BACKGROUND: Acute pulmonary thromboembolism (PTE) is a life-threatening disease. Considering the availability and accessibility of assessing the serum lipids, this study aims to define the predictive value of lipid profile, as well as the history of lipid disorders, for the mortality of PTE patients.
BACKGROUND: Clinical studies, in which the relation of lipid profile, including triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol, as well as history of imbalance of lipids, with mortality of PTE patients was reported, were included. Non-English articles, reviews, letters, editorials, and non-English papers were excluded. A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science databases. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tools and CMA 4 was utilized for the quantitative synthesis. Out of 3,724 records, six studies were included in this systematic review. Lipid profile is suggested as a prognostic marker for survival in patients with PTE so higher initial serum HDL, LDL, and total cholesterol levels were associated with lower mortality rates in PTE patients. In addition, dyslipidemia was found to be associated with mortality of PTE patients. Based on the quantitative synthesis, there was a greater serum level of HDL in the survival group (standardized mean difference: -0.98; 95 % CI: -1.22 to -0.75; p-value<0.01).
UNASSIGNED: Mortality is lower in PTE patients with greater serum lipid levels; therefore, the early prognosis of PTE may be ascertained by measuring serum lipids within the first 24 h of admission.

Behcet\'s disease (BD) is a chronic and inflammatory vasculitis characterized by recurrent oral and genital aphthous ulcers, uveitis, and skin lesions. Although there is a high rate of deep vein thrombosis in BD, pulmonary arterial thromboembolism (PTE) is a rare complication. We present a 30-year-old patient who was admitted with pleuritic chest pain, non-massive hemoptysis since 4 days ago and medical history of intermittent genial aphthous lesions, and skin lesions. During our evaluation, he had an S1Q3T3 pattern in the electrocardiogram, a high level of D-dimer, a low level of FDP and fibrinogen along with pulmonary emboli in lobar and segmental branches of the right pulmonary artery and segmental branches of left lower lobe pulmonary artery were detected in his pulmonary CT Angiography. Then, he was positive for HLA-B51. Based on his clinical condition and history of recurrent genital and skin lesions, a positive pathergy test. Therefore, the diagnosis of BD was confirmed for him. Diagnosis of PTE can be difficult due to the rarity of PTE in BD and nonspecific clinical symptoms; therefore, a high degree of suspicion and appropriate radiographic imaging is essential for the diagnosis.

Severe hypoxia due to coronavirus disease 2019 (COVID-19) is challenging in the intensive care unit (ICU). It is often unresponsive to mechanical ventilation at high positive end-expiratory pressure and the fraction of inspired oxygen combination. The cause of such worsening hypoxia may be microvascular thrombosis in the pulmonary vascular system because of the procoagulant nature of COVID-19 infection. Confirming the diagnosis with computed tomographic pulmonary angiography is not always possible, as the patients are too sick to be shifted. Tissue plasminogen activator (tPA) is recommended for pulmonary thromboembolism with hypotension and worsening hypoxia, as confirmed by computed tomography pulmonary angiography. However, its role in worsening hypoxia because of presumed microthrombi in the pulmonary vasculature in COVID-19 is unclear. We present six cases from our ICU where we used low-dose tPA in COVID-19 refractory hypoxia with presumed microthrombi in the pulmonary vasculature (oligemic lung field, refractory hypoxia, increased D dimer, electrocardiographic features of pulmonary embolism, and right ventricular strain on echocardiography). Oxygenation improved within 6 h and was maintained for up to 48 h in all patients. Therefore, there is a possible role of microthrombi in the mechanism of hypoxia in this setting. An early decision to start low-dose tPA may improve the outcome. However, all patients finally succumbed to sepsis and multiorgan failure later in their course. A systematic review of the literature has also been performed on the mechanism of thrombosis and the use of tPA in hypoxia due to COVID-19.

UNASSIGNED: To provide a reference for the diagnosis and treatment of patients with immune thrombocytopenia (ITP) complicated with pulmonary thromboembolism (PTE) by analyzing the clinical characteristics of five such patients.
UNASSIGNED: This paper summarizes the clinical manifestations and hematological indexes of five patients with ITP complicated with pulmonary embolism.
UNASSIGNED: In this study, the incidence of ITP complicated with PTE was 2.75%. All five cases were elderly patients with nonspecific clinical manifestations. Platelet counts were different when PTE occurred. The time from the diagnosis of ITP to the occurrence of PTE was from 5 to 24 months, with an average of 12.8 months. There was no significant change in hemoglobin, white blood cell levels, prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen levels, or the international normalized ratio. Four patients had significantly increased D-dimer levels, while D-dimer was only slightly increased in one patient. Antithrombin (AT) was significantly decreased in four cases (less than 70%), and C-reactive protein (CRP) was increased in all five cases.
UNASSIGNED: PTE may be related to AT and CRP in patients with ITP, which is of great clinical significance to the diagnosis and treatment of ITP complicated with PTE.

BACKGROUND: Behçet\'s syndrome is a type of systemic chronic vasculitis of unknown etiology, frequently characterized by recurrent oral and genital ulcers and uveitis. It is less commonly characterized by arthritis and skin, vascular, and gastrointestinal involvements. Behçet\'s syndrome affects various sizes of vessels by perivascular infiltration and vasculitis. Unlike other classic types of vasculitis, Behçet\'s syndrome patients can present with both arterial and venous involvement. Although vascular Behçet\'s syndrome is found in only around 15% of Behçet\'s syndrome patients, it is the major cause of morbidity and mortality among them. Furthermore, although deep venous thrombosis has high incidence in Behçet\'s syndrome patients, pulmonary artery thrombosis is an uncommon complication. Combining the findings of this and previous case reports of pulmonary artery thrombosis in Behçet\'s syndrome patients, we sought to determine the best treatment options for pulmonary artery thrombosis in Behçet\'s syndrome patients.
METHODS: We present the case of a 22-year-old Arabian male who was admitted to an emergency department with acute chest pain, dyspnea, and hemoptysis for 2 weeks. He gave a long history of recurrent oral and genital ulcers for the last 4 months but without seeking medical advice. Spiral computed tomography showed arterial filling defects with a pulmonary nodule for which the presence of a pulmonary artery aneurysm ruled out. The lung perfusion scan showed multiple pulmonary perfusion defects. After excluding common infectious diseases such as tuberculosis and brucellosis, a diagnosis of Behçet\'s syndrome with pulmonary artery thrombosis was made. Steroids with enoxaparin were initiated. The patient was discharged later on prednisolone (tapering dose) with adalimumab and apixaban. He was on regular follow-up for the next 9 months.
CONCLUSIONS: Vascular involvement in Behçet\'s syndrome is a major contributor to morbidity and mortality of Behçet\'s syndrome patients. Consequently, early detection of vascular involvement has a major impact on the prognosis of patients with Behçet\'s syndrome.

BACKGROUND: Pulmonary thromboembolism (PTE) is a serious postoperative complication that can occur after a fracture. Generally, PTE is caused by the falling off of lower extremity deep vein thrombosis (LEDVT) after lower limb fracture surgery. LEDVT and PTE after upper extremity fracture surgery are very rare. PTE is one of the most common clinical causes of sudden death. Venous thromboembolism includes PTE and DVT. We experienced one case of LEDVT and PTE after distal ulna and radius fracture surgery. The purpose of our report is to raise awareness for orthopedic surgeons that PTE can occur after distal ulna and radius fracture surgery, and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.
METHODS: We report a 51-year-old Chinese male who had severe fractures of the left distal ulna, radius and little finger after a motorcycle accident. The patient underwent external fixation, open reduction and internal fixation. On the third post-operative day, computed tomographic pulmonary angiography showed PTE. Doppler ultrasonography showed thrombus formation in the bilateral posterior tibial veins. After a period of anticoagulation therapy, on the 25th d after the PTE, computed tomographic pulmonary angiography showed that thrombus in both sides of the pulmonary artery disappeared. Furthermore, about 4 mo after the PTE, thrombosis in the deep veins of the lower limbs disappeared. About 1 year after the surgery, X-rays showed good fracture healing, and the function of the wrist joint recovered well.
CONCLUSIONS: Though rare, PTE can occur after distal ulna and radius fracture surgery and patients with high risk factors should be considered for prevention and treatment of thrombosis in a timely manner.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has rapidly emerged as a threatening pandemic. Clinical features of this pandemic involve a wide range of manifestations and are not completely known. Here, we present six cases of thrombotic events in patients with COVID-19.
METHODS: In this case series, we present six patients with confirmed COVID-19, according to real-time polymerase chain reaction, who were referred to our emergency department and were found to have thrombotic events. Pulmonary thromboembolism was diagnosed in three patients by computed tomography (CT) angiography. One patient was found to have deep vein thrombosis in Doppler ultrasonography. Another patient who presented with loss of consciousness was finally diagnosed with a cerebrovascular accident using brain CT. One of the patients had developed a myocardial infarction evident on the electrocardiogram.
CONCLUSIONS: It is ostensible that COVID-19 puts the patients at an increased risk for developing thrombotic conditions, possibly through formation of hyper-inflammatory and hyper-coagulative states. However, further prospective studies are recommended to confirm these findings.

Extracorporeal membrane oxygenation (ECMO) represents a therapeutic option for cardiopulmonary support in patients with high-risk pulmonary embolism (PE); however, no definite consensus exists on ECMO use in high-risk PE. Hence, we aim to provide insights into its real-world use pooling together all available published experiences. We performed a systematic review and pooled analysis of all published studies (up to April 17, 2020) investigating ECMO support in high-risk PE. All studies including at least four patients were collectively analyzed. Study outcomes were early all-cause death (primary endpoint) and relevant in-hospital adverse events. A total of 21 studies were included in the pooled analysis (n = 635 patients). In this population (mean age 47.8 ± 17.3 years, 44.5% females), ECMO was indicated for cardiac arrest in 62.3% and immediate ECMO support was pursued in 61.9% of patients. Adjunctive reperfusion therapies were implemented in 57.0% of patients. Pooled estimate rate of early all-cause mortality was 41.1% (95% CI 27.7%-54.5%). The most common in-hospital adverse event was major bleeding, with an estimated rate of 28.6% (95%CI 21.0%-36.3%). At meta-regression analyses, no significant impact of multiple covariates on the primary endpoint was found. In this systematic review of patients who received ECMO for high-risk PE, pooled all-cause mortality was 41.1%. Principal indication for ECMO was cardiac arrest, cannulation was chiefly performed at presentation, and major bleeding was the most common complication.

This study was aimed to assess the prevalence of pulmonary thromboembolism in patients with nephrotic syndrome. An electronic search was conducted through nine electronic databases for selection of relevant articles reporting the prevalence of pulmonary thromboembolism in patients with nephrotic syndrome. National Institute of Health was used to assess the quality of each study. Meta-analysis was used to pool the results. Of total 2267 reports screened, we finally included 11 studies including five retrospective cohorts, four prospective cohorts, and two case series studies. Out of these, ten articles were eligible for meta-analysis. The overall prevalence was 7.93% with 95% CI of 4.27 to 14.73. However, a significant heterogeneity (P < 0.001) was observed with I2= 96% and τ2= 0.899. Moreover, Egger\'s regression test showed a significant risk of bias (P = 0.006). Patients with nephrotic syndrome are prone to pulmonary embolism, therefore early management is critical to decreasing mortality burden.

Pulmonary artery sarcoma is a highly malignant and very rare tumor with a high rate of misdiagnosis. We present a case of a patient who complained of recurring fever for six months. He was diagnosed with pneumonia in a tertiary hospital in Nanjing and treated for more than one month, and was admitted with an initial diagnosis of pneumonia to our hospital. Pulmonary CT Angiography (CTPA) demonstrated pulmonary embolism. Until positron emission tomography-computed tomography (PET-CT) was performed, the patient was suspected to have pulmonary artery sarcoma (PAS). According to the histopathology from total left lung resection, he was eventually diagnosed with PAS and recovered very well. The prognosis of PAS depends very closely on early surgical treatment, and therefore physicians must be aware of PAS and grasp the best treatment opportunity.