Pulmonary thromboembolism

肺血栓栓塞症
  • 文章类型: Case Reports
    本文介绍一例63岁女性患者,最初因胸痛等症状误诊为支原体肺炎,咯血,发烧,但后来通过进一步检查证实患有肺血栓栓塞症(PTE)。这个病例突出了PTE和肺炎在症状方面的相似性,以及PTE诊断的复杂性。这篇文章提供了患者病史的详细描述,症状,考试过程,和治疗结果。此外,它讨论了误诊的可能原因,包括医生对PTE的认识不足,缺乏对D-二聚体水平异常升高的原因的深入研究,PTE的非特异性临床表现,以及患者家属对肺动脉CTA检查的担忧。此外,文章强调了临床医生提高对PTE的鉴别诊断能力的重要性,合理利用临床检查方法,并确保PTE的及时诊断和治疗。
    This paper presents a case of a 63-year-old female patient who was initially misdiagnosed with mycoplasma pneumonia due to symptoms such as chest pain, hemoptysis, and fever, but was later confirmed to have pulmonary thromboembolism (PTE) through further examination. This case highlights the similarities between PTE and pneumonia in terms of symptoms, as well as the complexity of PTE diagnosis. The article provides a detailed description of the patient\'s medical history, symptoms, examination process, and treatment outcomes. Furthermore, it discusses the possible reasons for the misdiagnosis, including insufficient awareness of PTE among physicians, lack of in-depth investigation into the causes of abnormally elevated D-dimer levels, the non-specific clinical manifestations of PTE, and the concerns of the patient\'s family regarding pulmonary artery CTA examination. Additionally, the article emphasizes the importance of clinicians in improving their ability to differentiate and diagnose PTE, rationally utilizing clinical examination methods, and ensuring timely diagnosis and treatment of PTE.
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  • 文章类型: Case Reports
    肺血栓栓塞症和活动性咯血代表不同但需要立即干预的严重紧急情况。然而,这些疾病的治疗方案-抗凝治疗和止血治疗-常常带来两难选择.
    我们介绍了一个25岁的女性患者,她出现咯血并同时诊断为肺血栓栓塞症。由于持续的活动性咯血,我们暂时暂停了抗凝治疗,选择了外科肺血栓切除术,能够安全恢复抗凝治疗。
    文献中很少报道肺血栓栓塞中发生咯血。缺乏针对此类病例的既定治疗指南。此病例可以为如何应对并发咯血和肺血栓栓塞带来的复杂治疗挑战提供指导。
    UNASSIGNED: Pulmonary thromboembolism and active haemoptysis represent distinct yet critical emergencies necessitating immediate intervention. However, the treatment protocols for these conditions-anticoagulation therapy and haemostatic therapy-often pose a dilemma.
    UNASSIGNED: We present the case of a 25-year-old female who presented to our emergency room with haemoptysis and a concurrent diagnosis of pulmonary thromboembolism. Due to persistent active haemoptysis, we temporarily paused anticoagulation and opted for surgical pulmonary thrombectomy, enabling the safe resumption of anticoagulation therapy.
    UNASSIGNED: Haemoptysis occurring in pulmonary thromboembolism is infrequently reported in the literature, and established treatment guidelines for such cases are lacking. This case could provide guidance on how to handle the intricate treatment challenges posed by concurrent haemoptysis and pulmonary thromboembolism.
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  • 文章类型: Case Reports
    Fontan手术旨在缓解双心室修复不可行的单心室先天性心脏病。文献中已经描述了大量的早期和晚期并发症。然而,肺血栓栓塞在这些患者中是一种罕见的并发症,导致缺乏关于诊断和治疗策略的证据。
    我们介绍了一例27岁女性出生时患有复杂的紫红色先天性心脏病,即肺动脉和三尖瓣狭窄伴主动脉室间连通和房间隔缺损,他接受了Blalock-Taussig分流术的姑息手术,双向格伦,和心外丰坦。她出现急性呼吸衰竭,住进医院,被诊断为双侧血栓栓塞。因为她的血液动力学稳定,最初,选择了保守的方法。然而,由于没有临床改善,她随后接受了双侧血栓抽吸术,同时恢复了肺循环.
    由于Fontan独特的病理生理学,在这种情况下,肺血栓栓塞症可能的生理和临床意义是深远的。因此,专业中心的护理和影像学检查很重要,因为这些患者的管理不同于双心室生理学患者。
    UNASSIGNED: Fontan surgery aims to palliate univentricular congenital heart diseases in which biventricular repair is not feasible. A large spectrum of early and late complications has been described in literature. However, pulmonary thromboembolism represents a rare complication in these patients, leading to a scarcity of evidence regarding diagnosis and treatment strategies.
    UNASSIGNED: We present a case of a 27-year-old woman born with a complex cyanotic congenital heart disease, namely pulmonary and tricuspid stenosis with subaortic interventricular communication and atrial septal defect, who underwent palliation surgery with Blalock-Taussig shunt, bidirectional Glenn, and extracardiac Fontan. She developed acute respiratory failure and was admitted to the hospital, being diagnosed with bilateral thromboembolism. Since she was haemodynamically stable, initially, a conservative approach was chosen. However, due to no clinical improvement, she subsequently underwent bilateral thromboaspiration with restoration of pulmonary circulation.
    UNASSIGNED: Due to the unique Fontan pathophysiology, the possible physiological and clinical implications of pulmonary thromboembolism in this condition are profound. Thus, care and imaging tests in specialized centres are important as the management of these patients is different from those with biventricular physiology.
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  • 文章类型: Journal Article
    精神疾病患者的静脉血栓栓塞风险尚未得到充分解决。本研究旨在评估该人群中高同型半胱氨酸血症与静脉血栓栓塞患病率之间的相关性。
    诊断为精神疾病并并发静脉血栓栓塞的患者,2014年1月至2021年12月期间入住浙江大学医学院附属邵逸夫医院,纳入静脉血栓栓塞组。对照组,大约两倍的大小,包括患有精神疾病但没有静脉血栓栓塞的个体。收集两个队列的基本临床数据。
    在精神病患者中,D-二聚体水平升高(OR=5.60,95%CI3.28-10.00),高同型半胱氨酸血症(OR=2.37,95%CI1.10-5.14),高泌乳素血症(OR=2.68,95%CI1.12~6.42)是静脉血栓栓塞的重要危险因素。根据进一步的亚组分析,高同型半胱氨酸血症是肺栓塞的重要危险因素,OR为5.08(95%CI1.20-21.48)。发现性别与同型半胱氨酸水平之间存在交互作用,p相互作用为0.022。随后的分析证实了女性精神病患者高同型半胱氨酸血症和静脉血栓栓塞之间的关联。OR为3.34(95%CI1.68-6.65),表明高同型半胱氨酸血症是女性静脉血栓栓塞的重要危险因素。
    患有精神疾病的患者静脉血栓栓塞的风险升高,这与D-二聚体水平升高有关,高催乳素血症,高同型半胱氨酸血症.在患有精神疾病的患者中,高同型半胱氨酸血症与肺栓塞之间存在很强的相关性。此外,研究显示,患有高同型半胱氨酸血症的女性精神病患者是静脉血栓栓塞症的高危人群.这一发现具有重要的临床意义,提示可对该高危人群实施早期预防措施,以降低精神病患者住院期间血栓栓塞事件的发生率.
    UNASSIGNED: The risk of venous thromboembolism in patients with mental illness has been insufficiently addressed. This study aimed to assess the correlation between hyperhomocysteinemia and venous thromboembolism prevalence among this population.
    UNASSIGNED: Patients with a diagnosis of mental illness and concurrent venous thromboembolism, admitted to Sir Run Run Shaw Hospital at Zhejiang University School of Medicine between January 2014 and December 2021, were included in the venous thromboembolism group. The control group, approximately twice the size, comprised individuals with mental illness but without venous thromboembolism. Basic clinical data were gathered for both cohorts.
    UNASSIGNED: In psychiatric patients, elevated D-dimer levels(OR=5.60,95% CI 3.28-10.00), hyperhomocysteinemia (OR=2.37,95% CI 1.10-5.14), and hyperprolactinemia(OR= 2.68,95% CI 1.12-6.42)were significant risk factors for venous thromboembolism. According to further subgroup analyses, hyperhomocysteinemia is a significant risk factor associated with pulmonary embolism, with an OR of 5.08 (95% CI 1.20-21.48). An interaction effect between gender and homocysteine level was found, with a p-interaction of 0.022. A subsequent analysis confirmed the association between hyperhomocysteinemia and venous thromboembolism in female psychiatric patients, with an OR of 3.34 (95% CI 1.68-6.65), indicating that hyperhomocysteinemia is a significant risk factor for venous thromboembolism in women.
    UNASSIGNED: Patients with psychiatric disorders were found to have an elevated risk of venous thromboembolism, which was associated with increased levels of D-dimer, hyperprolactinemia, and hyperhomocysteinemia. A strong correlation between hyperhomocysteinemia and pulmonary embolism was identified in patients with mental illnesses. Furthermore, the study revealed that female psychiatric patients with hyperhomocysteinemia constituted a high-risk group for venous thromboembolism. This finding holds significant clinical implications, suggesting that early preventative measures could be implemented for this high-risk population to reduce the incidence of thromboembolic events during hospitalization for psychiatric patients.
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  • 文章类型: Journal Article
    背景:关于静脉血栓栓塞(VTE)的围手术期预防尚无普遍共识,在接受脊柱手术的患者中使用或计时。VTE是当前关注的问题,因为,即使是一个不寻常的事件,它会导致严重的并发症。本研究的目的是提出预防后路脊柱手术中血栓事件的指南。深静脉血栓形成或肺血栓栓塞症。如果获得预防药物的患者数量减少,则可以预期硬膜外血肿的发生率会随之降低。
    方法:研究了在过去五年中接受过脊柱后路关节固定术的235例患者。所有这些都采用了由压力袜组成的机械血栓预防措施。每当观察到血栓形成的危险因素时,也使用抗凝药物。手术后立即恢复早期负重。人口统计,临床,收集手术变量,以及在随访期间出现的并发症,这被安排在一个,两个,四,手术后六个月和十二个月。血栓事件,如果存在,通过超声和CT血管造影等临床和影像学检查诊断。
    结果:在本系列的235名患者中,一百五十三例符合研究纳入标准.总共出现了4起血栓事件,两种形式为深静脉血栓形成,另外两种形式为肺血栓栓塞。这最后两个患有栓塞的患者因此死亡。研究的变量对血栓形成事件的发生无统计学意义。所有4例发生血栓事件的患者均接受抗凝药物治疗,除了机械压缩长袜,因为存在血栓形成的危险因素。
    结论:通过应用上述方案,在接受后路脊柱手术的研究人群中,血栓栓塞事件得到了充分预防.
    BACKGROUND: There is no generalized consensus regarding perioperative prophylaxis of venous thromboembolism (VTE), either on using or timing it in patients undergoing spine surgery. VTE is a current concern because, even though being an uncommon event, it can cause serious complications. The aim of the present study is to propose guidelines for the prevention of thrombotic events in posterior spinal surgery, either as deep vein thrombosis or pulmonary thromboembolism. If the number of patients getting prophylaxis drugs is reduced a subsequent reduction of the incidence of epidural hematoma can be expected.
    METHODS: A number of 235 patients who had undergone posterior spinal arthrodesis in the previous five years were studied. Mechanical thromboprophylaxis measures consisting of compression stockings were applied in all of them. Anticoagulant drugs were also applied whenever risk factors for thrombosis were observed. Early weight-bearing was resumed immediately after surgery. Demographic, clinical, and surgical variables were collected, as well as complications appearing during the follow-up period, that was scheduled at one, two, four, six and twelve months after the surgery. Thrombotic events, if present, were diagnosed by clinical and imaging tests such as ultrasound and CT angiography.
    RESULTS: From the total 235 patients of this series, one hundred and fifty-three cases met the study inclusion criteria. A total of four thrombotic events appeared, one in the form of deep vein thrombosis and other three in the form of pulmonary thromboembolism. These last patients suffering an embolism died because of it. None of the variables studied had statistical significance for the occurrence of a thrombotic event. All four patients who suffered thrombotic events were receiving anticoagulant drugs, in addition to mechanical compression stockings, because of the presence of risk factors for thrombosis.
    CONCLUSIONS: By applying the fore mentioned protocol, adequate prevention of thromboembolic events was achieved in this study population of patients undergoing posterior spinal surgery.
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  • 文章类型: Case Reports
    Behcet病(BD)是一种慢性和炎症性血管炎,其特征是复发性口腔和生殖器口疮溃疡,葡萄膜炎,和皮肤损伤。虽然BD的深静脉血栓发生率较高,肺动脉血栓栓塞症(PTE)是一种罕见的并发症。我们介绍了一名30岁的胸膜炎性胸痛患者,4天前出现非大咯血,有间歇性口疮性病变病史,和皮肤损伤。在我们的评估中,他的心电图有S1Q3T3模式,高水平的D-二聚体,在他的肺CT血管造影中,在右肺动脉的叶和节段分支以及左下叶肺动脉的节段分支中发现了低水平的FDP和纤维蛋白原以及肺栓塞。然后,HLA-B51阳性.根据他的临床状况和复发性生殖器和皮肤损伤的病史,积极的体形测试。因此,确诊为BD。由于BD中PTE的罕见性和非特异性临床症状,PTE的诊断可能很困难;因此,高度怀疑和适当的影像学检查对诊断至关重要.
    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.
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  • 文章类型: Case Reports
    在急诊室,有许多症状的患者存在。主要症状之一是发烧,这可能是唯一的症状,就像我们的病人一样。不仅感染,毒品,创伤,等。,引起发烧,但也不确定的癌症类型。在这种情况下,我们介绍了一名28岁的男性,发烧3周,被诊断为肺动脉内膜肉瘤,通常误认为是肺血栓栓塞,提高人们对这种致命癌症的认识.
    In the emergency department, there are many symptoms patients present. One of the major symptoms is fever which could be the only symptom, as our patient had. Not only do infections, drugs, trauma, etc., cause fever, but also undetermined cancer types do. In this case, we are presenting a 28-year-old male coming with a 3-week duration of fever and being admitted with the diagnosis of pulmonary artery intimal sarcoma as generally misconceived with pulmonary thromboembolism, to raise awareness of this fatal cancer.
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  • 文章类型: Case Reports
    Pichiaohmeri(P.ohmeri)是一种罕见的人类病原体,已知会导致严重的疾病,如败血症,真菌血症,心内膜炎,和腹膜炎,往往导致高死亡率。本报告介绍了一例发热的66岁男性,患有由P.ohmeri引起的尿路感染和真菌血症。该患者在左下肢有肺血栓栓塞症(PTE)和深静脉血栓形成(DVT)的其他并发症。值得注意的是,病原体是在尿液和血液培养物中分离的,在有免疫能力的患者中不常见的发现。根据抗真菌药敏试验(AFST)结果,开始使用氟康唑进行治疗。治疗后,患者出现发热和尿路感染症状逐渐消退。同时,抗凝治疗用于PTE和DVT的管理.患者最终病情稳定出院。
    Pichia ohmeri (P. ohmeri) is a rare human pathogen known to cause severe conditions such as sepsis, fungemia, endocarditis, and peritonitis, often resulting in high mortality rates. This report presents a case of a febrile 66-year-old male with a urinary tract infection and fungemia caused by P. ohmeri. The patient had additional complications of pulmonary thromboembolism (PTE) and deep venous thrombosis (DVT) in the left lower extremity. Notably, the pathogen was isolated in both urine and blood cultures, an uncommon finding in immunocompetent patients. Treatment with fluconazole was initiated based on the antifungal susceptibility testing (AFST) results. Following treatment, the patient experienced a gradual resolution of fever and urinary tract infection symptoms. Concurrently, anticoagulant therapy was administered for the management of PTE and DVT. The patient was eventually discharged in a stable condition.
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  • 文章类型: Case Reports
    This paper reported a case of acute severe nitrite poisoning with massive pulmonary thromboembolism (PTE), discussed the pathogenesis and summarized the treatment experience. Common symptoms of nitrite poisoning include headache, abdominal pain, shortness of breath, cyanosis, etc., which can be followed by encephalopathy, neurological dysfunction, hemolysis, etc. However, the cases of PTE are rare in clinical practice and are prone to missed diagnosis. Nitrite and methemoglobin may lead to vascular endothelial damage and promote thrombosis. In the diagnosis and treatment of acute severe nitrite poisoning patients, the targeted preventive measures should be taken.
    本文报道急性重症亚硝酸盐中毒并发大面积肺血栓栓塞症(PTE)1例,结合文献探讨其发病机制,总结治疗经验。亚硝酸盐中毒常见症状包括头痛、腹痛、气促、紫绀等,可继发脑病、神经功能障碍、溶血等,而并发PTE的病例在临床中较为罕见,容易发生漏诊。亚硝酸盐、高铁血红蛋白可能导致血管内皮受损,促进血栓形成,对于急性重症亚硝酸盐中毒患者的诊治中应采取针对性预防措施。.
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  • 文章类型: Case Reports
    怀疑间日疟原虫疟疾并发症需要低阈值。肺血栓栓塞症,虽然罕见,在无法解释和突然发作的呼吸急促的情况下,应将其视为并发症。
    疟疾的高凝并发症通常表现在微脉管系统中。然而,有几例由恶性疟原虫和间日疟原虫引起的颅内静脉血栓形成,恶性疟原虫导致肺血栓栓塞(PTE)1例。一名30岁的埃塞俄比亚男性患者突然出现呼吸急促3天。他也发高烧,发冷,以及与食欲减退和持续时间相似的疲劳相关的严寒。他来自疟疾流行地区。他的脉搏率为每分钟108次,呼吸频率为每分钟32次呼吸,氧气饱和度为82%,大气温度为38.9℃。进一步检查显示第二心音的肺部成分加重。全血细胞计数显示轻度贫血,外周血膜显示间日疟原虫滋养体。CT肺动脉造影显示右、左肺动脉充盈缺损。该患者被诊断为患有间日疟原虫并伴有PTE。他接受了鼻内氧气治疗,抗疟药,和抗凝。在随访的第三周和第二个月的系列评估中,他没有投诉,体检也不明显。疟疾是一种高死亡率和发病率的原生动物疾病。很长一段时间,严重的疟疾病例被认为主要由恶性疟原虫引起。然而,最近的证据显示了范式的转变,我们应该记住,间日疟原虫也可以引起严重的疟疾,这可能是复杂的高凝状态,包括PTE。
    UNASSIGNED: Low threshold is required to suspect complications of Plasmodium vivax malaria. Pulmonary thromboembolism, though rare, should be considered as its complication in the presence of unexplained and sudden onset shortness of breath.
    UNASSIGNED: The hypercoagulable complications of malaria typically manifest in the microvasculature. However, there are several cases of intracranial venous thrombosis caused by Plasmodium falciparum and Plasmodium vivax malaria, and there was one case report of pulmonary thromboembolism (PTE) due to P. falciparum. A 30-year-old Ethiopian male patient presented with sudden onset of shortness of breath for 3 days. He had also high-grade fever, chills, and rigors associated with loss of appetite and fatigue of similar duration. He was from malaria endemic area. He had a pulse rate of 108 beats per minutes, respiratory rate of 32 breaths per minute, oxygen saturation of 82% with atmospheric air and temperature of 38.9°C. Further examination revealed accentuation of pulmonary component of second heart sound. Complete blood count revealed mild anemia and peripheral blood film showed trophozoites of P. vivax. Pulmonary CT angiography showed filling defects in the right and left pulmonary arteries. The patient was diagnosed to have P. vivax malaria complicated by PTE. He was managed with intranasal oxygen, antimalarial agent, and anticoagulation. Upon serial evaluations on the third week and second month of follow up, he did not have complaints and physical examination was non-remarkable. Malaria is a protozoan disease with high mortality and morbidity. For a long time, severe cases of malaria were thought to be mostly caused by P. falciparum. However, recent evidences have shown a paradigm shift and we should remember that P. vivax can also cause severe malaria and this can be complicated by hypercoagulable conditions including PTE.
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