’s airway management,closely monitoring various indicators,and preventing postoperative complications.Targeted nursing measures were adopted:reasonable airway humidification and effective lung care were used to gradually control the patient’s pulmonary infection;fluid balance management and individualized care were implemented to ensure the patient’s normal circulating blood volume,thereby optimizing cerebral perfusion and cerebral oxygenation.Since the patient had overlapping risk factors for bleeding and thromboembolic events,evidence-based nursing principles were followed for thromboembolism prevention,and anticoagulation strategies and nursing plans were dynamically adjusted to reduce the occurrence of postoperative complications.Results:The patient’s condition improved and was successfully discharged on the 22^(nd) day after surgery,and then transferred to a local rehabilitation hospital for further treatment.At the 1-month follow-up after discharge,the patient recovered well;at the 3-month follow-up after discharge,the patient had recovered and returned home.Conclusion:The results show that standardized assessment and condition observation,multidisciplinary collaboration,and personalized nursing plans can significantly reduce the occurrence of postoperative complications and improve the patient’s prognosis.This nursing experience provides a reference for the nursing of similar patients in the future.展开更多
AIM： To determine risk factors for pulmonary embolism and estimate effects and benefits of prophylaxis. METHODS： We included 78 patients who died subsequently to a pulmonary embolism after major abdominal surgery fr...AIM： To determine risk factors for pulmonary embolism and estimate effects and benefits of prophylaxis. METHODS： We included 78 patients who died subsequently to a pulmonary embolism after major abdominal surgery from 1985 to 2003. A first, retrospective analysis involved 41 patients who underwent elective surgery between 1985 and 1990 without receiving any prophylaxis. In the prospectively evaluated subgroup, 37 patients undergoing major surgery between 1991 and 2003 were enrolled： all of them had received a prophylaxis consisting in lowmolecular weight heparin, given subcutaneously at a dose of 2850 IU AXa/0.3 mL （body weight 〈 50 kg） or 5700 IU AXa/0.6 mL （body weight ≥ 50 kg）. RESULTS： A higher incidence of thromboembolism （43.9% and 46.34% in the two groups, respectively） was found in older patients （〉 60 years）. The incidence of pulmonary embolism after major abdominal surgery in patients who had received the prophylaxis was significantly lower compared to the subjects with the same condition who had not received any prophylaxis （P 〈 0.001, OR = 2.825; 95% CI, 1.811-4.408）. Furthermore, the incidence of pulmonary embolism after colorectal cancer surgery was significantly higher compared to incidence of pulmonary embolism after other abdominal surgical procedures. Finally, the incidence of pulmonary embolism after colorectal cancer surgery among the patients who had received the prophylaxis （11/4316, 0.26%） was significantly lower compared to subjects undergoing a surgical procedure for the same indication but without prophylaxis （10/1562, 0.64%） （P 〈 0.05, OR = 2.522; 95% Ct, 1.069-5.949）. CONCLUSION： Prophylaxis with low molecular weight heparin is highly recommended during the preoperative period in patients with diagnosis of colorectal cancer due to high risk of pulmonary embolism after elective surgery.展开更多
Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a c...Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team.展开更多
Pulmonary contrast enhanced magnetic resonance angiography(CE-MRA)is useful for the primary diagnosis of pulmonary embolism(PE).Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE becaus...Pulmonary contrast enhanced magnetic resonance angiography(CE-MRA)is useful for the primary diagnosis of pulmonary embolism(PE).Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography(CTA).In this review,we discuss the strengths and weaknesses of CEMRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multiinstitutional experience in this area.The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules.Patients in extremis are not candidates for this test.Younger women(<35 years of age)and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test,recent technical innovations,artifacts,direct and indirect findings for PE,ancillary findings,and the effectiveness(patient outcomes)of CE-MRA for the exclusion of PE.Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.展开更多
BACKGROUND: There is controversy regarding whether saddle main pulmonary artery(MPA) embolism represents a high risk of deterioration in non-high-risk acute pulmonary embolism(PE) patients. This study aims to address ...BACKGROUND: There is controversy regarding whether saddle main pulmonary artery(MPA) embolism represents a high risk of deterioration in non-high-risk acute pulmonary embolism(PE) patients. This study aims to address this issue by conducting a propensity score matching(PSM) study.METHODS: A total of 727 non-high-risk acute PE patients were retrospectively evaluated. We evaluated the Bova score and risk stratification to examine the risk of deterioration. Deterioration defined as any adverse event within 30 days after admission. Computed tomographic pulmonary angiography was used to identify the embolism type. All patients were matched into four subgroups by PSM according to age, sex, Bova score, and risk stratification:(1) MPA and non-MPA embolism;(2) non-saddle MPA and non-MPA embolism;(3) saddle MPA and non-saddle MPA embolism;(4) saddle MPA and non-MPA embolism. Correlations were analyzed using Cox regression analysis, and deterioration risk was compared between subgroups using Kaplan-Meier analysis.RESULTS: Cox regression analysis revealed that MPA embolism was correlated with deterioration, regardless of whether saddle MPA embolism was included or excluded. Saddle MPA embolism was not correlated with deterioration, regardless of comparison with non-saddle MPA embolism or non-MPA embolism. Patients with MPA and non-saddle MPA embolism presented a high risk for deterioration(logrank test=5.23 and 4.70, P=0.022 and 0.030, respetively), while patients with saddle MPA embolism were not at a high risk of deterioration(log-rank test=1.20 and 3.17, P=0.729 and 0.077, respetively).CONCLUSIONS: Saddle MPA embolism is not indicative of a high risk of deterioration in nonhigh-risk acute PE patients.展开更多
In the present study, we evaluated computed tomography pulmonary angiography （CTPA） in guiding therapeutic decisions and monitoring patients undergoing percutaneous catheter fragmentation in acute massive pulmonary ...In the present study, we evaluated computed tomography pulmonary angiography （CTPA） in guiding therapeutic decisions and monitoring patients undergoing percutaneous catheter fragmentation in acute massive pulmonary embolism. From Jan 2003 to Dec 2009, 35 patients were diagnosed with acute massive pulmonary embolism by CTPA （TO） and treated with percutaneous catheter fragmentation. The severity was assessed by CT obstruction index （Qanadli index） and compared with Miller index. CTPA, oxygen saturation （SaO2） and pulmonary artery pressure were performed as follow-up index. The mean percentage of Qanadli index was （55 ± 13）% （range, 40%- 75%）, and Miller index was （62 ± 15）% （range, 45%-85%）. Correlations between them were statistically significant （r = 0.867, P 〈 0.0001）. The Qanadli index showed significant reduction [TO： （55±13）%; TI： （12±10）%; P 〈 0.001] in 33 patients. Significant correlation was observed between the Qanadli index, SaO2 （r = 0.934）, and pulmonary artery pressure （r = 0.813）. The Qanadli index provides an accurate method for distinguishing massive pulmonary embolism from sub-massive pulmonary embolism. It can be used to determine therapeutic options and monitor clinical outcomes.展开更多
文摘Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.
基金supported by Research Project on Traditional Chinese Medicine in Heilongjiang Province in 2025(Research on the pharmacological substance basis of Huangqi Guizhi decoction in improving acute pulmonary embolism and lung injury based on the theory of“Diaphoresis and expanding meridian”No.ZHY2025-043).
文摘This study explored the therapeutic targets and molecular mechanisms of Huangqi Guizhi Decoction (HGD) in alleviatingpulmonary embolism (PE) by employing network pharmacology and molecular docking techniques. Firstly, the effective activecomponents of the Chinese herbs in HGD were retrieved from the Traditional Chinese Medicine Systems Pharmacology Database(TCMSP), and their potential therapeutic targets were predicted using the Swiss Target Prediction platform. Subsequently, PErelatedtarget genes were obtained from the Online Mendelian Inheritance in Man (OMIM) database and GeneCards database.Then, the Wei Sheng Xin tool was used to generate a Venn diagram for identifying the common targets between the herb-relatedtargets and PE-related targets. After screening these common targets, a “drug-component-target network” and a protein-proteininteraction (PPI) network were constructed. Furthermore, Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia ofGenes and Genomes (KEGG) enrichment analysis were conducted on the intersecting targets, and molecular docking verificationwas performed using AutoDockTools and PyMol software. Finally, 20 active components were screened from Astragali Radix, 7from Cinnamomi Ramulus, 13 from Paeoniae Radix Alba, 5 from Zingiberis Rhizoma Recens, and 29 from Jujubae Fructus, witha total of 983 therapeutic targets. Among these targets, 134 were associated with PE, and protein kinase B1 (AKT1), mitogenactivatedprotein kinase 1 (MAPK1), and transformation-related protein 53 (TP53) served as the core targets. The results of GOand KEGG enrichment analyses indicated that the alleviation of PE by HGD is mainly related to pathways including immuneresponse, regulation of gene expression, atherosclerosis, and tumorigenesis. Molecular docking results showed that the keyactive components in HGD could bind to the core targets spontaneously and stably. This study revealed that HGD may alleviatesymptoms in PE patients by regulating signaling pathways, modulating platelet function to exert anticoagulant effects, andregulating the expression of anti-inflammatory genes, which provided a direction for subsequent experimental research.
基金Supported by Medical Scientific Research Foundation of Zhejiang Province, No. 2008A082, China
文摘Pulmonary and cerebral lipiodol embolism after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma is rare. To our knowledge, only 7 cases have been reported in the literature. We present a case of pulmonary and cerebral lipiodol embolism, and analyzed retrospectively the imaging and clinical data of the patient and conclude the most probable mechanism of pulmonary and cerebral lipiodol embolism, which is different from that of the cases reported previously.
基金Supported by the Scientific Research Found Projects of Shanghai Health Bureau(2009Y066)
文摘To study the clinical characteristics and treatment of pulmonary embolism （PE） after transcatheter arterial chemoembolization （TACE） for hepatocellular carcinoma （HCC）. Methods： The clinical records of 13 512 patients diagnosed with HCC and received TACE from January 2000 to December 2009 were reviewed. Among these patients, 5 031 were allocated into group A who had one or more disorders like diabetes, hypertension, coronary heart disease, obesity or varicose vein of lower limb, while the other 8 481 patients who did not have such disorders were in group B. Results： A total of 39 185 TACE procedures were performed for the 13 512 patients. Five （0.01%） patients in group A developed PE after TACE, of whom two recovered 4 and 5 d later with early anticoagulant therapy while the hypertension, coronary heart disease, obesity or varicose vein of lower limb are possibly more likely to develop PE other 3 died of respiratory failure within 5 h. The mortality of PE was 60% （3/5）. Conelusion： HCC patients with diabetes, after TACE than those without such disorders. Patients who have such disorders should be more carefully observed after TACE and early treatment with heparin should be applied once PE develops.
基金Supported by Scientific Research Projects from Wuhan Municipal Health Commission of China,No.WX23B42.
文摘BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.
文摘Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.
文摘Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis and treatment modalities.Unfavorable prognosis may be attributed to the increasing incidence of the disease and pitfalls in risk stratification using the established risk stratification tools that fail to recognize patients with intermediate-high risk PE at normotensive shock in order to prevent further deterioration.In this light,research has been focused to identify novel risk stratification tools,based on the hemodynamic impact of PE on right ventricular function.Furthermore,a growing body of evidence has demonstrated that novel interventional treatments for PE,including catheter directed thrombolysis,mechanical thrombectomy and computer-assisted aspiration,are promising solutions in terms of efficacy and safety,when targeted at specific populations of the intermediate-high-and high-risk spectrum.Various therapeutic protocols have been suggested worldwide,regarding the indications and proper timing for interventional strategies.A STelevation myocardial infarction-like timing approach has been suggested in highrisk PE with contraindications for fibrinolysis,while optimal timing of the procedure in intermediate-high risk patients is still a matter of debate;however,early interventions,within 24-48 hours of presentation,are associated with more favorable outcomes.
文摘Objective:To investigate the differential effects of different rivaroxaban dosing regimens on symptom relief,fluctuations in laboratory parameters,and medication safety in patients with stable pulmonary embolism(PE).Methods:This study enrolled 100 patients in the maintenance phase of PE who were treated at our hospital between January 2022 and December 2023.They were randomly divided into a control group and an observation group using a random number table,with 50 subjects in each group.The treatment period was uniformly set at 6 months.The control group received oral rivaroxaban 10 mg once daily,while the observation group received oral rivaroxaban 5 mg once daily.The study focused on comparing the two groups regarding the degree of clinical symptom relief,coagulation function parameters(including D-dimer levels,PT,and APTT),cardiac function markers(NT-proBNP),and drug-related adverse events.All data were processed using SPSS 26.0 statistical software.Measurement data are presented as mean±standard deviation,intergroup differences were verified by t-test,categorical variables were analyzed by chi-square test,and the statistical significance level was set at P<0.05.Results:After six months of treatment intervention,there was no significant difference in the overall relief of core clinical symptoms such as dyspnea and chest pain between the two groups.Regarding laboratory indicators,post-treatment D-dimer levels,prothrombin time,activated partial thromboplastin time,and NT-proBNP values were significantly optimized compared to baseline in both groups(P<0.05),but intergroup comparisons did not reach statistical significance.Notably,the overall incidence of bleeding events in the observation group was significantly lower than that in the control group(P<0.05),while there were no significant differences in the incidence rates of other adverse events between the two groups.Conclusion:In the maintenance phase treatment of pulmonary embolism,rivaroxaban 5 mg and 10 mg doses are equivalent in efficacy regarding improvement of clinical symptoms and blood indicators.However,the 5 mg dose significantly reduces the risk of bleeding,offers better safety,and is more suitable for long-term anticoagulation management in some high-risk populations.
文摘BACKGROUND Pulmonary embolism(PE)is a leading cause of cardiovascular mortality.Although anticoagulation is the cornerstone of treatment,aspirin’s potential to modulate thromboinflammation and improve outcomes in non-surgical PE patients remains underexplored.AIM To assess whether prehospital aspirin use is associated with improved outcomes in patients hospitalized with acute PE.METHODS We conducted a retrospective case-control study of 323 adult patients admitted with computed tomography-confirmed acute PE from January 2020 to December 2023.Patients were stratified according to documented daily aspirin use for≥7 days prior to hospital admission.Primary outcomes included right ventricular strain,intensive care admission,shock,mechanical ventilation,and in-hospital mortality.Univariate logistic regression was used.A P value<0.05 was considered significant.RESULTS Total of 323 patients,90(27.9%)used aspirin prehospital.Aspirin users were older(74.2±14.3 years vs 66.9±16.7 years,P<0.001)and had more coronary artery disease.Aspirin use was associated with significantly lower rates of right ventricular strain on computed tomography[22.2% vs 34.8%,odds ratio(OR)=0.536,95%confidence interval(CI):0.305-0.944,P=0.029],Intensive care admission(16.7%vs 28.8%,OR=0.496,95% CI:0.266-0.924,P=0.025),shock(2.2%vs 9.9%,OR=0.208,95% CI:0.048-0.899,P=0.021),and in-hospital mortality(3.3% vs 11.6%,OR=0.260,95% CI:0.080-0.889,P=0.022).CONCLUSION Prehospital aspirin use is associated with reduced severity and mortality in acute PE.These findings support a potential protective role for aspirin and warrant validation in prospective,multicenter trials.
文摘Pulmonary embolism(PE)can range from minor,asymptomatic blood clots to life-threatening emboli capable of obstructing pulmonary arteries,potentially leading to cardiac arrest and fatal outcomes.Due to this significant mortality risk,risk stratification is essential following PE diagnosis to guide appropriate therapeutic intervention.This study proposes a machine learning-based methodology for PE risk stratification,utilizing clinical data from a cohort of 139 patients.The predictive framework integrates an enhanced binary Honey Badger Algorithm(BCCHBA)with the K-Nearest Neighbor(KNN)classifier.To comprehensively evaluate the performance of the core optimization algorithm(CCHBA),a series of benchmark function tests were conducted.Furthermore,diagnostic validation tests were performed using real-world PE patient data collected from medical facilities,demonstrating the clinical significance and practical utility of the BCCHBA-KNN system.Analysis revealed the critical importance of specific indicators,including neutrophil percentage(NEUT%),systolic blood pressure(SBP),oxygen saturation(SaO2%),white blood cell count(WBC),and syncope.The classification results demonstrated exceptional performance,with the prediction model achieving 100%sensitivity and 99.09%accuracy.This approach holds promise as a novel and accurate method for assessing PE severity.
基金Supported by the National Natural Science Foundation of China,No.82200981Natural Science Foundation of Shandong Province,No.ZR2022QH358and Special Funds of Taishan Scholars Project of Shandong Province,No.tsqn202312384.
文摘BACKGROUND Coronary heart disease(CHD)and pulmonary embolism(PE)are thrombotic diseases.Patients with CHD and PE are common in clinical practice.However,the clinical diagnosis of PE is challenging due to overlapping primary symptoms,such as chest tightness and dyspnea.This confluence frequently leads to the misdiagnosis of PE,thus precipitating treatment delays and compromising patient outcomes.Herein,we report the case of a patient with both diseases who under-went surgery and medication therapy.CASE SUMMARY A 51-year-old man with a history of hypertension for 2 years visited a local hospital because of paroxysmal chest tightness for 1 d and was diagnosed with CHD.However,he refused hospitalization.He visited our hospital for the treatment of recurring symptoms.A comprehensive examination after admission revealed elevated D-dimer levels,and computed tomography pulmonary angio-graphy was performed to confirm the diagnosis of PE.The patient successfully underwent coronary artery bypass grafting with anticoagulant and antiplatelet drugs and had a prognosis.CONCLUSION D-dimer is useful in screening for PE,whereas computed tomography pulmonary angiography is important for diagnosis.For patients with CHD and PE,coronary artery bypass grafting combined with anticoagulant and antiplatelet therapy is feasible.
基金supported by the Capital Medical University Undergraduate Innovation Project 2025(XSKY20-25251).
文摘Intravenous leiomyomatosis(IVL)is a rare,histologically benign uterine smooth muscle tumor with malignant biological behavior due to its propensity for intravascular extension.[1]While gynecological in origin,its most severe manifestations are cardiovascular,arising from tumor propagation through the venous system into the inferior vena cava(IVC),right heart,and pulmonary arteries,mimicking thromboembolic disease.[2,3]This can lead to pulmonary embolism(PE),right heart obstruction,and even sudden cardiac death.[4]Diagnosis is challenging,often delayed by misdiagnosis as conventional PE.We present two cases of IVL initially presenting with PE,highlighting the critical cardiovascular implications and diagnostic pitfalls.
文摘Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow.While intermediate–HR(IHR)individuals remain hemodynamically stable,they face a significant chance of clinical decline and thus need close and continuous observation.Effective risk assessment,mortality prediction,and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies.Catheter-directed therapy(CDT)has emerged as a promising option,offering the ability to alleviate clot burden and reduce strain on the right ventricle,all while posing a lower risk of major bleeding compared to systemic thrombolysis.The growing adoption of CDT reflects its increasing relevance in PE treatment,especially when managed by specialized PE response teams that ensure individualized,multidisciplinary care.As clinical practices evolve,further studies and robust clinical trials are necessary to clearly define CDT’s role in lowering the risks of complications and death among IHR PE patients.This article explores the current understanding and future direction of managing PE,focusing in the role of catheter-based interventions.
文摘The aim of this study is to analyze the risk factors and clinical characteristics of pulmonary embolism in northern Shaanxi.In this study,162 patients with venous thrombosis admitted between June 2023 and June 2024 underwent CT pulmonary angiography to investigate the risk factors and clinical characteristics of pulmonary embolism(PE)in northern Shaanxi.The patients were divided into a control group(no PE,n=98)and a study group(PE,n=64)based on the presence or absence of PE.Data were collected using a Case Report Form,and statistical analyses were conducted to summarize clinical features and risk factors,followed by three months of targeted therapy.Significant differences were observed between the two groups in clinical manifestations such as pleural pain,dyspnea,and hemoptysis,as well as in past medical histories(including malignant tumor history and right ventricular dysfunction),physical signs like lung rales,and laboratory parameters such as hemoglobin,albumin,white blood cell count,D-dimer,blood oxygen saturation,total cholesterol,triglycerides,and high-density lipoprotein cholesterol(all P<0.05).Multivariate logistic regression analysis identified pleural pain,dyspnea,malignancy,right ventricular dysfunction,lung rales,D-dimer,white blood cell levels,and blood oxygen saturation as risk factors for PE in patients with venous thrombosis.Following targeted therapy,the proportions of patients with pleural pain,dyspnea,and lung rales decreased significantly,with concurrent reductions in right ventricular end-diastolic inner diameter(RVD),D-dimer,and white blood cell levels,and a significant increase in blood oxygen saturation.These findings suggest that early prevention and intervention based on these risk factors can effectively reduce the incidence of PE in northern Shaanxi.
文摘Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracranial aneurysm rupture and hemorrhage and developed pulmonary embolism after clipping surgery,was selected as the research subject.Through multidisciplinary collaboration,standardized assessment and dynamic condition observation,various risks were identified early.Combined with the patient’s individual characteristics,a personalized nursing plan was formulated.During the treatment process,emphasis was placed on strengthening the patient’s airway management,closely monitoring various indicators,and preventing postoperative complications.Targeted nursing measures were adopted:reasonable airway humidification and effective lung care were used to gradually control the patient’s pulmonary infection;fluid balance management and individualized care were implemented to ensure the patient’s normal circulating blood volume,thereby optimizing cerebral perfusion and cerebral oxygenation.Since the patient had overlapping risk factors for bleeding and thromboembolic events,evidence-based nursing principles were followed for thromboembolism prevention,and anticoagulation strategies and nursing plans were dynamically adjusted to reduce the occurrence of postoperative complications.Results:The patient’s condition improved and was successfully discharged on the 22^(nd) day after surgery,and then transferred to a local rehabilitation hospital for further treatment.At the 1-month follow-up after discharge,the patient recovered well;at the 3-month follow-up after discharge,the patient had recovered and returned home.Conclusion:The results show that standardized assessment and condition observation,multidisciplinary collaboration,and personalized nursing plans can significantly reduce the occurrence of postoperative complications and improve the patient’s prognosis.This nursing experience provides a reference for the nursing of similar patients in the future.
文摘AIM： To determine risk factors for pulmonary embolism and estimate effects and benefits of prophylaxis. METHODS： We included 78 patients who died subsequently to a pulmonary embolism after major abdominal surgery from 1985 to 2003. A first, retrospective analysis involved 41 patients who underwent elective surgery between 1985 and 1990 without receiving any prophylaxis. In the prospectively evaluated subgroup, 37 patients undergoing major surgery between 1991 and 2003 were enrolled： all of them had received a prophylaxis consisting in lowmolecular weight heparin, given subcutaneously at a dose of 2850 IU AXa/0.3 mL （body weight 〈 50 kg） or 5700 IU AXa/0.6 mL （body weight ≥ 50 kg）. RESULTS： A higher incidence of thromboembolism （43.9% and 46.34% in the two groups, respectively） was found in older patients （〉 60 years）. The incidence of pulmonary embolism after major abdominal surgery in patients who had received the prophylaxis was significantly lower compared to the subjects with the same condition who had not received any prophylaxis （P 〈 0.001, OR = 2.825; 95% CI, 1.811-4.408）. Furthermore, the incidence of pulmonary embolism after colorectal cancer surgery was significantly higher compared to incidence of pulmonary embolism after other abdominal surgical procedures. Finally, the incidence of pulmonary embolism after colorectal cancer surgery among the patients who had received the prophylaxis （11/4316, 0.26%） was significantly lower compared to subjects undergoing a surgical procedure for the same indication but without prophylaxis （10/1562, 0.64%） （P 〈 0.05, OR = 2.522; 95% Ct, 1.069-5.949）. CONCLUSION： Prophylaxis with low molecular weight heparin is highly recommended during the preoperative period in patients with diagnosis of colorectal cancer due to high risk of pulmonary embolism after elective surgery.
文摘Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team.
基金research support of the Department of Radiology,UW-Madison and GE Healthcare
文摘Pulmonary contrast enhanced magnetic resonance angiography(CE-MRA)is useful for the primary diagnosis of pulmonary embolism(PE).Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography(CTA).In this review,we discuss the strengths and weaknesses of CEMRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multiinstitutional experience in this area.The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules.Patients in extremis are not candidates for this test.Younger women(<35 years of age)and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test,recent technical innovations,artifacts,direct and indirect findings for PE,ancillary findings,and the effectiveness(patient outcomes)of CE-MRA for the exclusion of PE.Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.
基金supported by the 345 Talent Project,Shengjing Hospital of China Medical University。
文摘BACKGROUND: There is controversy regarding whether saddle main pulmonary artery(MPA) embolism represents a high risk of deterioration in non-high-risk acute pulmonary embolism(PE) patients. This study aims to address this issue by conducting a propensity score matching(PSM) study.METHODS: A total of 727 non-high-risk acute PE patients were retrospectively evaluated. We evaluated the Bova score and risk stratification to examine the risk of deterioration. Deterioration defined as any adverse event within 30 days after admission. Computed tomographic pulmonary angiography was used to identify the embolism type. All patients were matched into four subgroups by PSM according to age, sex, Bova score, and risk stratification:(1) MPA and non-MPA embolism;(2) non-saddle MPA and non-MPA embolism;(3) saddle MPA and non-saddle MPA embolism;(4) saddle MPA and non-MPA embolism. Correlations were analyzed using Cox regression analysis, and deterioration risk was compared between subgroups using Kaplan-Meier analysis.RESULTS: Cox regression analysis revealed that MPA embolism was correlated with deterioration, regardless of whether saddle MPA embolism was included or excluded. Saddle MPA embolism was not correlated with deterioration, regardless of comparison with non-saddle MPA embolism or non-MPA embolism. Patients with MPA and non-saddle MPA embolism presented a high risk for deterioration(logrank test=5.23 and 4.70, P=0.022 and 0.030, respetively), while patients with saddle MPA embolism were not at a high risk of deterioration(log-rank test=1.20 and 3.17, P=0.729 and 0.077, respetively).CONCLUSIONS: Saddle MPA embolism is not indicative of a high risk of deterioration in nonhigh-risk acute PE patients.
文摘In the present study, we evaluated computed tomography pulmonary angiography （CTPA） in guiding therapeutic decisions and monitoring patients undergoing percutaneous catheter fragmentation in acute massive pulmonary embolism. From Jan 2003 to Dec 2009, 35 patients were diagnosed with acute massive pulmonary embolism by CTPA （TO） and treated with percutaneous catheter fragmentation. The severity was assessed by CT obstruction index （Qanadli index） and compared with Miller index. CTPA, oxygen saturation （SaO2） and pulmonary artery pressure were performed as follow-up index. The mean percentage of Qanadli index was （55 ± 13）% （range, 40%- 75%）, and Miller index was （62 ± 15）% （range, 45%-85%）. Correlations between them were statistically significant （r = 0.867, P 〈 0.0001）. The Qanadli index showed significant reduction [TO： （55±13）%; TI： （12±10）%; P 〈 0.001] in 33 patients. Significant correlation was observed between the Qanadli index, SaO2 （r = 0.934）, and pulmonary artery pressure （r = 0.813）. The Qanadli index provides an accurate method for distinguishing massive pulmonary embolism from sub-massive pulmonary embolism. It can be used to determine therapeutic options and monitor clinical outcomes.
