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Sample records for cholesterol-crystal embolism presenting

  1. Cholesterol crystal embolization diagnosed on bladder transurethral resection.

    PubMed

    Chatelain, Denis; Cordonnier, Carole; Brevet, Marie; Petit, Jacques; Sevestre, Henri

    2005-08-01

    Cholesterol crystal embolization (CCE) is a severe systemic disorder caused by vascular migration of cholesterol crystals originating from ulcerative atherosclerotic plaques located in large arteries. We report 2 cases of CCE diagnosed on bladder transurethral resection in 2 men aged 94 and 72 years. Both patients had atherosclerosis disease. One patient had been treated by heparin 1 month before for pulmonary embolism and the other had had a coronary angiography and bypass graft surgery 5 months before for silent myocardial infarction. One patient presented with hematuria and the other with acute renal failure. Cystoscopy showed multiple papillary tumors of the bladder wall. Bladder transurethral resections showed transitional cell carcinoma with cholesterol crystals occluding the lumen of small arterioles in the submucosa. Eight cases of CCE in the bladder wall have been reported in the literature in 3 women and 5 men aged 56 to 79 years. Cholesterol crystal embolization is often discovered in the bladder wall on necropsy specimens. Only 2 cases have been fortuitously discovered on bladder transurethral resection performed for transitional cell carcinoma. Cholesterol crystal embolization in the bladder wall is often a marker of severe disease although the evolution is quite favorable in our patients, still alive 1 and 2 years after diagnosis. PMID:16084459

  2. Ileus caused by cholesterol crystal embolization: A case report

    PubMed Central

    Azuma, Shunjiro; Ikenouchi, Maiko; Akamatsu, Takuji; Seta, Takeshi; Urai, Shunji; Uenoyama, Yoshito; Yamashita, Yukitaka

    2016-01-01

    Cholesterol crystal embolization (CCE) is a rare systemic embolism caused by formation of cholesterol crystals from atherosclerotic plaques. CCE usually occurs during vascular manipulation, such as vascular surgery or endovascular catheter manipulation, or due to anticoagulation or thrombolytic therapy. We report a rare case of intestinal obstruction caused by spontaneous CCE. An 81-year-old man with a history of hypertension was admitted for complaints of abdominal pain, bloating, and anorexia persisting for 4 mo. An abdominal computed tomography revealed intestinal ileus. His symptoms were immediately relieved by an ileus tube insertion, and he was discharged 6 d later. However, these symptoms immediately reappeared and persisted, and partial resection of the small intestine was performed. A histopathological examination indicated that small intestine obstruction was caused by CCE. At the 12-mo follow-up, the patient showed no evidence of CCE recurrence. Thus, in cases of intestinal obstruction, CCE should also be considered. PMID:27022232

  3. [Cholesterol crystal embolization following urinary diversion: a case report].

    PubMed

    Fujikawa, Shohei; Iguchi, Ryo; Noguchi, Tetsuya; Sasaki, Miharu

    2015-03-01

    Cholesterol crystal embolization (CCE) is a cardiovascular disorder with poor prognosis, causing multiple organ failure. The primary pathological condition of the disease is embolization of cholesterol crystals in peripheral vessels. We report a case of CCE following urinary diversion. The patient is a 82-year-old male with history of hypertention, pneumonectasia, interstitial pneumonia, and heavy smoking. He was afflicted with advanced bladder cancer. He underwent urinary diversion, and had been scheduled for palliative radiotherapy. The next day, he developed thromboembolism of the left lower leg as acomplication of urinary diversion. Thrombectomy by endovascular catheter procedure was performed immediately, and anticoagulant therapy was started. The day after the thrombectomy, his lower legs showed livedo reticularis and toes showed cyanosis (blue toe). Since the laboratory data showed acute deterioration in renal function, hemodialysis was initiated. Three days after the thrombectomy he died of multiple organ failure. At autopsy, diffuse atherosclerosis of the aorta was observed, and cholesterol crystalemboli were found in the skin of the left foot ; and, the diagnosis of CCE was confirmed. This case suggests that tissue examinations for early diagnosis and stopping anticoagulant therapy are preferred when CCE is suspected. PMID:25918267

  4. A case of repeated small bowel perforations in a short period in a patient with cholesterol crystal embolism.

    PubMed

    Shinozuka, Eriko; Yamada, Takeshi; Kan, Hayato; Matsumoto, Satoshi; Koizumi, Michihiro; Shinji, Seiichi; Arai, Hiroki; Naito, Zenya; Uchida, Eiji

    2016-05-01

    We report a case of jejunal perforation related to cholesterol crystal embolism (CCE) in a woman in her seventies. The jejunum was partially resected;histological examination of the resected tissue revealed that the perforation was caused by CCE. On postoperative day 12, computed tomography (CT) showed free air in the abdomen. We then performed a second operation to alleviate the anastomotic leakage. Subsequently, 26 days after the second surgery, CT again showed free air in the abdomen. A third operation was performed, and multiple perforations of the jejunum were detected. She died of multiple organ failure 43 days after the first surgery. The prognosis of CCE with gastrointestinal perforation is reported to beextremely poor, and there is a high rate of anastomotic leakage. Partial resection of the intestine and ileostomy might be useful for removing the intestinal perforations caused by a CCE. Steroid administration should be continued, however, because discontinuation may worsen the problem. PMID:27151477

  5. Mechanical modeling of cholesterol crystallization in atherosclerotic plaques base on Micro-OCT images (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Luo, Yuemei; Liu, Xinyu; Chen, Si; Cui, Dongyao; Wang, Xianghong; Liu, Linbo

    2016-02-01

    Plaque rupture is the critical cause of cardiovascular thrombosis but this process is still under discussion. Recent studies show that, during crystallization, cholesterol crystals in atheromatous plaques accumulate rapidly in a limited space and may result in plaque rupture. However, the actual role of cholesterol crystals on plaque rupture remains unclear due to the lack of detailed morphological information of cholesterol crystals. In this study, we used a Micro-optical coherence tomography (µOCT) setup with 1-2 µm spatial resolution to extract the geometry of cholesterol crystals from human atherosclerotic artery ex vivo firstly. With measured dimensions of cholesterol crystals by this µOCT system (the average length and thickness of 269.1±80.16 µm and 3.0±0.33 µm), we developed a two-dimensional mechanical model in which rectangular shaped cholesterol crystals distribute at different locations spatially. We predicted the stress on the thin cap induced by the expansion of cholesterol crystals by use of finite-element method. Since a large portion of plaques (58%) rupture at points of peak circumferential stress (PCS), we used PCS as the primary indicator of plaque stability with blood pressure of 14.6 kPa on the lumen. The results demonstrate that loading of the concentrated crystals especially at the cap shoulder destabilize the plaque by proportionally increasing the PCS, while evenly distributed crystals loading along the cap might impose less PCS to the plaque than the concentrated case.

  6. Patient Presentation and Management of Labial Ulceration Following Uterine Artery Embolization

    SciTech Connect

    Gonsalves, Carin Franciosa, Stefan V.; Shah, Suken; Bonn, Joseph; Wu, Christine

    2007-11-15

    Uterine artery embolization is a safe and effective procedure for the treatment of symptomatic uterine fibroids. Nontarget embolization of adjacent internal iliac artery branches is a reported complication of uterine artery embolization. The following report describes the presentation and management of ulcerations of the labium minora due to nontarget embolization of the internal pudendal artery.

  7. Distal embolization as a presenting symptom of aortic aneurysms.

    PubMed

    Baxter, B T; McGee, G S; Flinn, W R; McCarthy, W J; Pearce, W H; Yao, J S

    1990-08-01

    The records of 302 patients who underwent abdominal aortic aneurysm (AAA) repair between 1985 and 1990 were reviewed. Two hundred and forty-eight patients (82%) were asymptomatic, while 32 patients (11%) had ruptured aneurysms. During this period, 15 patients (5%) presented with distal embolization as the first manifestation of their AAA. The preoperative embolic event resulted in limb-threatening ischemia in 3 patients, digital ischemia in 11, and calf myonecrosis in 1. CT scan was performed in 14 of 15 patients demonstrating irregular, heterogeneous thrombus within the AAA. Only two of the AAAs were larger than 5 cm. Angiography demonstrated occlusive lesions but was not diagnostic for AAA in seven patients and resulted in three episodes of embolization. AAA was repaired with a tube graft in 4 patients while a bifurcated graft was required in 11 patients for aneurysmal (in 4 patients) and occlusive disease (in 7 patients) of the iliac arteries. All cases employed a transperitoneal approach, systemic heparin, and distal occlusion prior to aortic clamping. Complications included three major (below-knee) and five minor amputations, developing or worsening renal failure in five patients (33%), and death in two (13%). In comparison, mortality was 5% for elective repair and 66% for rupture during this same period. CT scan was safer and more informative than angiography. The morbidity of patients with AAA presenting with emboli is comparable with rupture. The risk of embolization does not correlate with size and indicates the potentially dangerous nature of small AAAs. PMID:2200293

  8. A new subgroup of lectin-bound biliary proteins binds to cholesterol crystals, modifies crystal morphology, and inhibits cholesterol crystallization.

    PubMed Central

    Busch, N; Lammert, F; Marschall, H U; Matern, S

    1995-01-01

    Biliary proteins inhibiting or promoting cholesterol crystallization are assumed to play a major role in cholesterol gallstone pathogenesis. We now report a new group of biliary proteins that bind to cholesterol crystals, modify crystal morphology, and inhibit cholesterol crystallization. Various glycoprotein mixtures were extracted from abnormal human gallbladder bile using lectin affinity chromatography on concanavalin A, lentil, and Helix pomatia columns and were added to supersaturated model bile. Independent of the protein mixtures added, from the cholesterol crystals harvested, the same four GPs were isolated having molecular masses of 16, 28, 63, and 74 kD, respectively. Each protein was purified using preparative SDS-PAGE, and influence on cholesterol crystallization in model bile was tested at 10 microg/ml. Crystal growth was reduced by 76% (GP63), 65% (GP16), 55% (GP74), and 40% (GP28), respectively. Thus, these glycoproteins are the most potent biliary inhibitors of cholesterol crystallization known so far. Evidence that the inhibiting effect on cholesterol crystallization is mediated via protein-crystal interaction was further provided from scanning electron microscopy studies. Crystals grown in presence of inhibiting proteins showed significantly more ordered structures. Incidence of triclinic crystals and regular aggregates was shifted from 30 to 70% compared with controls. These observations may have important implications for understanding the role of biliary proteins in cholesterol crystallization and gallstone pathogenesis. Images PMID:8675674

  9. Hepatic cholesterol crystals and crown-like structures distinguish NASH from simple steatosis.

    PubMed

    Ioannou, George N; Haigh, W Geoffrey; Thorning, David; Savard, Christopher

    2013-05-01

    We sought to determine whether hepatic cholesterol crystals are present in patients or mice with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NASH), and whether their presence or distribution correlates with the presence of NASH as compared with simple steatosis. We identified, by filipin staining, free cholesterol within hepatocyte lipid droplets in patients with NASH and in C57BL/6J mice that developed NASH following a high-fat high-cholesterol diet. Under polarized light these lipid droplets exhibited strong birefringence suggesting that some of the cholesterol was present in the form of crystals. Activated Kupffer cells aggregated around dead hepatocytes that included strongly birefringent cholesterol crystals, forming "crown-like structures" similar to those recently described in inflamed visceral adipose tissue. These Kupffer cells appeared to process the lipid of dead hepatocytes turning it into activated lipid-laden "foam cells" with numerous small cholesterol-containing droplets. In contrast, hepatocyte lipid droplets in patients and mice with simple steatosis did not exhibit cholesterol crystals and their Kupffer cells did not form crown-like structures or transform into foam cells. Our results suggest that cholesterol crystallization within hepatocyte lipid droplets and aggregation and activation of Kupffer cells in crown-like structures around such droplets represent an important, novel mechanism for progression of simple steatosis to NASH. PMID:23417738

  10. Atypical Presentation of a Pulmonary Embolism in the Perioperative Setting.

    PubMed

    Viswanath, Omar; Simpao, Allan F; Santhosh, Sushmitha

    2015-08-15

    We present the case of an asymptomatic 82-year-old patient with no coronary artery disease and a negative cardiac workup who presented to the hospital for an elective total knee replacement. The patient had stable vital signs in the preanesthesia holding unit, yet the anesthesiologist recognized new-onset atrial fibrillation on the patient's monitor. The dysrhythmia was confirmed with a 12-lead electrocardiogram. The procedure was canceled, and the patient was sent for additional evaluation. An echocardiogram revealed a pulmonary embolism. This case report illustrates the need for a questioning attitude and diligent monitoring in all phases of perioperative care. PMID:26275306

  11. Syncope as a presentation of acute pulmonary embolism

    PubMed Central

    Altınsoy, Bülent; Erboy, Fatma; Tanrıverdi, Hakan; Uygur, Fırat; Örnek, Tacettin; Atalay, Figen; Tor, Meltem

    2016-01-01

    Purpose Syncope is an atypical presentation for acute pulmonary embolism (APE). There are conflicting data concerning syncope and prognosis of APE. Patients and methods One hundred and seventy-nine consecutive patients aged 22–96 years (median, 68 years) with APE were retrospectively enrolled in the study. Results Prevalence of syncope was 13% (n=23) at the time of presentation. Compared to patients without syncope, those with syncope had a higher rate of central embolism (83% vs 43%, respectively, P=0.002), right ventricular dysfunction (91% vs 68%, P=0.021), and troponin positivity (80% vs 39%, P=0.001) but not 30-day mortality (13% vs 10%, P=0.716). Multivariate analysis showed that central localization (odds ratio: 9.08) and cardiac troponin positivity (odds ratio: 4.67) were the independent correlates of the presence of syncope in the patients with APE. Frequency of cardiopulmonary disease was lower, and duration from symptom onset to hospital admission was shorter in patients with syncope (P=0.138 and 0.118, respectively), although not significant. Conclusion Syncope most likely represents an intermediate condition between massive APE and hypotension. In APE patients with syncope, the prognosis seems to depend on the underlying pathology, the patient’s age, comorbidities and duration from symptom onset to hospital admission, and the use of thrombolytic therapy. PMID:27390523

  12. Clinical Presentation of Acute Pulmonary Embolism: Survey of 800 Cases

    PubMed Central

    Miniati, Massimo; Cenci, Caterina; Monti, Simonetta; Poli, Daniela

    2012-01-01

    Background Pulmonary embolism (PE) is a common and potentially fatal disease that is still underdiagnosed. The objective of our study was to reappraise the clinical presentation of PE with emphasis on the identification of the symptoms and signs that prompt the patients to seek medical attention. Methodology/Principal Findings We studied 800 patients with PE from two different clinical settings: 440 were recruited in Pisa (Italy) as part of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISAPED); 360 were diagnosed with and treated for PE in seven hospitals of central Tuscany, and evaluated at the Atherothrombotic Disorders Unit, Firenze (Italy), shortly after hospital discharge. We interviewed the patients directly using a standardized, self-administered questionnaire originally utilized in the PISAPED. The two samples differed significantly as regards age, proportion of outpatients, prevalence of unprovoked PE, and of active cancer. Sudden onset dyspnea was the most frequent symptom in both samples (81 and 78%), followed by chest pain (56 and 39%), fainting or syncope (26 and 22%), and hemoptysis (7 and 5%). At least one of the above symptoms was reported by 756 (94%) of 800 patients. Isolated symptoms and signs of deep vein thrombosis occurred in 3% of the cases. Only 7 (1%) of 800 patients had no symptoms before PE was diagnosed. Conclusions/Significance Most patients with PE feature at least one of four symptoms which, in decreasing order of frequency, are sudden onset dyspnea, chest pain, fainting (or syncope), and hemoptysis. The occurrence of such symptoms, if not explained otherwise, should alert the clinicians to consider PE in differential diagnosis, and order the appropriate objective test. PMID:22383978

  13. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism

    PubMed Central

    Bĕlohlávek, Jan; Dytrych, Vladimír; Linhart, Aleš

    2013-01-01

    Pulmonary embolism is an important clinical entity with considerable mortality despite advances in diagnosis and treatment. In the present article, the authors offer a comprehensive review focused mainly on epidemiology, risk factors, risk stratification, pathophysiological considerations and clinical presentation. Diagnosis based on assessment of clinical likelihood, electrocardiography, chest x-ray, D-dimer levels, markers of myocardial injury and overload, and blood gases is discussed in detail. Special attention is devoted to the clinical use of computed tomography, pulmonary angiography and echocardiography in the setting of pulmonary embolism. PMID:23940438

  14. Managing pulmonary embolism from presentation to extended treatment.

    PubMed

    Cohen, Alexander T; Dobromirski, Mark; Gurwith, Meredith M P

    2014-02-01

    Pulmonary embolism (PE) remains a major healthcare problem. PE presents with a variety of non-specific symptoms, and confirmation of diagnosis involves the use of clinical risk scores, scanning techniques and laboratory tests. Treatment choice is informed by the risk of sudden death, with high-risk patients recommended to receive thrombolytic therapy or thrombectomy. Patients with less severe presentations are given anticoagulant therapy, traditionally with parenteral heparins in the acute phase of treatment, transitioning to oral vitamin K antagonists (VKAs). The limitations of these agents and the introduction of non-VKA oral anticoagulants challenge this paradigm. To date, clinical studies of four non-VKA oral anticoagulants to treat acute thrombosis have been published, and rivaroxaban is now approved for treatment and prevention of PE (and deep vein thrombosis). Rivaroxaban and apixaban alone, and dabigatran and edoxaban after parenteral anticoagulant induction, were non-inferior to enoxaparin/VKA for the prevention of recurrent venous thromboembolism; the risk of major bleeding was similar with dabigatran and edoxaban and significantly reduced with rivaroxaban and apixaban. Patients with an initial PE are recommended to receive continued anticoagulation for 3 months or longer, depending on individual risk factors, and studies of non-VKA oral anticoagulants have shown a continued benefit for up to 2 years, without a significantly increased risk of major bleeding. Given that the non-VKA oral anticoagulants are given at fixed doses without the need for routine coagulation monitoring, their adoption is likely to ease the burden on both PE patients and healthcare practitioners when longer-term or extended anticoagulation is warranted. PMID:24182642

  15. Modeling of Mechanical Stress Exerted by Cholesterol Crystallization on Atherosclerotic Plaques

    PubMed Central

    Cui, Dongyao; Yu, Xiaojun; Chen, Si; Liu, Xinyu; Tang, Hongying; Wang, Xianghong; Liu, Linbo

    2016-01-01

    Plaque rupture is the critical cause of cardiovascular thrombosis, but the detailed mechanisms are not fully understood. Recent studies have found abundant cholesterol crystals in ruptured plaques, and it has been proposed that the rapid expansion of cholesterol crystals in a limited space during crystallization may contribute to plaque rupture. To evaluate the effect of cholesterol crystal growth on atherosclerotic plaques, we modeled the expansion of cholesterol crystals during the crystallization process in the necrotic core and estimated the stress on the thin cap with different arrangements of cholesterol crystals. We developed a two-dimensional finite element method model of atherosclerotic plaques containing expanding cholesterol crystals and investigated the effect of the magnitude and distribution of crystallization on the peak circumferential stress born by the cap. Using micro-optical coherence tomography (μOCT), we extracted the cross-sectional geometric information of cholesterol crystals in human atherosclerotic aorta tissue ex vivo and applied the information to the model. The results demonstrate that (1) the peak circumference stress is proportionally dependent on the cholesterol crystal growth; (2) cholesterol crystals at the cap shoulder impose the highest peak circumference stress; and (3) spatial distributions of cholesterol crystals have a significant impact on the peak circumference stress: evenly distributed cholesterol crystals exert less peak circumferential stress on the cap than concentrated crystals. PMID:27149381

  16. Cholesterol crystal induced arterial inflammation and destabilization of atherosclerotic plaque.

    PubMed

    Janoudi, Abed; Shamoun, Fadi E; Kalavakunta, Jagadeesh K; Abela, George S

    2016-07-01

    Evolution of plaque that is prone to rupture is characterized by inflammation and physical changes. Accumulation of low-density lipoprotein in the sub-intima provides esterified cholesterol (ESC) to macrophages and smooth muscle cells that convert it into free cholesterol (FRC) by cholesteryl ester hydrolases (CEHs). Membrane-bound cholesterol carriers transport FRC to high-density lipoprotein (HDL). Impaired HDL transport function and altered composition can lead to extracellular accumulation of FRC, whereas impaired membrane carrier activity can lead to intracellular FRC accumulation. Saturation of FRC can result in cholesterol crystallization with cell death and intimal injury. Disequilibrium between ESC and FRC can impact foam cell and cholesterol crystal (CC) formation. Cholesterol crystals initiate inflammation via NLRP3 inflammasome leading to interleukin-1β (IL-1β) production inducing C-reactive protein. Eventually, crystals growing from within the plaque and associated inflammation destabilize the plaque. Thus, inhibition of inflammation by antagonists to IL-1β or agents that dissolve or prevent CC formation may stabilize vulnerable plaques. PMID:26705388

  17. Feasibility of the Assessment of Cholesterol Crystals in Human Macrophages Using Micro Optical Coherence Tomography

    PubMed Central

    Kashiwagi, Manabu; Liu, Linbo; Chu, Kengyeh K.; Sun, Chen-Hsin; Tanaka, Atsushi; Gardecki, Joseph A.; Tearney, Guillermo J.

    2014-01-01

    The presence of cholesterol crystals is a hallmark of atherosclerosis, but until recently, such crystals have been considered to be passive components of necrotic plaque cores. Recent studies have demonstrated that phagocytosis of cholesterol crystals by macrophages may actively precipitate plaque progression via an inflammatory pathway, emphasizing the need for methods to study the interaction between macrophages and crystalline cholesterol. In this study, we demonstrate the feasibility of detecting cholesterol in macrophages in situ using Micro-Optical Coherence Tomography (µOCT), an imaging modality we have recently developed with 1-µm resolution. Macrophages containing cholesterol crystals frequently demonstrated highly scattering constituents in their cytoplasm on µOCT imaging, and µOCT was able to evaluate cholesterol crystals in cultured macrophage cells. Our results suggest that µOCT may be useful for the detection and characterization of inflammatory activity associated with cholesterol crystals in the coronary artery. PMID:25048105

  18. Pulmonary cement embolization after vertebroplasty, an uncommon presentation of pulmonary embolism: A case report and literature review

    PubMed Central

    Sinha, Nishant; Padegal, Vivek; Satyanarayana, Satish; Santosh, Hassan Krishnamurthy

    2015-01-01

    Pulmonary Cement Embolization (PCE) is a rare complication of vertebroplasty surgery. There is no clear guideline for management of this entity. There is no definite protocol for anticoagulation in PCE. This is a case report of our patient who was diagnosed to have Pulmonary Cement Embolization, which was quite significant involving both lungs. She was successfully managed without long term anticoagulation. PMID:26664167

  19. Pulmonary Embolism.

    PubMed

    Rali, Parth; Gandhi, Viral; Malik, Khalid

    2016-01-01

    Pulmonary embolism covers a wide spectrum of presentation from an asymptomatic individual to a life-threatening medical emergency. It is of paramount importance to appropriately risk stratify patients with pulmonary embolism, particularly with those who present without hypotension. Right ventricular dysfunction can evolve after a patient has received a diagnosis of pulmonary embolism, necessitating aggressive measures rather than simple anticoagulation. In this review, we discuss definition, risk stratification, pathogenesis, diagnostic approach, and management, with particular focus on massive pulmonary embolism. PMID:26919674

  20. Delayed migration of embolized coil with large renal stone formation: a rare presentation.

    PubMed

    Kumar, Santosh; Jayant, Kumar; Singh, Shrawan K; Parmar, Kalpesh M; Devana, Sudheer K; Choudhari, Gautam R; Mittal, Ankur

    2014-01-01

    Delayed bleeding following percutaneous nephrolithotomy (PCNL) usually occurs due to development of the pseudoaneurysm which can be successfully managed with coil embolization. However very few cases of such complications have been reported in the literature. Here we are reporting a case of delayed post-PCNL bleeding that occurred in a 53-year-old diabetic patient operated on for renal stone. Computed tomography scan revealed a presence of the pseudoaneurysm in the segmental branch of right renal artery, which was successfully managed with coiling. Patient remained asymptomatic for the next 9 years after which he again presented with similar complaints. X-ray KUB was done which revealed a 2.7 cms renal pelvic calculus with the migrated coil in its center and a left upper ureteric calculus. His routine haemogram, coagulogram, serum electrolytes, and liver function tests, renal function tests, vitamin D3, and PTH (parathyroid hormone) were within normal limits. He underwent left laparoscopic ureterolithotomy and right percutaneous nephrolithotomy (PCNL). Intraoperatively the migrated stainless steel embolization coil was seen engulfed all around by the multiple stones in the right renal pelvis. Postoperative period was uneventful. Later he was followed in the outpatient department and was doing well. To conclude, this is the only case report of development of a large calculus around a migrated embolization coil which was successfully managed with PCNL. PCNL offers better stone clearance in cases of stones being formed over foreign bodies like fragmented double J stents, fragmented nephrostomies, or migrated embolization coil. PMID:25610700

  1. Delayed Migration of Embolized Coil with Large Renal Stone Formation: A Rare Presentation

    PubMed Central

    Jayant, Kumar; Singh, Shrawan K.; Parmar, Kalpesh M.; Devana, Sudheer K.; Choudhari, Gautam R.; Mittal, Ankur

    2014-01-01

    Delayed bleeding following percutaneous nephrolithotomy (PCNL) usually occurs due to development of the pseudoaneurysm which can be successfully managed with coil embolization. However very few cases of such complications have been reported in the literature. Here we are reporting a case of delayed post-PCNL bleeding that occurred in a 53-year-old diabetic patient operated on for renal stone. Computed tomography scan revealed a presence of the pseudoaneurysm in the segmental branch of right renal artery, which was successfully managed with coiling. Patient remained asymptomatic for the next 9 years after which he again presented with similar complaints. X-ray KUB was done which revealed a 2.7 cms renal pelvic calculus with the migrated coil in its center and a left upper ureteric calculus. His routine haemogram, coagulogram, serum electrolytes, and liver function tests, renal function tests, vitamin D3, and PTH (parathyroid hormone) were within normal limits. He underwent left laparoscopic ureterolithotomy and right percutaneous nephrolithotomy (PCNL). Intraoperatively the migrated stainless steel embolization coil was seen engulfed all around by the multiple stones in the right renal pelvis. Postoperative period was uneventful. Later he was followed in the outpatient department and was doing well. To conclude, this is the only case report of development of a large calculus around a migrated embolization coil which was successfully managed with PCNL. PCNL offers better stone clearance in cases of stones being formed over foreign bodies like fragmented double J stents, fragmented nephrostomies, or migrated embolization coil. PMID:25610700

  2. Infective splenic rupture presenting with symptoms of a pulmonary embolism.

    PubMed

    Shah, M; Muquit, S; Azam, B

    2008-12-01

    Splenic rupture following infectious mononucleosis is rare. The case history is presented of a man who presented with sudden onset pleuritic left chest pain. An ultrasound scan of the abdomen showed an enlarged spleen with an abnormal echo pattern and a CT scan of the abdomen showed severe splenic rupture. The patient remembered that he had been unwell 2 weeks earlier with flu-like symptoms and enlarged cervical lymph nodes. Serological examination was positive for Ebstein-Barr virus, confirming the diagnosis of splenic rupture following splenomegaly due to infectious mononucleosis. Management was initially conservative but he became haemodynamically unstable and an emergency splenectomy was performed. PMID:19033515

  3. Biliary proteins. Unique inhibitors of cholesterol crystal nucleation in human gallbladder bile.

    PubMed Central

    Holzbach, R T; Kibe, A; Thiel, E; Howell, J H; Marsh, M; Hermann, R E

    1984-01-01

    The onset time for cholesterol crystal nucleation of supersaturated normal human gallbladder biles is consistently prolonged when compared with biles from patients with cholesterol gallstone disease. Investigation of the factor(s) responsible for the suspended supersaturation (metastability) of normal human biles revealed that model bile solutions of cholesterol saturation index (CSI) and molar lipid composition identical to individual gallbladder bile specimens had much shorter crystal nucleation times, i.e., exhibited decreased metastability. Unsaturated normal biles, after supplementation with lecithin, cholesterol, and sodium taurocholate to a 'standard' supersaturated lipid composition, also demonstrated nucleation times three- to 15-fold longer than the comparable standard model bile. Total lipid extracts of normal biles, however, when similarly supplemented, did not differ in nucleation time from the control model solution. Gallbladder biles were fractionated by gel chromatography and the eluted fractions were pooled into two fractions. The fractions eluting in about the first 25% of the included volume when mixed with the supersaturated standard model bile induced a modest increase in nucleation time of approximately 1.5 times the control value. The fractions eluting in the second 25% of the included volume and which contained all of the bile lipids, were concentrated and supplemented with lipids to the standard composition. The nucleation times of these supplements were 3-10 times longer than the control nucleation times. Delipidated bile protein mixtures, purified by discontinuous sucrose gradient centrifugation, were recombined with purified lipids at the standard composition used previously. The nucleation times of these mixtures were significantly prolonged to the same extent as those associated with the second chromatographic fraction. These observations demonstrate that the delayed onset (inhibition) of cholesterol crystal nucleation observed in

  4. Stent-assisted coil embolization for anterior cerebral artery dissection presented with cerebral infarction

    PubMed Central

    Iwasaki, Mitsuhiro; Hattori, Itaro; Sasaki, Makoto; Ishimori, Hisatsugu; Nemoto, Akihiro; Hikita, Chiyoe; Sato, Junko; Fukuta, Shinya; Morimoto, Masafumi

    2015-01-01

    Background: Compared to those found in the vertebrobasilar system, intracranial dissection in the anterior circulation is relatively rare, especially in the anterior cerebral artery (ACA). Moreover, only several cases of ACA dissection that underwent endovascular treatment have been reported. Here we present a rare case of gradually developing ACA dissecting aneurysm causing cerebral infarction, successfully treated by stent-assisted coil embolization. Case Description: A 36-year-old man was admitted with sudden right hemiparesis. Diffusion-weighted magnetic resonance (MR) imaging showed cerebral infarction in the left ACA territory, and MR angiography showed segmental stenosis at the A2 portion of the left ACA. Three-dimensional digital subtraction angiogram showed segmental dilatation and stenosis at the left A2 portion. We diagnosed ACA dissection causing acute cerebral infarction and treated the patient conservatively. Five months after the onset, the dissecting artery at the left A2 portion formed a gradually dilating aneurysm, suggesting increased risk for aneurysmal rupture. We attempted endovascular treatment entailing coil embolization of an aneurysm while preserving the left A2 with stent assistance. The patient remained neurologically stable 6 months after the procedure. Conclusions: Although there are few reported cases of ACA dissection where endovascular treatment was attempted, we consider stent-assisted embolization for gradually developing ACA dissecting aneurysm as an alternative method to prevent bleeding and recurrent infarction. PMID:26677416

  5. Partial replacement of bile salts causes marked changes of cholesterol crystallization in supersaturated model bile systems.

    PubMed Central

    Nishioka, T; Tazuma, S; Yamashita, G; Kajiyama, G

    1999-01-01

    Cholesterol crystallization is a key step in gallstone formation and is influenced by numerous factors. Human bile contains various bile salts having different hydrophobicity and micelle-forming capacities, but the importance of lipid composition to bile metastability remains unclear. This study investigated the effect of bile salts on cholesterol crystallization in model bile (MB) systems. Supersaturated MB systems were prepared with an identical composition on a molar basis (taurocholate/phosphatidylcholine/cholesterol, 152 mM:38 mM: 24 mM), except for partial replacement of taurocholate (10, 20, and 30%) with various taurine-conjugated bile salts. Cholesterol crystallization was quantitatively estimated by spectrophotometrically measuring crystal-related turbidity and morphologically scanned by video-enhanced microscopy. After partial replacement of taurocholate with hydrophobic bile salts, cholesterol crystallization increased dose-dependently without changing the size of vesicles or crystal morphology and the rank order of crystallization was deoxycholate>chenodeoxycholate>cholate (control MB). All of the hydrophilic bile salts (ursodeoxycholate, ursocholate and beta-muricholate) inhibited cholesterol precipitation by forming a stable liquid-crystal phase, and there were no significant differences among the hydrophilic bile-salt species. Cholesterol crystallization was markedly altered by partial replacement of bile salts with a different hydrophobicity. Thus minimal changes in bile-salt composition may dramatically alter bile lipid metastability. PMID:10333488

  6. Acute pulmonary embolism caused by enlarged uterine leiomyoma: A rare presentation

    PubMed Central

    Khademvatani, Kamal; Rezaei, Yousef; Kerachian, Abdollah; Seyyed-Mohammadzad, Mir Hossein; Eskandari, Ramin; Rostamzadeh, Alireza

    2014-01-01

    Patient: Female, 42 Final Diagnosis: Acute pulmonary embolism Symptoms: Chest pain • dyspnea Medication: Streptokinase • Warfarin Clinical Procedure: — Specialty: Cardiology and Neoplasm Objective: Management of emergency care Background: Deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) caused by pelvic vein compression are rare and life-threatening complications of leiomyoma of the uterus. Case Report: We report a 42-year-old virgin woman with a history of leiomyoma who presented to the emergency department with complaints of dyspnea and pleuritic chest pain with transient spotting. On physical examination, she had a non-tender abdomen with a 20-week size uterus. Imaging investigations revealed an acute DVT in her left leg and a huge uterine-derived mass compressing the common iliac veins. Transesophageal echocardiography (TEE) demonstrated an echogenic mass in her right pulmonary artery consistent with thrombosis. The patient was completely cured using thrombolytic therapy and myomectomy, and was well at 1 year after thrombolysis. Conclusions: PE caused by pelvic vein compression is a rare complication of leiomyoma, which should be considered. Thrombolytic therapy associated with myomectomy can be implemented for treating such cases, and TEE can be used for diagnosing suspected high-risk PE. PMID:25061497

  7. Q Fever Endocarditis Presenting with Superior Mesenteric Artery Embolism and Renal Infarction.

    PubMed

    Raizada, Amol; Apte, Nachiket; Pham, Scott

    2016-02-01

    Q fever is a zoonotic disease with a reservoir in mammals, birds, and ticks. Acute cases in human beings can be asymptomatic, or they can present with a flu-like illness, pneumonia, or hepatitis. Approximately 5% of cases progress to chronic Q fever. Endocarditis, the most typical manifestation of chronic Q fever, is usually associated with small vegetations that occur in patients who have had prior valvular damage or who are immunocompromised. We present what we think is the first reported case of superior mesenteric artery embolism from Q fever endocarditis of the aortic valve, in a 39-year-old woman who needed surgical embolectomy and subsequent aortic valve replacement. PMID:27047296

  8. Clinical presentation and in-hospital death in acute pulmonary embolism: does cancer matter?

    PubMed

    Casazza, Franco; Becattini, Cecilia; Rulli, Eliana; Pacchetti, Ilaria; Floriani, Irene; Biancardi, Marco; Scardovi, Angela Beatrice; Enea, Iolanda; Bongarzoni, Amedeo; Pignataro, Luigi; Agnelli, Giancarlo

    2016-09-01

    Cancer is one of the most common risk factors for acute pulmonary embolism (PE), but only few studies report on the short-term outcome of patients with PE and a history of cancer. The aim of the study was to assess whether a cancer diagnosis affects the clinical presentation and short-term outcome in patients hospitalized for PE who were included in the Italian Pulmonary Embolism Registry. All-cause and PE-related in-hospital deaths were also analyzed. Out of 1702 patients, 451 (26.5 %) of patients had a diagnosis of cancer: cancer was known at presentation in 365, or diagnosed during the hospital stay for PE in 86 (19 % of cancer patients). Patients with and without cancer were similar concerning clinical status at presentation. Patients with cancer less commonly received thrombolytic therapy, and more often had an inferior vena cava filter inserted. Major or intracranial bleeding was not different between groups. In-hospital all-cause death occurred in 8.4 and 5.9 % of patients with and without cancer, respectively. At multivariate analysis, cancer (OR 2.24, 95 % CI 1.27-3.98; P = 0.006) was an independent predictor of in-hospital death. Clinical instability, PE recurrence, age ≥75 years, recent bed rest ≥3 days, but not cancer, were independent predictors of in-hospital death due to PE. Cancer seems a weaker predictor of all-cause in-hospital death compared to other factors; the mere presence of cancer, without other risk factors, leads to a probability of early death of 2 %. In patients with acute PE, cancer increases the probability of in-hospital all-cause death, but does not seem to affect the clinical presentation or the risk of in-hospital PE-related death. PMID:27023066

  9. Effort Thrombosis Presenting as Pulmonary Embolism in a Professional Baseball Pitcher

    PubMed Central

    Bushnell, Brandon D.; Anz, Adam W.; Dugger, Keith; Sakryd, Gary A.; Noonan, Thomas J.

    2009-01-01

    Context: Effort thrombosis, or Paget-Schroetter’s syndrome, is a rare subset of thoracic outlet syndrome in which deep venous thrombosis of the upper extremity occurs as the result of repetitive overhead motion. It is occasionally associated with pulmonary embolism. This case of effort thrombosis and pulmonary embolus was in a 25-year-old major league professional baseball pitcher, in which the only presenting complaints involved dizziness and shortness of breath without complaints involving the upper extremity—usually, a hallmark of most cases of this condition. The patient successfully returned to play for 5 subsequent seasons at the major league level after multimodal treatment that included surgery for thoracic outlet syndrome. Objective: Though rare, effort thrombosis should be included in the differential diagnosis of throwing athletes with traditional extremity-focused symptoms and in cases involving pulmonary or thoracic complaints. Rapid diagnosis is a critical component of successful treatment. PMID:23015912

  10. Effect of dietary fenugreek seeds on biliary proteins that influence nucleation of cholesterol crystals in bile.

    PubMed

    Reddy, Raghunatha R L; Srinivasan, Krishnapura

    2011-04-01

    Formation of cholesterol gallstones in gallbladder is controlled by procrystallising and anticrystallising factors present in bile. Dietary fenugreek seed has been recently observed to possess anti-lithogenic potential in experimental mice. In the current animal study, we evaluated the effect of dietary fenugreek on the compositional changes in the bile, particularly its effect on glycoproteins, low-molecular-weight (LMW) and high-molecular-weight (HMW) proteins, cholesterol nucleation time and cholesterol crystal growth. Groups of Wistar rats were fed for 10 weeks with diets: (1) basal control (C), (2) C+fenugreek (12%), (3) high cholesterol diet (HCD) and (4) HCD+fenugreek (12%). Feeding of HCD containing 0.5% cholesterol for 10 weeks rendered the bile lithogenic. Incorporation of fenugreek into HCD decreased the cholesterol content (70.5%), total protein (58.3%), glycoprotein (27.5%), lipid peroxides (13.6%) and cholesterol saturation index (from 1.98 to 0.75) in bile, increased the bile flow rate (19.5%), prolonged the cholesterol nucleation time and reduced the vesicular form of cholesterol (65%), which was accompanied with an increase in smaller vesicular form (94%). There was an increase in biliary phospholipid (33%) and total bile acid (49%) contents in the HCD+fenugreek group as compared with the HCD group. Electrophoretic separation of biliary LMW proteins showed the presence of a high concentration of 28-kDa protein, which might be responsible for the prolongation of cholesterol nucleation time in the fenugreek-fed groups. These findings indicate that the beneficial anti-lithogenic effect of dietary fenugreek, which primarily is due to reduction in the cholesterol content in bile, was additionally affected through a modulation of the nucleating and anti-nucleating proteins, which, in turn, affect cholesterol crystallisation. PMID:21215764

  11. CAV1 Prevents Gallbladder Cholesterol Crystallization by Regulating Biosynthesis and Transport of Bile Salts.

    PubMed

    Xu, Guoqiang; Li, Yiqiao; Jiang, Xin; Chen, Hongtan

    2016-09-01

    Cholesterol gallstone disease (CGD) is a hepatobiliary disorder which results from a biochemical imbalance in the gallbladder bile. Here we show that loss of CAV1 sensitized mice to lithogenic diet-induced gallbladder cholesterol crystallization, which was associated with dysregulation of several hepatic transporters that efflux cholesterol, phospholipids, and bile salts. The combined effect of increased biliary cholesterol concentration and decreased biliary bile salt secretion in CAV1(-/-) mice led to an increased cholesterol saturation index and the formation of cholesterol crystals. At the signaling level, the ERK/AP-1 pathway seems to mediate the effects of CAV1 on biliary BA homeostasis and might be developed as a therapeutic target for CGD. We propose that CAV1 is an anti-lithogenic factor and that the CAV1(-/-) mice may offer a convenient CGD model to develop therapeutic interventions for this disease. J. Cell. Biochem. 117: 2118-2127, 2016. © 2016 Wiley Periodicals, Inc. PMID:26875794

  12. Cholesterol Crystals Activate the NLRP3 Inflammasome in Human Macrophages: A Novel Link between Cholesterol Metabolism and Inflammation

    PubMed Central

    Rajamäki, Kristiina; Lappalainen, Jani; Öörni, Katariina; Välimäki, Elina; Matikainen, Sampsa; Kovanen, Petri T.; Eklund, Kari K.

    2010-01-01

    Background Chronic inflammation of the arterial wall is a key element in the pathogenesis of atherosclerosis, yet the factors that trigger and sustain the inflammation remain elusive. Inflammasomes are cytoplasmic caspase-1-activating protein complexes that promote maturation and secretion of the proinflammatory cytokines interleukin(IL)-1β and IL-18. The most intensively studied inflammasome, NLRP3 inflammasome, is activated by diverse substances, including crystalline and particulate materials. As cholesterol crystals are abundant in atherosclerotic lesions, and IL-1β has been linked to atherogenesis, we explored the possibility that cholesterol crystals promote inflammation by activating the inflammasome pathway. Principal Findings Here we show that human macrophages avidly phagocytose cholesterol crystals and store the ingested cholesterol as cholesteryl esters. Importantly, cholesterol crystals induced dose-dependent secretion of mature IL-1β from human monocytes and macrophages. The cholesterol crystal-induced secretion of IL-1β was caspase-1-dependent, suggesting the involvement of an inflammasome-mediated pathway. Silencing of the NLRP3 receptor, the crucial component in NLRP3 inflammasome, completely abolished crystal-induced IL-1β secretion, thus identifying NLRP3 inflammasome as the cholesterol crystal-responsive element in macrophages. The crystals were shown to induce leakage of the lysosomal protease cathepsin B into the cytoplasm and inhibition of this enzyme reduced cholesterol crystal-induced IL-1β secretion, suggesting that NLRP3 inflammasome activation occurred via lysosomal destabilization. Conclusions The cholesterol crystal-induced inflammasome activation in macrophages may represent an important link between cholesterol metabolism and inflammation in atherosclerotic lesions. PMID:20668705

  13. Unusual Presentation of Recurrent Pyogenic Bilateral Psoas Abscess Causing Bilateral Pulmonary Embolism by Iliac Vein Compression

    PubMed Central

    Ijaz, Mohsin; Sakam, Sailaja; Ashraf, Umair; Marquez, Jose Gomez

    2015-01-01

    Patient: Male, 47 Final Diagnosis: Bilateral psoas abscess • acute lower extremity deep vein thrombosis • bilateral pulmonary embolism Symptoms: Progressive left leg swelling • productive cough with whitish sputum • right flank pain Medication: Antibiotics and anticoagulation Clinical Procedure: CT-guided percutaneous drain placement Specialty: Internal Medicine/Critical Care Objective: Unusual presentation Background: Psoas abscesses are a known cause of back pain, but they have not been reported as a cause of acute lower extremity thromboses and bilateral pulmonary emboli. We report a patient with bilateral psoas abscesses causing extensive pulmonary emboli through compression of the iliac vein. Case Report: A 47-year-old man presented with bilateral leg swelling over 4 weeks. Physical examination revealed a thin male with bilateral leg swelling, extending to the thigh on his left side. He had hemoglobin of 10.5 g/dl, leukocytosis of 16 000/ml, and an elevated D-dimer. A computed tomography (CT) angiogram of his chest showed extensive bilateral pulmonary emboli and infarcts. He remained febrile with vague flank pain, prompting a CT of his abdomen and pelvis that showed large, multiloculated, septated, bilateral psoas abscesses with compression of the left femoral vein by the left psoas abscess and a thrombus distal to the occlusion. Two liters of pus was drained from the left psoas abscess by CT-guidance, and although the Gram staining showed Gram-positive cocci in clusters, cultures from the abscess and blood were negative. A repeat CT showed resolution of the abscesses, and the drain was removed. He was discharged to a nursing home to complete a course of intravenous antibiotics and anticoagulation. Conclusions: Although the infectious complications of psoas abscesses have been described in the literature, the mechanical complications of bilateral psoas abscesses are lacking. It is important to assess for complete resolution of psoas abscesses through

  14. Fat embolism syndrome

    PubMed Central

    George, Jacob; George, Reeba; Dixit, R.; Gupta, R. C.; Gupta, N.

    2013-01-01

    Fat embolism syndrome is an often overlooked cause of breathlessness in trauma wards. Presenting in a wide range of clinical signs of varying severity, fat embolism is usually diagnosed by a physician who keeps a high degree of suspicion. The clinical background, chronology of symptoms and corroborative laboratory findings are instrumental in a diagnosis of fat embolism syndrome. There are a few diagnostic criteria which are helpful in making a diagnosis of fat embolism syndrome. Management is mainly prevention of fat embolism syndrome, and organ supportive care. Except in fulminant fat embolism syndrome, the prognosis is usually good. PMID:23661916

  15. Pulmonary embolism

    SciTech Connect

    Dunnick, N.R.; Newman, G.E.; Perlmutt, L.M.; Braun, S.D.

    1988-11-01

    Pulmonary embolism is a common medical problem whose incidence is likely to increase in our aging population. Although it is life-threatening, effective therapy exists. The treatment is not, however, without significant complications. Thus, accurate diagnosis is important. Unfortunately, the clinical manifestations of pulmonary embolism are nonspecific. Furthermore, in many patients the symptoms of an acute embolism are superimposed on underlying chronic heart or lung disease. Thus, a high index of suspicion is needed to identify pulmonary emboli. Laboratory parameters, including arterial oxygen tensions and electrocardiography, are as nonspecific as the clinical signs. They may be more useful in excluding another process than in diagnosing pulmonary embolism. The first radiologic examination is the chest radiograph, but the clinical symptoms are frequently out of proportion to the findings on the chest films. Classic manifestations of pulmonary embolism on the chest radiograph include a wedge-shaped peripheral opacity and a segmental or lobar diminution in vascularity with prominent central arteries. However, these findings are not commonly seen and, even when present, are not specific. Even less specific findings include cardiomegaly, pulmonary infiltrate, elevation of a hemidiaphragm, and pleural effusion. Many patients with pulmonary embolism may have a normal chest radiograph. The chest radiograph is essential, however, for two purposes. First, it may identify another cause of the patient's symptoms, such as a rib fracture, dissecting aortic aneurysm, or pneumothorax. Second, a chest radiograph is essential to interpretation of the radionuclide V/Q scan. The perfusion scan accurately reflects the perfusion of the lung. However, a perfusion defect may result from a variety of etiologies. Any process such as vascular stenosis or compression by tumor may restrict blood flow. 84 references.

  16. Ursodeoxycholic acid impairs atherogenesis and promotes plaque regression by cholesterol crystal dissolution in mice.

    PubMed

    Bode, Niklas; Grebe, Alena; Kerksiek, Anja; Lütjohann, Dieter; Werner, Nikos; Nickenig, Georg; Latz, Eicke; Zimmer, Sebastian

    2016-09-01

    Atherosclerosis is a chronic inflammatory disease driven primarily by a continuous retention of cholesterol within the subendothelial space where it precipitates to form cholesterol crystals (CC). These CC trigger a complex inflammatory response through activation of the NLRP3 inflammasome and promote lesion development. Here we examined whether increasing cholesterol solubility with ursodeoxycholic acid (UDCA) affects vascular CC formation and ultimately atherosclerotic lesion development. UDCA mediated intracellular CC dissolution in macrophages and reduced IL-1β production. In ApoE(-/-) mice, UDCA treatment not only impaired atherosclerotic plaque development but also mediated regression of established vascular lesions. Importantly, mice treated with UDCA had decreased CC-depositions in atherosclerotic plaques compared to controls. Together, our data demonstrate that UDCA impaired CC and NLRP3 dependent inflammation by increasing cholesterol solubility and diminished atherosclerosis in mice. PMID:27416761

  17. Endovascular embolization

    MedlinePlus

    Treatment - endovascular embolism; Coil embolization; Cerebral aneurysm - endovascular; Coiling - endovascular; Saccular aneurysm - endovascular; Berry aneurysm - endovascular repair; Fusiform aneurysm repair - endovascular; Aneurysm repair - endovascular

  18. Anticoagulant Treatment of Deep Vein Thrombosis and Pulmonary Embolism: The Present State of the Art

    PubMed Central

    Thaler, Johannes; Pabinger, Ingrid; Ay, Cihan

    2015-01-01

    Venous thromboembolism (VTE), a disease entity comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a frequent and potentially life-threatening event. To date different agents are available for the effective treatment of acute VTE and the prevention of recurrence. For several years, the standard of care was the subcutaneous application of a low molecular weight heparin (LMWH) or fondaparinux, followed by a vitamin K antagonist (VKA). The so-called direct oral anticoagulants (DOAC) were introduced rather recently in clinical practice for the treatment of VTE. DOAC seem to have a favorable risk-benefit profile compared to VKA. Moreover, DOAC significantly simplify VTE treatment because they are administered in fixed doses and no routine monitoring is needed. Patients with objectively diagnosed DVT or PE should receive therapeutic anticoagulation for a minimum of 3 months. Whether a patient ought to receive extended treatment needs to be evaluated on an individual basis, depending mainly on risk factors determined by characteristics of the thrombotic event and patient-related factors. In specific patient groups (e.g., pregnant women, cancer patients, and elderly patients), treatment of VTE is more challenging than that in the general population and additional issues need to be considered in those patients. The aim of this review is to give an overview of the currently available treatment modalities of acute VTE and secondary prophylaxis. In particular, specific aspects regarding the initiation of VTE treatment, duration of anticoagulation, and specific patient groups will be discussed. PMID:26664901

  19. Pulmonary Embolism in Ischemic Stroke: Clinical Presentation, Risk Factors, and Outcome

    PubMed Central

    Pongmoragot, Jitphapa; Rabinstein, Alejandro A.; Nilanont, Yongchai; Swartz, Richard H.; Zhou, Limei; Saposnik, Gustavo

    2013-01-01

    Background Limited information is available on the frequency of pulmonary embolism (PE) in patients with an acute ischemic stroke (AIS). We evaluated clinical characteristics, predisposing factors, and outcomes in AIS patients with PE. Methods and Results We included all AIS patients admitted to participating institutions in the Registry of the Canadian Stroke Network. Clinically PE was documented by a physician and confirmed by computed tomography pulmonary angiography within 30 days of the stroke case index. The primary outcome was death or disability at discharge. Secondary outcomes included disposition, length of hospital stay, mortality at 3 months and 1 year. Among 11 287 patients with AIS, PE was found in 89 (0.78%) patients. History of cancer, deep vein thrombosis (DVT)/PE, and DVT during the hospitalization were associated with PE. PE was associated with higher risk of death at 30 days (25.8% versus 13.6%; P<0.001), at 1 year (47.2% versus 24.6%; P<0.001), and disability at discharge (85.4% versus 63.6%; P<0.001). Mean length of stay was longer in stroke patients with PE (36 versus 16 days; P=0.001). After adjusting for age, sex, and stroke severity, PE remained associated with lower survival at 30 days and 1 year, and death or disability at discharge (OR 3.02; 95% CI 1.56 to 5.83). Conclusions In this large cohort study, PE occurred in nearly 1% of AIS patients. PE was more common in patients with severe stroke, history of cancer, previous DVT/PE or acute DVT and associated with lower short‐ and long‐term survival, greater disability, and longer length of stay. PMID:24275627

  20. Pulmonary Embolism

    MedlinePlus

    ... pulmonary embolism is a sudden blockage in a lung artery. The cause is usually a blood clot ... loose and travels through the bloodstream to the lung. Pulmonary embolism is a serious condition that can ...

  1. Vertebral Arteriovenous Fistula Presenting as Cervical Myelopathy: A Rapid Recovery with Balloon Embolization

    SciTech Connect

    Modi, Manish; Bapuraj, J. Rajiv; Lal, Anupam; Prabhakar, S.; Khandelwal, N.

    2010-12-15

    A 24-year-old male presented with progressive cervical myelopathy of 2 months' duration. Magnetic resonance imaging of the cervical spine and angiography revealed a large arteriovenous fistula arising from the left vertebral artery. The present case highlights the clinical features and dramatic recovery following endovascular balloon occlusion of a giant cervical arteriovenous fistula.

  2. [Pulmonary embolism].

    PubMed

    Söffker, Gerold; Kluge, Stefan

    2015-01-01

    Acute pulmonary embolism is an important differential diagnosis of acute chest pain. The clinical signs are often non-specific. However, diagnosis and therapy must be done quickly in order to reduce morbidity and mortality. The new (2014) European guidelines for acute pulmonary embolism (PE) focus on risk-adapted diagnostic algorithms and prognosis adapted therapy concepts. According to the hemodynamic presentation the division in a high-risk group (unstable patient with persistent hypotension or shock) or in non-high-risk groups (hemodynamically stable) was proposed. In the high-risk group the immediate diagnosis is usually done by multidetector spiral computed tomography (MDCT) and primarily the medical therapy of right ventricular dysfunction and thrombolysis is recommended.In the non-high-risk group, this is subdivided into an intermediate-risk group and low-risk group, the diagnosis algorithm based on the PE-pretest probability--determined by validated scores. Moreover, the diagnosis is usually secured by MDCT--the new gold standard in the PE-diagnosis, scores, or it can be primarily ruled out due to the high negative predictive value of D-dimer determination. To improve the prognostic risk stratification in non-high-risk group patients the additional detection of right ventricular dysfunction (MDCT, echocardiography), cardiac biomarkers (troponin, NT proBNP) and validated scores (e.g. Pulmonary Embolism Severity Index) is recommended. Therefore, the intermediate-risk group can be further subdivided. For treatment of non-high-risk group patients, the initial anticoagulation (except those with severe renal insufficiency) using low molecular weight heparin/fondaparinux and conversion to vitamin-K antagonists or alternatively with direct oral anticoagulants (DOAK) is recommended. Hemodynamically stable patients with right ventricular dysfunction and myocardial ischemia (Intermediate-high-risk group patients) but with clinically progressive hemodynamic

  3. Pulmonary embolism

    PubMed Central

    Tarbox, Abigail K.; Swaroop, Mamta

    2013-01-01

    Pulmonary embolism (PE) is responsible for approximately 100,000 to 200,000 deaths in the United States each year. With a diverse range of clinical presentations from asymptomatic to death, diagnosing PE can be challenging. Various resources are available, such as clinical scoring systems, laboratory data, and imaging studies which help guide clinicians in their work-up of PE. Prompt recognition and treatment are essential for minimizing the mortality and morbidity associated with PE. Advances in recognition and treatment have also enabled treatment of some patients in the home setting and limited the amount of time spent in the hospital. This article will review the risk factors, pathophysiology, clinical presentation, evaluation, and treatment of PE. PMID:23724389

  4. Pulmonary Embolism

    MedlinePlus

    ... is a sudden blockage in a lung artery. The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lung. Pulmonary embolism is a ...

  5. The effects of the 3-hydroxy, 3-methylglutaryl coenzyme A reductase inhibitor pravastatin on bile composition and nucleation of cholesterol crystals in cholesterol gallstone disease.

    PubMed

    Smit, J W; van Erpecum, K J; Renooij, W; Stolk, M F; Edgar, P; Doornewaard, H; Vanberge-Henegouwen, G P

    1995-06-01

    3-hydroxy,3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors reduce biliary cholesterol saturation index (CSI) in duodenal bile in hypercholesterolemic patients and might be useful for gallstone dissolution. However, preliminary data suggest that these drugs are not effective in this respect. We therefore studied 33 patients with radiolucent gallstones in an opacifying gallbladder who were scheduled for elective cholecystectomy. Patients were treated with 40 mg pravastatin day-1 or placebo during the 3 weeks before surgery. Six patients could not be evaluated. Baseline characteristics (age, sex, body mass index, serum cholesterol, and the solitary/multiple gallstone ratio) were similar in both groups. Serum cholesterol fell by 39% in the pravastatin group (P < .001) and remained unchanged in the placebo group. Biliary cholesterol (9.5 +/- 1.3 vs. 14.3 +/- 1.5 mmol/L, P = .026), and phospholipid concentrations (24.8 +/- 3.9 vs. 36.7 +/- 3.9 mmol/L, P = .043) were lower in the pravastatin group. Although bile salt concentrations were lower in the pravastatin group (114 +/- 21 vs. 152 +/- 15 mmol/L), this difference was not significant. CSI was not different between both groups (142 +/- 27% [pravastatin] vs. 113 +/- 6% [placebo], P = NS). Cholesterol crystals were present in fresh bile in 7 of 13 patients in the pravastatin group and in 11 of 14 controls (P = NS). Nucleation time was comparable between the 2 groups (13 +/- 3 vs. 9 +/- 3 days, P = NS). Bile salt species and molecular species of phospholipids determined with high-performance liquid chromatography did not differ either between both groups.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7768495

  6. Cholesterol Crystals Activate the Lectin Complement Pathway via Ficolin-2 and Mannose-Binding Lectin: Implications for the Progression of Atherosclerosis.

    PubMed

    Pilely, Katrine; Rosbjerg, Anne; Genster, Ninette; Gal, Peter; Pál, Gábor; Halvorsen, Bente; Holm, Sverre; Aukrust, Pål; Bakke, Siril Skaret; Sporsheim, Bjørnar; Nervik, Ingunn; Niyonzima, Nathalie; Bartels, Emil D; Stahl, Gregory L; Mollnes, Tom Eirik; Espevik, Terje; Garred, Peter

    2016-06-15

    Cholesterol crystals (CC) play an essential role in the formation of atherosclerotic plaques. CC activate the classical and the alternative complement pathways, but the role of the lectin pathway is unknown. We hypothesized that the pattern recognition molecules (PRMs) from the lectin pathway bind CC and function as an upstream innate inflammatory signal in the pathophysiology of atherosclerosis. We investigated the binding of the PRMs mannose-binding lectin (MBL), ficolin-1, ficolin-2, and ficolin-3, the associated serine proteases, and complement activation products to CC in vitro using recombinant proteins, specific inhibitors, as well as deficient and normal sera. Additionally, we examined the deposition of ficolin-2 and MBL in human carotid plaques by immunohistochemistry and fluorescence microscopy. The results showed that the lectin pathway was activated on CC by binding of ficolin-2 and MBL in vitro, resulting in activation and deposition of complement activation products. MBL bound to CC in a calcium-dependent manner whereas ficolin-2 binding was calcium-independent. No binding was observed for ficolin-1 or ficolin-3. MBL and ficolin-2 were present in human carotid plaques, and binding of MBL to CC was confirmed in vivo by immunohistochemistry, showing localization of MBL around CC clefts. Moreover, we demonstrated that IgM, but not IgG, bound to CC in vitro and that C1q binding was facilitated by IgM. In conclusion, our study demonstrates that PRMs from the lectin pathway recognize CC and provides evidence for an important role for this pathway in the inflammatory response induced by CC in the pathophysiology of atherosclerosis. PMID:27183610

  7. Fat embolism syndrome.

    PubMed

    Taviloglu, Korhan; Yanar, Hakan

    2007-01-01

    Fat embolism syndrome (FES) was first described in 1862, but its frequency today is still unclear. A diagnosis of FES is often missed because of a subclinical illness or coexisting confusing injuries or disease. Fat embolism syndrome develops most commonly after orthopedic injuries, but it has also been reported after other forms of trauma such as severe burns, liver injury, closed-chest cardiac massage, bone marrow transplantation, and liposuction. Although FES usually presents as a multisystem disorder, the most seriously affected organs are the lung, brain, cardiovascular system, and skin. Fat embolism syndrome is a self-limiting disease and treatment should be mainly supportive. Many drugs have been used to treat FES, but the results are inconclusive. PMID:17186337

  8. Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

    SciTech Connect

    Arrayeh, Elnasif; Fidelman, Nicholas Gordon, Roy L.; LaBerge, Jeanne M.; Kerlan, Robert K.; Klimov, Alexander; Bloom, Allan I.

    2012-12-15

    Purpose: To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically. Methods: Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared.ResultsFor patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006). Conclusion: Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.

  9. Fat embolism after liposuction.

    PubMed

    Ross, R M; Johnson, G W

    1988-06-01

    We present a case of adult respiratory distress syndrome (ARDS) after extensive liposuction. On the basis of fever, tachypnea, hypoxia, and ARDS occurring within 48 hours after surgery without evidence of cardiogenic pulmonary edema or sepsis, the etiology is believed to be fat embolism. Although liposuction is generally an effective and safe procedure, awareness of this life-threatening complication is important in order to institute prompt and appropriate treatment. Fat embolism must be differentiated from thromboembolism, as the treatment is different, and heparin is not indicated. It is recommended that training standards and guidelines be devised in order to reduce morbidity and mortality associated with this procedure. PMID:3371109

  10. Renal Artery Stump to Inferior Vena Cava Fistula: Unusual Clinical Presentation and Transcatheter Embolization with the Amplatzer Vascular Plug

    SciTech Connect

    Taneja, Manish; Lath, Narayan Soo, Tan Bien; Hiong, Tay Kiang; Htoo, Maung Myint; Richard, Lo; Fui, Alexander Chung Yaw

    2008-07-15

    Fistulous communication between the renal artery stump and inferior vena cava following nephrectomy is rare. We describe the case of a 52-year-old man with a fistula detected on investigation for hemolytic anemia in the postoperative period. The patient had had a nephrectomy performed 2 weeks prior to presentation for blunt abdominal trauma. The fistula was successfully occluded percutaneously using an Amplatzer vascular plug. The patient recovered completely and was discharged 2 weeks later.

  11. Amniotic fluid embolism

    PubMed Central

    Kaur, Kiranpreet; Bhardwaj, Mamta; Kumar, Prashant; Singhal, Suresh; Singh, Tarandeep; Hooda, Sarla

    2016-01-01

    Amniotic fluid embolism (AFE) is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion. The pathophysiology of AFE is not completely understood. Possible historical cause is that any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation. The presenting signs and symptoms of AFE involve many organ systems. Clinical signs and symptoms are acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy etc. Besides basic investigations lung scan, serum tryptase levels, serum levels of C3 and C4 complements, zinc coproporphyrin, serum sialyl Tn etc are helpful in establishing the diagnosis. Treatment is mainly supportive, but exchange transfusion, extracorporeal membrane oxygenation, and uterine artery embolization have been tried from time to time. The maternal prognosis after amniotic fluid embolism is very poor though infant survival rate is around 70%. PMID:27275041

  12. Amniotic fluid embolism.

    PubMed

    Kaur, Kiranpreet; Bhardwaj, Mamta; Kumar, Prashant; Singhal, Suresh; Singh, Tarandeep; Hooda, Sarla

    2016-01-01

    Amniotic fluid embolism (AFE) is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion. The pathophysiology of AFE is not completely understood. Possible historical cause is that any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation. The presenting signs and symptoms of AFE involve many organ systems. Clinical signs and symptoms are acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy etc. Besides basic investigations lung scan, serum tryptase levels, serum levels of C3 and C4 complements, zinc coproporphyrin, serum sialyl Tn etc are helpful in establishing the diagnosis. Treatment is mainly supportive, but exchange transfusion, extracorporeal membrane oxygenation, and uterine artery embolization have been tried from time to time. The maternal prognosis after amniotic fluid embolism is very poor though infant survival rate is around 70%. PMID:27275041

  13. Amniotic fluid embolism.

    PubMed

    Clark, Steven L

    2014-02-01

    Amniotic fluid embolism remains one of the most devastating conditions in obstetric practice with an incidence of approximately 1 in 40,000 deliveries and a reported mortality rate ranging from 20% to 60%. The pathophysiology appears to involve an abnormal maternal response to fetal tissue exposure associated with breaches of the maternal-fetal physiologic barrier during parturition. This response and its subsequent injury appear to involve activation of proinflammatory mediators similar to that seen with the classic systemic inflammatory response syndrome. Progress in our understanding of this syndrome continues to be hampered by a lack of universally acknowledged diagnostic criteria, the clinical similarities of this condition to other types of acute critical maternal illness, and the presence of a broad spectrum of disease severity. Clinical series based on population or administrative databases that do not include individual chart review by individuals with expertise in critical care obstetrics are likely to both overestimate the incidence and underestimate the mortality of this condition by the inclusion of women who did not have amniotic fluid embolism. Data regarding the presence of risk factors for amniotic fluid embolism are inconsistent and contradictory; at present, no putative risk factor has been identified that would justify modification of standard obstetric practice to reduce the risk of this condition. Maternal treatment is primarily supportive, whereas prompt delivery of the mother who has sustained cardiopulmonary arrest is critical for improved newborn outcome. PMID:24402585

  14. Complications and Their Management During NBCA Embolization of Craniospinal Lesions

    PubMed Central

    Niimi, Y.; Berenstein, A.; Setton, A.

    2003-01-01

    Summary Technical complications during embolization of craniospinal lesions using NBCA may be classified as nonspecific catheterization-related or specific embolization-related. Catheterization-related complications include vessel injuries such as spasm, dissection or perforation, catheter injuries and thrombus formation. Embolization-related complications include occlusion of normal territories, migration of the embolic material to the venous side, and catheter gluing to the vessel wall. Causes, prevention and management of each complication are discussed with presentation of demonstrative cases. PMID:20591246

  15. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery

    PubMed Central

    Schrufer-Poland, Tabitha; Singh, Paul; Jodicke, Cristiano; Reynolds, Sara; Maulik, Dev

    2014-01-01

    Introduction Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality. PMID:26199788

  16. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery.

    PubMed

    Schrufer-Poland, Tabitha; Singh, Paul; Jodicke, Cristiano; Reynolds, Sara; Maulik, Dev

    2015-04-01

    Introduction Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality. PMID:26199788

  17. Pulmonary Embolism Following Outpatient Vasectomy

    PubMed Central

    Mott, Frank E.; Farooqi, Bilal; Moore, Harry

    2016-01-01

    Venous thromboembolic events have several known major risk factors such as prolonged immobilization or major surgery. Pulmonary embolism has rarely been reported after an outpatient vasectomy was completed. We present the rare case of a healthy 32-year-old Caucasian male with no known risk factors who presented with pleuritic chest pain 26 days after his outpatient vasectomy was performed. Subsequently, he was found to have a pulmonary embolism as per radiological imaging. We explore the association between outpatient vasectomies and venous thromboembolic events. A review of the literature is also included. PMID:26989373

  18. Pulmonary Embolism Following Outpatient Vasectomy.

    PubMed

    Mott, Frank E; Farooqi, Bilal; Moore, Harry

    2016-02-01

    Venous thromboembolic events have several known major risk factors such as prolonged immobilization or major surgery. Pulmonary embolism has rarely been reported after an outpatient vasectomy was completed. We present the rare case of a healthy 32-year-old Caucasian male with no known risk factors who presented with pleuritic chest pain 26 days after his outpatient vasectomy was performed. Subsequently, he was found to have a pulmonary embolism as per radiological imaging. We explore the association between outpatient vasectomies and venous thromboembolic events. A review of the literature is also included. PMID:26989373

  19. Two Microcatheter Technique for Embolization of Arteriovenous Fistula with Liquid Embolic Agent

    PubMed Central

    Zhao, Lin-Bo; Shim, Jae Ho; Lee, Dong-geun

    2014-01-01

    Problem with embolization of arteriovenous fistula (AVF) with liquid embolic agent is its over-penetration into the veins or regurgitation to the proximal feeder without reaching the shunt point. We present a technique that controls the flow of AVF during embolization. Two microcatheter technique consists of positioning one microcatheter close to the AVF for embolization, and with another microcatheter at the proximal feeding artery to control the AVF flow by coiling. Selective angiograms obtained using a distally positioned microcatheter before and after coiling, were compared how much stagnant effect was achieved. Using two microcatheter technique, AVF occlusion was achieved with good penetration of glue to the venous side of the AVF. Its advantage is the ability to push glue into the shunt without causing over-penetration of glue or its reflux along the feeder. Two microcatheter technique was safe and effective in glue embolization of AVF and also expected to be applied with other liquid embolic agent like Onyx. PMID:24642961

  20. Pulmonary and Cerebral Fat Embolism Syndrome After Total Knee Replacement

    PubMed Central

    Yeo, Soo Hyun; Chang, Hyuk Won; Sohn, Sung Il; Cho, Chul Hyun; Bae, Ki-Cheor

    2013-01-01

    Fat embolism occurs after long bone fracture or orthopedic surgery and usually shows mild symptom. But it rarely results in fat embolism syndrome, presenting as multiorgan dysfunction such as lung, brain and skin. Although the diagnosis of fat embolism syndrome is mostly based on clinical features, we experienced fat embolism syndrome involving lung and brain, showing typical imaging findings in pulmonary computed tomography and brain magnetic resonance image. So we present interesting case about fat embolism syndrome after total knee replacement with reviewing associated literatures including imaging findings. PMID:23671550

  1. Transcatheter Embolization of Pseudoaneurysms Complicating Pancreatitis

    SciTech Connect

    Golzarian, Jafar; Nicaise, Nicole; Deviere, Jacques; Ghysels, Marc; Wery, Didier; Dussaussois, Luc; Gansbeke, Daniel van; Struyven, Julien

    1997-11-15

    Purpose: To evaluate the therapeutic role of angiography in patients with pseudoaneurysms complicating pancreatitis. Methods: Thirteen symptomatic pseudoaneurysms were treated in nine patients with pancreatitis. Eight patients had chronic pancreatitis and pseudocyst and one had acute pancreatitis. Clinical presentation included gastrointestinal bleeding in seven patients and epigastric pain without bleeding in two. All patients underwent transcatheter embolization. Results: Transcatheter embolization resulted in symptomatic resolution in all patients. Rebleeding occurred in two patients, 18 and 28 days after embolization respectively, and was successfully treated by repeated emnbolization. One patient with severe pancreatitis died from sepsis 28 days after embolization. Follow-up was then available for eight patients with no relapse of bleeding after a mean follow-up of 32 months (range 9-48 months). Conclusion: Transcatheter embolization is safe and effective in the management of pseudoaneurysms complicating pancreatitis.

  2. Paradoxical embolism interrupted.

    PubMed

    Desai, Ravi; Ayub, Bilal; Martinez, Matthew W

    2014-02-01

    A 41 year-old African-American male presented with syncope preceded by shortness of breath at outside facility and transferred to us for management of extensive pulmonary embolism with unstable vital signs. Electrocardiogram showed sinus tachycardia with S1Q3T3 pattern. A transthoracic echocardiogram revealed a freely mobile strand like mass in the left atrium. A transoesophageal echocardiogram showed a very large freely mobile thrombus extending from a patent foramen ovale in to the left atrium. He underwent emergent surgery for the extraction of clot followed by thromboembolectomy from both pulmonary arteries. He made a remarkable recovery and was discharged after seven days of hospital stay. PMID:23764146

  3. [Amniotic fluid embolism].

    PubMed

    António, Carlos; Marçal, Nelson; Lopes, Carlos; Tortosa, Francisco; Acevedo, Pilar; Monteiro, Jorge; Monteiro, Filipe; Correia, Llurdes; Brum, Ganriela; De Almeida, A Bugalho

    2011-01-01

    Amniotic fluid embolism (AFE) is a rare pathological syndrome, sometimes fatal that arises as an obstetric complication during vaginal delivery, caesarean, immediate postpartum or during pregnancy. It remains as an important cause of fetal and maternal morbidity and mortality. The authors present a clinical report of a young woman who developed an acute respiratory failure during labour demanding invasive mechanical ventilation and an urgent caesarean. In spite of early medical intensive therapy, hypoxemia was refractory and had a progressive worsening leading to multi-organ failure and ultimately to death. Diagnosis was confirmed through the identification of fetal material in the lumen of maternal pulmonary microcirculation. PMID:22713206

  4. Traumatic fat embolism syndrome.

    PubMed

    Al-Khuwaitir, Tarig S; Al-Moghairi, Abdurahman M; Sherbeeni, Suphia M; Subh, Hamed M

    2002-12-01

    Traumatic fat embolism syndrome occurs most often following fractures of long bones sustained in road traffic accidents and is a common cause of medical consultation from the orthopedic surgery department. The sub-clinical presentation is subtle and expresses itself by the presence of hypoxemia, while the full clinical syndrome compromises respiratory insufficiency, an altered consciousness and a characteristic petechial rash. Recognition is simple once the patient is viewed in the context of his or her clinical setting. Diagnosis is aided further by the presence of hematological and biochemical abnormalities including anemia, thrombocytopenia, an elevated erythrocyte sedimentation rate and fat macroglobulinemia. Imaging by chest radiograph, computed tomography or magnetic resonance of the brain is used to confirm the extent of the respective organ involvement and to exclude alternative pathologies. The release of free fatty acids into the circulation and their subsequent effects is the key pathological event. Treatment is based on supportive care and high-dose corticosteroid therapy. We report a patient with traumatic fat embolism syndrome who developed the syndromes classical symptoms and signs following fracture of the long bones of his left lower leg. Admission to an intensive care unit, mechanical ventilatory support with positive end-expiratory pressure and corticosteroid therapy lead to his improvement and allowed eventual open reduction and internal fixation and discharge of our patient. Modern therapy offers a relatively good prognosis for patients with traumatic fat embolism syndrome; the optimal dose and timing of corticosteroid therapy in prophylaxis and treatment however, remain the subject of intense debate. PMID:12518208

  5. [Morphological diagnostics of fat embolism].

    PubMed

    Dorosevich, A E; Dmitriev, I V

    2016-01-01

    The present review of the literature concerns the problem of morphological diagnostics of fat embolism, i.e. mechanical obturation of multiple blood vessels with fat globules, that can be detected by a variety of methods including polarization microscopy, staining of native, frozen, and paraffin-embedded histological sections with the use of immunohistochemical techniques, electron microscopy, etc. PMID:27144263

  6. Pulmonary imaging in fat embolism syndrome.

    PubMed

    Park, H M; Ducret, R P; Brindley, D C

    1986-07-01

    Ventilation/perfusion lung scanning can be used to effectively detect fat embolism following skeletal trauma. Typical ventilation/perfusion findings may be present when the chest radiograph is normal, and clinical findings are equivocal. PMID:3731656

  7. [Posttraumatic fat embolism].

    PubMed

    Bouffard, Y; Guillaume, C; Perrot, D; Delafosse, B; Motin, J

    1984-01-01

    Between 1977 and 1982, fifty cases of post-traumatic fat embolism were treated in a general intensive care unit. Average age of patients was 25.5 +/- 13 years; there was no male majority. Mean free interval was 39 +/- 27 h. 12 cases (24%) had single fractures and 38 (76%) multiple fractures. Forty-four patients had a fractured femur. Thirty-two patients presented the complete clinical syndrome with general, respiratory, neurological and cutaneous signs. Thrombocytopaenia and hypocholesterolaemia were the biological signs most often seen. In forty-four patients, orthopaedic treatment consisted of immediate immobilization, usually with traction. Twenty-six patients were reoperated on: intramedullary nail for twenty patients, plate for the other six. Fat embolism appeared in spite of surgery in six cases; it worsened after surgery in six others. Seven patients had per- or postanaesthetic problems. Fourteen per cent of patients died. The decrease in mortality was mainly due to an improvement in mechanical ventilation techniques. Early surgical fixation remained the rule if there was no serious respiratory distress or haemodynamic instability, although it did not seem to change the mortality rate in this group of patients. PMID:6497076

  8. Massive pulmonary embolism: the place for embolectomy

    PubMed Central

    Buckels, N J; Mulholland, C; Galvin, I; Gladstone, D; Cleland, J

    1988-01-01

    Untreated massive pulmonary embolism is associated with a high mortality. Pulmonary embolectomy has been largely superceded by thrombolytic therapy, but there are cases in which pulmonary embolectomy remains the treatment of choice. We present three case reports and discuss the merits of the various treatments available for massive pulmonary embolism. The primary treatment of massive pulmonary embolism should be thrombolytic therapy, but for patients who are at risk of haemorrhage following surgery, who are in cardiogenic shock despite medical treatment, or fail to improve following cardiac arrest, then pulmonary embolectomy remains the treatment of choice. ImagesFig 1Fig 2Fig 3 PMID:3232251

  9. Fat embolism syndrome following bone marrow harvesting.

    PubMed

    Baselga, J; Reich, L; Doherty, M; Gulati, S

    1991-06-01

    A case of fat embolism syndrome is reported following an uncomplicated bone marrow harvest. The presenting symptoms were restlessness, shortness of breath and arterial hypoxemia. A lung perfusion scan ruled out the presence of a lung thromboembolism. The patient received supportive therapy and recovered within a few hours. We speculate that the larger gauge needle (13 vs 15) used to aspirate the bone marrow may have represented increased trauma to the iliac crest leading to fat embolism. PMID:1873595

  10. Diagnosis of pulmonary embolism.

    PubMed

    Iber, C; Sirr, S

    1988-09-01

    Pulmonary embolism (PE) is often unrecognized or misdiagnosed because of the lack of specificity of clinical signs and symptoms. PE shares many of the clinical features of pneumonia and is therefore often unrecognized in elderly patients who present with low-grade fever, modest leukocytosis, and pulmonary infiltrates. Assessment of clinical risk factors increases the usefulness of diagnostic tests. The accuracy of diagnosis is improved if specific tests are performed. Ventilation-perfusion lung scans, noninvasive or contrast venography, and pulmonary angiography increase the likelihood of correct diagnosis. Since pulmonary angiography is a relatively low-risk procedure, it should be performed in most patients suspected of having PE who have nondiagnostic lung scans and negative lower extremity venous studies. PMID:3055112

  11. [Pulmogenic air embolism].

    PubMed

    Adebahr, G

    1985-01-01

    Interstitial emphysema and pulmonic hemorrhage alone are not the causes of pulmonic air embolism. The conditions making the entrance of air from the lungs to the vessels of pulmonary circulation are obviously present only if the expiration pressure is suddenly strongly elevated. Based on this point of view, investigations were performed in autopsy cases--falls from a height, being run over, a gunshot in the abdomen. We have succeeded in proving the entrance of air into capillaries and branches of the pulmonary vein. The precipitation of thrombocytes at the margin of large air bubbles in pulmonary veins shows the finding of air in the vessels as a vital or supravital reaction. PMID:4090761

  12. Serum and urinary enzyme activities in renal artery embolism.

    PubMed

    Donadio, C; Auner, I; Giordani, R; Lucchetti, A; Pentimone, F

    1986-10-31

    Renal artery embolism is not a rare occurrence, especially in patients with valvular heart disease, but the early diagnosis of this condition is infrequently accomplished. We report the clinical and laboratory data of 2 patients with valvular heart disease who presented with unilateral renal artery embolization. The usefulness of the determination of serum and urinary enzymes and renal function tests is discussed. We propose that these parameters support an earlier and more accurate diagnosis of renal artery embolism. PMID:2877758

  13. Successful Embolization of an Ovarian Artery Pseudoaneurysm Complicating Obstetric Hysterectomy

    SciTech Connect

    Rathod, Krantikumar R Deshmukh, Hemant L; Asrani, Ashwin; Salvi, Vinita S; Prabhu, Santoshi

    2005-01-15

    Transcatheter arterial embolization is becoming the therapy of choice for controlling obstetric hemorrhage, affording the ability to control persistent bleeding from pelvic vessels while avoiding the morbidity of surgical exploration. The clinicians are left with little choice if pelvic hemorrhage continues after hysterectomy and ligation of anterior division of both internal iliac arteries. We present one such case of intractable post-obstetric hysterectomy hemorrhage in which an ovarian artery pseudoaneurysm was diagnosed angiographically and successfully embolized, highlighting the role of transcatheter embolization.

  14. Glue embolism: a rare cause of pulmonary embolism.

    PubMed

    Ashraf, Pervez; Haqqi, Syed Afzal-ul-Haq; Shaikh, Hafeezullah; Wakani, Asif J

    2011-09-01

    N-butyl-2-cyanoacrylate is widely used to sclerose bleeding gastric varices. We report the case of a 65-year-old lady, known case of cirrhosis secondary to hepatitis C infection, who presented to the emergency department with coffee ground vomiting and melena for four days. Gastroscopy showed non-bleeding small esophageal varices, mild portal hypertensive gastropathy and a large gastric fundal varix. Injection sclerotherapy was completed successfully and haemostasis was secured. During the procedure, she was hemodynamically stable with an oxygen saturation of 98%. Immediately after the procedure, she went into cardiopulmonary arrest; cardiopulmonary resuscitation (CPR) was started, but she could not be revived. A provisional diagnosis of pulmonary embolism was made. X-ray chest showed linear hyperdense shadows in both pulmonary arteries and in some of their branches, which were not seen on pre-procedural chest X-ray. The patient died of massive pulmonary embolism as confirmed on X-ray chest. PMID:21914421

  15. Acute tumor lysis syndrome after proximal splenic artery embolization.

    PubMed

    Salsamendi, Jason T; Doshi, Mehul H; Gortes, Francisco J; Levi, Joe U; Narayanan, Govindarajan

    2016-06-01

    Preoperative splenic artery embolization for massive splenomegaly has been shown to reduce intraoperative hemorrhage during splenectomy. We describe a case of tumor lysis syndrome after proximal splenic artery embolization in a patient with advanced mantle cell lymphoma and splenic involvement. The patient presented initially with hyperkalemia two days after embolization that worsened during splenectomy. He was stabilized, but developed laboratory tumor lysis syndrome with renal failure and expired. High clinical suspicion of tumor lysis syndrome in this setting is advised. Treatment must be started early to avoid serious renal injury and death. Lastly, same day splenectomy and embolization should be considered to decrease the likelihood of developing tumor lysis syndrome. PMID:27257458

  16. Pulmonary embolism during delivery--treatment and outcome.

    PubMed

    Zamurović, M; Damnjanović, D

    2015-01-01

    Pulmonary embolism during delivery is not a frequent occurrence. It is often impossible to ascertain whether it is a case of embolism by amniotic fluid or thromboembolism. Diagnostics of pulmonary embolism in labor is based solely on clinical symptoms. Immediate interdisciplinary treatment with cardiopulmonary resuscitation, hemodynamic stabilization, and correction of haemostasis disorders play a decisive role in prognosis. This paper presents diagnostics, treatment, and consequences of pulmonary embolism in expulsion phase during delivery in epidural anesthesia of a multiparous patient aged 37. PMID:26753499

  17. Embolization of uterine arteriovenous malformation

    PubMed Central

    Chen, Yan; Wang, Guoyun; Xie, Fubo; Wang, Bo; Tao, Guowei; Kong, Beihua

    2013-01-01

    Background: Uterine arteriovenous malformation is a rare but potential life-threatening source of bleeding. A high index of suspicion and accurate diagnosis of the condition in a timely manor are essential because instrumentation that is often used for other sources of uterine bleeding can be lead to massive hemorrhage. Case: We describe here a case of uterine arteriovenous malformation. A 32-year-old woman presented abnormal vaginal bleeding following the induced abortion. A diagnosis of uterine arteriovenous malformation made on the basis of Doppler ultrasonraphy was confirmed through pelvic angiography. The embolization of bilateral uterine arteries was performed successfully. Conclusion: Uterine arteriovenous malformation should be suspected in patient with abnormal vaginal bleeding, especially who had the past medical history incluing cesarean section, induced abortion, or Dillation and Curethage and so on. Although angiography remains the gold standard, Doppler ultrasonography is also a good noninvasive technique. The transcatheter uterine artery embolization offers a safe and effective treatment PMID:24639742

  18. Foreign body pulmonary embolism.

    PubMed

    Rief, Peter; Belaj, Klara; Smaczny, Nicole; Augustin, Michael; Eller, Philipp; Brodmann, Marianne; Pilger, Ernst

    2013-06-01

    We report a case of a foreign body embolism caused by a tip of an explanted port-a-cath system. The embolus could be removed with a gooseneck snare catheter, the patient fully recovered. PMID:23765525

  19. Embolization of Brain Aneurysms and Fistulas

    MedlinePlus

    ... Professions Site Index A-Z Embolization of Brain Aneurysms and Arteriovenous Malformations/Fistulas Embolization of brain aneurysms ... Aneurysms and Fistulas? What is Embolization of Brain Aneurysms and Fistulas? Embolization of brain aneurysms and arteriovenous ...

  20. Experimental study of temperature-sensitive chitosan/β-glycerophosphate embolic material in embolizing the basicranial rete mirabile in swines

    PubMed Central

    NING, XIANBIN; ZHAO, CHANGFU; PANG, JINFENG; DING, ZHAOYI; WANG, YUBO; XU, KAN; CHEN, HAO; LI, BINGWEI; LUO, QI

    2015-01-01

    The aim of the present study was to evaluate the feasibility of the non-adhesive temperature-sensitive liquid embolic material, chitosan/β-glycerophosphate (C/GP), in embolizing the basicranial rete mirabile (REM) in a swine model of cerebral arteriovenous malformation (cAVM). A total of 24 domestic swines were used as the experimental animals, among which 12 pigs underwent direct embolization of one side of the REM, while the other 12 pigs underwent embolization of the bilateral REM following anastomosis of the carotid artery and jugular vein. A super-selective microcatheter was introduced into the REM during the embolization procedure, and the C/GP hydrogel was injected until an image of the REM disappeared in the angiography examination. Further angiography examinations were performed after 2 and 6 weeks, and histological examination of the REM was performed after 6 weeks. Of the 24 domestic swines, 23 cases underwent successful thrombosis. Convulsions occurred in one case and that pig died during the embolization procedure. Following embolization, the angiography observations revealed that the embolized REM was no longer able to be developed, and adhesion of the microcatheter tip with the embolic agent did not occur. In addition, no apparent revascularization was observed in the angiography examinations performed at weeks 2 and 6. Therefore, the current preliminary study indicated that use of the non-adhesive temperature-sensitive embolic material was feasible for the embolization of cAVM; thus, C/GP may be used as an ideal embolic material for the treatment of cAVM. PMID:26170955

  1. Spontaneous fracture and embolization of an inferior vena cava cannula: is it possible?

    PubMed

    Velasco Garcia de Sierra, Carlos; Marini Díaz, Milagros; Fernández Arias, Laura; Estévez Cid, Francisco

    2016-06-01

    We present a case of spontaneous fracture and embolization of the distal part of a cannula into the left inferior lobar artery. The embolized fragment was captured with an angioplasty balloon and extracted through the right atrium appendage. No adverse event related to the embolization was observed and the patient was discharged with no sequelae. PMID:26503726

  2. Crural Artery Traumatic Injuries: Treatment with Embolization

    SciTech Connect

    Lopera, Jorge E. Suri, Rajeev; Cura, Marco; Kroma, Ghazwan; El-Merhi, Fadi

    2008-05-15

    The purpose of this paper is to report our experience with the endovascular treatment of crural arterial injuries using transcatheter and direct embolization techniques. A total of eight consecutive patients have been treated during a 7-year period. Six males and two females, mean age 32 years (range, 15-56 years), presented with penetrating trauma to the lower extremities. Mechanisms of injuries were stab wounds in six patients, gun shot wound in one patient, and iatrogenic injury in one patient. Five patients presented with acute trauma, while three patients presented with delayed injuries. Crural arterial injuries encountered included pseudoaneurysms with arteriovenous fistulas (n = 6), pseudoaneurysms with vessel transections (n = 2), and pseudoaneurysm (n = 1). Proximal and distal embolization with coils was used in three cases, proximal embolization with coils in three cases, percutaneous thrombin injection in one case, and liquid n-butyl cyanoacrylate in one case. Complete exclusion of the lesions was accomplished by sacrifice of one crural vessel in seven cases and of two crural vessels in one case. Two cases of delayed injuries required combined coil and liquid embolization techniques for lesion exclusion. A minor complication (groin hematoma) occurred in one patient, no distal ischemia was seen, and no amputations were required. Mean follow-up was 61 days (range, 1-180 days). One pseudoaneurysm treated with thrombin injection recurred and required surgical excision. We conclude that transcatheter embolization alone or in combination with different endovascular techniques is useful in the treatment of traumatic crural vessel injuries.

  3. Episode of massive pulmonary embolism after bilateral breast augmentation

    PubMed Central

    Schonauer, Fabrizio; Nele, Gisella; Di Martino, Annalena; Santoro, Mariangela; Santanelli di Pompeo, Fabio

    2015-01-01

    Pulmonary embolism is a rare postsurgical complication, even more so following breast augmentation. Herein we present a case of a 23-year-old woman who survived an episode of massive pulmonary embolism after breast implant surgery. Current literature about this subject is very scarce.

  4. Pulmonary embolism and amniotic fluid embolism in pregnancy.

    PubMed

    Brennan, Matthew C; Moore, Lisa E

    2013-03-01

    Amniotic fluid embolism and pulmonary embolism are 2 of the most common causes of maternal mortality in the developed world. Symptoms of pulmonary embolism include tachycardia, tachypnea, and shortness of breath, all of which are common complaints in pregnancy. Heightened awareness leads to rapid diagnosis and institution of therapy. Amniotic fluid embolism is associated with maternal collapse. There are currently no proven therapies, although rapid initiation of supportive care may decrease the risk of mortality. PMID:23466134

  5. Permanent Cortical Blindness After Bronchial Artery Embolization

    SciTech Connect

    Doorn, Colette S. van De Boo, Diederick W.; Weersink, Els J. M.; Delden, Otto M. van Reekers, Jim A. Lienden, Krijn P. van

    2013-12-15

    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

  6. Renal Artery Embolization

    PubMed Central

    Sauk, Steven; Zuckerman, Darryl A.

    2011-01-01

    Renal artery embolization (RAE) is an effective minimally invasive alternative procedure for the treatment of a variety of conditions. Since the 1970s when RAE was first developed, technical advances and growing experience have expanded the indications to not only include treatment of conditions such as symptomatic hematuria and palliation for metastatic renal cancer, but also preoperative infarction of renal tumors, treatment of angiomyolipomas, vascular malformations, medical renal disease, and complications following renal transplantation. With the drastically improved morbidity associated with this technique in part due to the introduction of more precise embolic agents and smaller delivery catheters, RAE continues to gain popularity for various urologic conditions. The indications and techniques for renal artery embolization are reviewed in the following sections. PMID:23204638

  7. Cerebral air embolism caused by a bronchogenic cyst.

    PubMed

    Jung, Simon; Wiest, Roland; Frigerio, Susanna; Mattle, Heinrich P; Hess, Christian W

    2010-06-01

    An unusual case is presented of a tourist who developed fatal cerebral air embolism, pneumomediastinum and pneumopericardium while ascending from low altitude to Europe's highest railway station. Presumably the air embolism originated from rupture of the unsuspected bronchogenic cyst as a result of pressure changes during the ascent. Cerebral air embolism has been observed during surgery, in scuba diving accidents, submarine escapes and less frequently during exposure to very high altitude. People with known bronchogenic cysts should be informed about the risk of cerebral air embolism and surgical removal should be considered. Cerebral air embolism is a rare cause of coma and stroke in all activities with rapid air pressure changes, including alpine tourism, as our unfortunate tourist illustrates. PMID:20498190

  8. Fat embolism syndrome

    PubMed Central

    Kwiatt, Michael E.; Seamon, Mark J.

    2013-01-01

    Fat embolism syndrome (FES) is an ill-defined clinical entity that arises from the systemic manifestations of fat emboli within the microcirculation. Embolized fat within capillary beds cause direct tissue damage as well as induce a systemic inflammatory response resulting in pulmonary, cutaneous, neurological, and retinal symptoms. This is most commonly seen following orthopedic trauma; however, patients with many clinical conditions including bone marrow transplant, pancreatitis, and following liposuction. No definitive diagnostic criteria or tests have been developed, making the diagnosis of FES difficult. While treatment for FES is largely supportive, early operative fixation of long bone fractures decreases the likelihood of a patient developing FES. PMID:23724388

  9. Coronary embolism in valvular heart disease.

    PubMed

    Charles, R G; Epstein, E J; Holt, S; Coulshed, N

    1982-01-01

    Coronary embolism is considered to be rare but recent evidence suggests that it may be underdiagnosed, and implicated in acute myocardial infarction associated with angiographically normal coronary arteries. Twenty-six patients were studied. In six, coronary embolism was a primary cause of death confirmed at autopsy. In 20 patients, 23 episodes of coronary embolism were diagnosed clinically. The left coronary system was occluded in 65 per cent, transient electrocardiographic changes occurred in 30 per cent, and either no history or an atypical history of acute myocardial infarction occurred in 29 per cent. Other systemic emboli occurred in 25 per cent. Aortic valve lesions were present in 70 per cent and combined mitral and aortic valve disease in 55 per cent of the patients. The incidence of coronary risk factors was low. Sequelae included increased dyspnoea (35 per cent), ventricular aneurysm (25 per cent) and cardiac failure (12 per cent). Angina rarely followed acute myocardial infarction. PMID:7111677

  10. Pulmonary embolism, part II: Management

    PubMed Central

    Bĕlohlávek, Jan; Dytrych, Vladimír; Linhart, Aleš

    2013-01-01

    Acute pulmonary embolism (PE) bears a significant burden on health and survival. Rapid and accurate risk stratification and management are of paramount importance to ensure the highest quality of care. This present article summarizes currently available and emerging management strategies for the disease. The authors not only review current evidence regarding early therapy of acute PE, including supportive care, anticoagulation, thrombolysis, surgical and catheter-based treatment, but also the possible role of mechanical circulatory support in PE. The authors also discuss complications related to PE and its management. PMID:23940439

  11. Animal Models for Therapeutic Embolization

    SciTech Connect

    Moreira, Patricia L.; An, Yuehuei H.

    2003-04-15

    Embolization techniques have been performed in different animals to accumulate basic data before a clinical trial.Choosing the right embolization model for a specific project is critical. However, there are several variables when defining the best model for embolization research such as the size of the animal to be used, the target organs, the route of introducing the embolization agent, and the feasible methods of evaluation. Commonly used research animals for endovascular embolization include rabbits, dogs, and rats. Frequently used target organs are the kidney and the liver. Most models use a transcatheter for introducing the embolus and occasionally open surgery and direct arterial injection are used. Basic methods of evaluation are straightforward, and commonly include macro observation of the embolized organs, angiogram, and histology. This article concisely reviews the available animal models and their evaluation for embolization research to help researchers to choose the appropriate model.

  12. Uterine artery embolization

    MedlinePlus

    ... the procedure. UAE is less invasive than surgical treatments for uterine fibroids. Many women may return more quickly to activities ... SC, Spies JB, Worthington-Kirsch R, et al. Uterine artery embolization for ... from the FIBROID registry. Obstet Gynecol . 2008; 111:22-33. Munro ...

  13. DVT and pulmonary embolism: Part I. Diagnosis.

    PubMed

    Ramzi, Dino W; Leeper, Kenneth V

    2004-06-15

    The incidence of venous thromboembolic diseases is increasing as the U.S. population ages. At least one established risk factor is present in approximately 75 percent of patients who develop these diseases. Hospitalized patients and nursing home residents account for one half of all cases of deep venous thrombosis. A well-validated clinical prediction rule can be used for risk stratification of patients with suspected deep venous thrombosis. Used in combination with D-dimer or Doppler ultrasound tests, the prediction rule can reduce the need for contrast venography, as well as the likelihood of false-positive or false-negative test results. The inclusion of helical computed tomographic venography (i.e., a below-the-pelvis component) in pulmonary embolism protocols remains under evaluation. Specific combinations of a clinical prediction rule, ventilation-perfusion scanning, and D-dimer testing can rule out pulmonary embolism without an invasive or expensive investigation. A clinical prediction rule for pulmonary embolism is most helpful when it is used with subsequent evaluations such as ventilation-perfusion scanning, D-dimer testing, or computed tomography. Technologic advances are improving the resolution of helical computed tomography to allow detection of smaller emboli; however, further study is needed to provide definitive evidence supporting the role of this imaging technique in the diagnosis of pulmonary embolism. D-dimer testing is helpful clinically only when the result is negative. A negative D-dimer test can be used in combination with a clinical decision rule, ventilation-perfusion scanning, and/or helical computed tomography to lower the probability of pulmonary embolism to the point that aggressive treatment is not required. Evidence-based algorithms help guide the diagnosis of deep venous thrombosis and pulmonary embolism. PMID:15222648

  14. Acute Renal Failure after Uterine Artery Embolization

    SciTech Connect

    Rastogi, Sachin; Wu, Yu-Hsin; Shlansky-Goldberg, Richard D.; Stavropoulos, S. William

    2004-09-15

    Renal failure is a potential complication of any endovascular procedure using iodinated contrast, including uterine artery embolization (UAE). In this report we present a case of acute renal failure (ARF) following UAE performed as a treatment for uterine fibroids. The likely causes of ARF in this patient are explored and the possible etiologies of renal failure in patients undergoing UAE are reviewed.

  15. Arterial air embolism

    PubMed Central

    Nicks, Rowan

    1967-01-01

    The incidence and the outcome of systemic air embolism in 340 consecutive patients who underwent cardiac surgery under cardiopulmonary bypass in this unit for congenital defects of the cardiac septa and diseases involving the aortic and mitral valves have been studied. This was thought to have occurred in 40 patients, of whom 10 died. The distribution of air embolism according to the types of operation undertaken was as follows: six of 127 for atrial septal defect; six of 36 for ventricular septal defect; seven of 42 for mitral valve replacement; seven of 47 for aortic valve débridement; and 14 of 55 for aortic valve replacement. The cause was considered to have been systolic ejection of air into the aorta which, following cardiotomy, had been trapped in the pulmonary veins, the left atrium, the ventricular trabeculae, and the aortic root. Since the adoption of a more rigid `debubbling' routine, air embolism has not occurred. The incidence of pulmonary complications occurring in these patients after bypass was studied. Unilateral atelectasis, which occurred in five patients, resulted from retained bronchial secretions in all and was cured by bronchoscopic aspiration in all. The cause of bilateral atelectases, occurring in nine patients and fatal in eight of these, appeared to be related to cardiopulmonary factors and not to air embolism. Acute air injection made into the pulmonary artery of a dog resulted in pulmonary hypertension and a grossly deficient pulmonary circulation, but changes were largely resolved within a week. In view of this, it is considered that pulmonary air embolism may temporarily embarrass the right heart after the repair of a ventricular septal defect in a patient with an elevated pulmonary vascular resistance and diminished pulmonary vascular bed. Images PMID:6035795

  16. Facial palsy following embolization of a dural arteriovenous fistula.

    PubMed

    Ozluoglu, Levent N; Koycu, A; Jafarov, S; Hizal, E; Boyvat, F

    2016-09-01

    Intracranial arteriovenous malformations are infrequent. Advances in endovascular treatment techniques have promoted the use of endovascular embolization in management of intracranial arteriovenous malformations. Transvenous or transarterial embolization procedures are effective options in the treatment of the arteriovenous fistulas. However, complications such as cranial nerve palsies may occur. Here, we present a case of right-sided lower motor neuron facial paralysis due to embolization of an intracranial dural arteriovenous fistula that have presented with clinical findings on the left eye. Facial functions of the patient improved from total weakness to House-Brackmann grade II, following facial nerve decompression surgery. PMID:26329900

  17. Postcoital Hemorrhage of a Recurrent Seminal Vesicle Cyst Requiring Embolization.

    PubMed

    Royston, Eric; Walker, Marc; Ching, Brian; Morilla, Daniel; Sterbis, Joseph; McMann, Leah

    2014-09-01

    Herein is a case of a 23-year-old man with recurrence of a seminal vesicle cyst after percutaneous drainage and laparoscopic excision complicated by hemorrhage requiring embolization. He presented to the emergency department for pain after ejaculation. Computed tomographic scan of his pelvis revealed extravasation of contrast near his cyst and pelvic fluid collection suspicious for a hematoma. The patient had steadily decreasing hemoglobin and hematocrit levels. An interventional radiologist performed an embolization of the left seminal vesicle cystic arteries. Hemoglobin and hematocrit values improved and he was discharged. Hemorrhage resolved with embolization procedure and pain dissipated over the course of follow up care. PMID:26958478

  18. Cerebral infarction following thrombolysis for massive pulmonary embolism.

    PubMed

    Bracey, Tim S; Langrish, Chris; Darby, Mike; Soar, Jasmeet

    2006-01-01

    A 29-year-old male developed a fatal stroke 6 h after successful thrombolysis for massive pulmonary embolism. Autopsy showed thrombus protruding through a patent foramen ovale (PFO). A strand of thrombus extended from the aortic arch into the left common carotid artery. The brain showed extensive infarction of the left fronto-parietal area. Thrombolysis caused initial disintegration of the embolism. It is likely that thrombolysis caused fragments of clot to later break lose and embolise into the cerebral circulation. We discuss the need for risk stratification in patients who present with massive pulmonary embolism and PFO. PMID:16219407

  19. Evaluation of meteorological and epidemiological characteristics of fatal pulmonary embolism.

    PubMed

    Törő, Klára; Pongrácz, Rita; Bartholy, Judit; Váradi-T, Aletta; Marcsa, Boglárka; Szilágyi, Brigitta; Lovas, Attila; Dunay, György; Sótonyi, Péter

    2016-03-01

    The objective of the present study was to identify risk factors among epidemiological factors and meteorological conditions in connection with fatal pulmonary embolism. Information was collected from forensic autopsy records in sudden unexpected death cases where pulmonary embolism was the exact cause of death between 2001 and 2010 in Budapest. Meteorological parameters were detected during the investigated period. Gender, age, manner of death, cause of death, place of death, post-mortem pathomorphological changes and daily meteorological conditions (i.e. daily mean temperature and atmospheric pressure) were examined. We detected that the number of registered pulmonary embolism (No 467, 211 male) follows power law in time regardless of the manner of death. We first described that the number of registered fatal pulmonary embolism up to the nth day can be expressed as Y(n) = α ⋅ n (β) where Y denotes the number of fatal pulmonary embolisms up to the nth day and α > 0 and β > 1 are model parameters. We found that there is a definite link between the cold temperature and the increasing incidence of fatal pulmonary embolism. Cold temperature and the change of air pressure appear to be predisposing factors for fatal pulmonary embolism. Meteorological parameters should have provided additional information about the predisposing factors of thromboembolism. PMID:26178756

  20. Evaluation of meteorological and epidemiological characteristics of fatal pulmonary embolism

    NASA Astrophysics Data System (ADS)

    Törő, Klára; Pongrácz, Rita; Bartholy, Judit; Váradi-T, Aletta; Marcsa, Boglárka; Szilágyi, Brigitta; Lovas, Attila; Dunay, György; Sótonyi, Péter

    2016-03-01

    The objective of the present study was to identify risk factors among epidemiological factors and meteorological conditions in connection with fatal pulmonary embolism. Information was collected from forensic autopsy records in sudden unexpected death cases where pulmonary embolism was the exact cause of death between 2001 and 2010 in Budapest. Meteorological parameters were detected during the investigated period. Gender, age, manner of death, cause of death, place of death, post-mortem pathomorphological changes and daily meteorological conditions (i.e. daily mean temperature and atmospheric pressure) were examined. We detected that the number of registered pulmonary embolism (No 467, 211 male) follows power law in time regardless of the manner of death. We first described that the number of registered fatal pulmonary embolism up to the nth day can be expressed as Y( n) = α ṡ n β where Y denotes the number of fatal pulmonary embolisms up to the nth day and α > 0 and β > 1 are model parameters. We found that there is a definite link between the cold temperature and the increasing incidence of fatal pulmonary embolism. Cold temperature and the change of air pressure appear to be predisposing factors for fatal pulmonary embolism. Meteorological parameters should have provided additional information about the predisposing factors of thromboembolism.

  1. An interesting septic embolism

    PubMed Central

    Uluorman, Funda; Tanrıverdi, Zülkif; Sevinç, Can; Badak, Özer; Çatalyürek, Hüdai

    2014-01-01

    Septic pulmonary embolism is a rare disease but mortality and morbidity of it is high. Septic pulmonary emboli comes from infected heart valves, thrombophlebitis, and pulmonary artery catheter or infected pacemaker wires as many sources [1,2]. In recent years, pacemaker is a common treatment of the bradiarrhythmia that is persisted in the etiology of septic embolism, its applications has started to pick up [3]. There is the growing number of patients with pacemaker, according to this the frequency of pacemaker lead infection and the number of patients at risk for right-sided endocarditis increase [4]. The patients don't have specific clinical and radiological features because of this it is very difficult to define, so the diagnosis is often delayed [5]. A detailed medical history, a detailed physical examination in diagnosis and evaluation of good additional imaging methods is very important. Early diagnosis and proper treatment, the implementation of the management, can provide good results. PMID:26029562

  2. Associations and Outcomes of Septic Pulmonary Embolism

    PubMed Central

    Goswami, Umesh; Brenes, Jorge A; Punjabi, Gopal V; LeClaire, Michele M; Williams, David N

    2014-01-01

    Background: Septic pulmonary embolism is a serious but uncommon syndrome posing diagnostic challenges because of its broad range of clinical presentation and etiologies. Objective: To understand the clinical and radiographic associations of septic pulmonary embolism in patients presenting to an acute care safety net hospital. Methods: We conducted a retrospective analysis of imaging and electronic health records of all patients diagnosed with septic pulmonary embolism in our hospital between January 2000 and January 2013. Results: 41 episodes of septic pulmonary embolism were identified in 40 patients aged 17 to 71 years (median 46); 29 (72%) were men. Presenting symptoms included: febrile illness (85%); pulmonary complaints (66%) including pleuritic chest pain (22%), cough (19%) and dyspnea (15%); and those related to the peripheral foci of infection (24%) and shock (19%). Sources of infection included: skin and soft tissue (44%); infective endocarditis (27%); and infected peripheral deep venous thrombosis (17%). 35/41 (85%) were bacteremic with staphylococcus aureus. All patients had peripheral nodular lesions on chest CT scan. Treatment included intravenous antibiotics in all patients. Twenty six (63%) patients required pleural drainage and/or drainage of peripheral abscesses. Seven (17%) patients received systemic anticoagulants. Eight (20%) patients died due to various complications. Conclusion: The epidemiology of septic pulmonary embolism has broadened over the past decade with an increase in identified extrapulmonary, non-cardiac sources. In the context of an extrapulmonary infection, clinical features of persistent fever, bacteremia and pulmonary complaints should raise suspicion for this syndrome, and typical findings on the chest CT scans confirm the diagnosis. Antibiotics, local drainage procedures and increasingly, anticoagulation are keys to successful outcomes. PMID:25184008

  3. Preventing, Recognizing, Treating Pulmonary Embolism

    PubMed Central

    Selzer, Arthur

    1965-01-01

    Pulmonary embolism occurs in three forms: (1) Asymptomatic “silent” embolization of lungs; (2) pulmonary infarction; and (3) massive pulmonary embolization leading to acute cor pulmonale. The commonest source of emboli are veins of the lower extremities and of the pelvic organs. The prevention and the treatment of pulmonary embolism overlap, for except for the heroic procedure of pulmonary embolectomy, treatment is equivalent to the prevention of further emboli. The diagnosis may be easy in typical cases and very difficult in others. PMID:14341314

  4. Cerebral Air Embolism from Angioinvasive Cavitary Aspergillosis

    PubMed Central

    Lin, Chen; Barrio, George A.; Hurwitz, Lynne M.; Kranz, Peter G.

    2014-01-01

    Background. Nontraumatic cerebral air embolism cases are rare. We report a case of an air embolism resulting in cerebral infarction related to angioinvasive cavitary aspergillosis. To our knowledge, there have been no previous reports associating these two conditions together. Case Presentation. A 32-year-old female was admitted for treatment of acute lymphoblastic leukemia (ALL). Her hospital course was complicated by pulmonary aspergillosis. On hospital day 55, she acutely developed severe global aphasia with right hemiplegia. A CT and CT-angiogram of her head and neck were obtained demonstrating intravascular air emboli within the left middle cerebral artery (MCA) branches. She was emergently taken for hyperbaric oxygen therapy (HBOT). Evaluation for origin of the air embolus revealed an air focus along the left lower pulmonary vein. Over the course of 48 hours, her symptoms significantly improved. Conclusion. This unique case details an immunocompromised patient with pulmonary aspergillosis cavitary lesions that invaded into a pulmonary vein and caused a cerebral air embolism. With cerebral air embolisms, the acute treatment option differs from the typical ischemic stroke pathway and the provider should consider emergent HBOT. This case highlights the importance of considering atypical causes of acute ischemic stroke. PMID:25197589

  5. Bronchial Artery Aneurysm Embolization with NBCA

    SciTech Connect

    Aburano, Hiroyuki Kawamori, Yasuhiro; Horiti, Yasushi; Kitagawa, Kiyohide; Sanada, Junichiro; Matsui, Osamu

    2006-12-15

    We present a case of asymptomatic bronchial artery aneurysm that formed a fistula with part of the pulmonary artery (there was no definite fistula with the pulmonary vein). We were able to catheterize the feeding vessel but could not reach the aneurysm. We therefore injected a mixture of N-butyl-2-cyanoacrylate (NBCA; Histoacryl, B. Braun, Melsungen, Germany) and iodized oil (Lipiodol; Guerbet, Aulnay-sous-Bois, France) from the feeding vessel. The fistula, aneurysm, and feeding vessel were almost totally occluded. After embolization, the patient coughed a little; there were no other definite side effects or complications. One and 3 months later, on chest CT, the aneurysm was almost completely occupied with hyperattenuating NBCA-Lipiodol embolization. NBCA is a liquid embolization material whose time to coagulation after injection can be controlled by diluting it with Lipiodol. It is therefore possible to embolize an aneurysm, feeding vessels, and efferent vessels (in our case, it was a fistula) by using an NBCA-Lipiodol mixture of an appropriate concentration, regardless of whether the catheter can reach the aneurysm or not.

  6. Hemoptysis workup before embolization: single-center experience with a 15-year period follow-up.

    PubMed

    de Gregorio, Miguel A; Medrano, Joaquin; Laborda, Alicia; Higuera, Teresa

    2007-12-01

    The objective of this work was to present our experience in arterial embolization in the endovascular treatment of massive hemoptysis and remark on the importance of the workup before embolization. We present some clinical aspects to keep in mind before carrying out a bronchial embolization in a patient with severe hemoptysis. The main causes of hemoptysis are presented, as well as diagnosis means and the most important therapeutic procedures aimed to stabilize the patient who will undergo a bronchial arterial embolization. Likewise, we present our own experience with 401 patients with over a 15-year period of follow-up. PMID:18572140

  7. Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis.

    PubMed

    Kirschen, Matthew P; Dori, Yoav; Itkin, Maxim; Licht, Daniel J; Ichord, Rebecca; Vossough, Arastoo

    2016-09-01

    An adolescent with plastic bronchitis due to congenital heart disease had altered mental status after an interventional lymphatic procedure in which lipiodol contrast was used. Neuroimaging revealed cerebral lipiodol embolization due to direct shunting between lymphatic channels and pulmonary veins. Cerebral lipiodol embolization is a potential neurologic morbidity associated with interventional lymphatic procedures. PMID:27297208

  8. Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis

    PubMed Central

    Kirschen, Matthew P.; Dori, Yoav; Itkin, Maxim; Licht, Daniel J.; Ichord, Rebecca; Vossough, Arastoo

    2016-01-01

    An adolescent with plastic bronchitis due to congenital heart disease had altered mental status after an interventional lymphatic procedure in which lipiodol contrast was used. Neuroimaging revealed cerebral lipiodol embolization due to direct shunting between lymphatic channels and pulmonary veins. Cerebral lipiodol embolization is a potential neurologic morbidity associated with interventional lymphatic procedures. PMID:27297208

  9. Fat embolism syndromes following liposuction.

    PubMed

    Wang, Hui-Dong; Zheng, Jiang-Hong; Deng, Chen-Liang; Liu, Qin-Yang; Yang, Song-Lin

    2008-09-01

    Fat embolism syndrome (FES) after liposuction is likely a life-threatening disorder, though its incidence is low. The three chief clinical manifestations include respiratory insufficiency, cerebral involvement, and petechial rash. Although FES is a multisystem disorder, the most seriously affected organs are the lungs, brain, cardiavascular system, and skin. Many laboratory findings are characteristic but nonspecific. The pathogenesis of FES after liposuction has been looked at both mechanically and biochemically. Diagnosis is difficult; Gurd and Wilson's diagnostic criteria based on clinical examination is still extensively used in clinics at present. There is no specific therapy for FES after liposuction for the moment, so prevention, early diagnosis, and supportive therapies are important. In this article we discuss the clinical presentation, pathogensis, and current methods to prevent FES and, if possible, ways to treat this complication. PMID:18509699

  10. Patent foramen ovale and paradoxical embolization: a historical perspective.

    PubMed Central

    Lippmann, H.; Rafferty, T.

    1993-01-01

    The use of transesophageal echocardiography for intraoperative management of critically ill patients allows for routine evaluation of foramen ovale patency. The high prevalence of preoperatively unrecognized flow-patency of this structure has led investigators to emphasize the potential for paradoxical embolization in any patient undergoing anesthesia. This perspective led us to research earliest documentation of paradoxical embolization through a patent foramen ovale as a historical issue with present day relevance. This report examines the 1877 text of Julius Cohnheim in which he described a fatal case of paradoxical embolization to the middle meningeal artery. The 1880 manuscript of Moritz Litten documenting paradoxical embolization to the lower extremity is also presented. Both translations, to our knowledge, represent the first such representations of both the original 1877 edition of Cohnheim's work and Litten's journal article. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 PMID:8256459

  11. Pulmonary Artery Access Embolization in Patients with Massive Hemoptysis in Whom Bronchial and/or Nonbronchial Systemic Artery Embolization Is Contraindicated

    SciTech Connect

    Tamashiro, Alberto; Miceli, Marisa H.; Rando, Cristian; Tamashiro, Gustavo A.; Villegas, Miguel O.; Dini, Andres E.; Balestrin, Aristobulo E.; Diaz, Jose A.

    2008-05-15

    The objective of this paper is to present an alternative therapeutic approach for the treatment of patients with massive hemoptysis in whom bronchial and/or nonbronchial systemic arterial embolization is not possible. We describe a percutaneous procedure for pulmonary segmental artery embolization. Between May 2000 and July 2006, 27 adult patients with hemoptysis underwent percutaneous treatment at our department; 20 of 27 patients were embolized via bronchial and or nonbronchial systemic arteries and 7 patients were embolized via pulmonary artery. Femoral arterial access for systemic artery catheterization and femoral vein access for pulmonary arterial catheterization were used. Gelfoam particles and coils were used for embolization. In this study, we report on three cases of massive hemoptysis from a systemic arterial source in whom bronchial and/or nonbronchial arteries embolization was not possible. Percutaneous embolization via the pulmonary artery access was successful in all three patients. In conclusion, embolization via pulmonary artery is presented as an alternative approach for the management of hemoptysis in patients in whom bronchial arterial embolization is not possible.

  12. Percutaneous Retrieval of an Embolized Catheter Tip With the Balloon Dilatation Technique

    PubMed Central

    Karaca, Oguz; Cakal, Beytullah; Omaygenc, Onur; Turkmen, Muhsin

    2016-01-01

    Introduction: Increasing numbers of complex percutaneous coronary interventions have been accompanied by various intra-procedural complications. The fracture and embolization of devices or their fragments are potentially life-threatening situations, depending on the site of embolization. Different non-surgical methods to handle embolic complications have been proposed for different clinical situations. Case Presentation: We present a case of a distally embolized catheter fragment that was percutaneously retrieved. The catheter fragment was tightly held by the inflated balloon, moved together with the system, and successfully retrieved out of the circulation via the femoral sheath. Considerable distal embolization of the foreign body and retrieval with the balloon dilatation technique are the unique features of this case. Conclusions: The present case appears to offer a safe and relatively simple method of balloon dilatation inside the lumen of the embolized fragment when the foreign body is too distal to retrieve with conventional snare systems. PMID:26889462

  13. Emergency Transcatheter Arterial Embolization for Acute Renal Hemorrhage

    PubMed Central

    Wang, Hong Liang; Xu, Chun Yang; Wang, Hong Hui; Xu, Wei

    2015-01-01

    Abstract The aims of this study were to identify arteriographic manifestations of acute renal hemorrhage and to evaluate the efficacy of emergency embolization. Emergency renal artery angiography was performed on 83 patients with acute renal hemorrhage. As soon as bleeding arteries were identified, emergency embolization was performed using gelatin sponge, polyvinyl alcohol particles, and coils. The arteriographic presentation and the effect of the treatment for acute renal hemorrhage were analyzed retrospectively. Contrast extravasation was observed in 41 patients. Renal arteriovenous fistulas were found in 12 of the 41 patients. In all, 8 other patients had a renal pseudoaneurysm, 5 had pseudoaneurysm rupture complicated by a renal arteriovenous fistula, and 1 had pseudoaneurysm rupture complicated by a renal artery-calyceal fistula. Another 16 patients had tumor vasculature seen on arteriography. Before the procedure, 35 patients underwent renal artery computed tomography angiography (CTA). Following emergency embolization, complete hemostasis was achieved in 80 patients, although persistent hematuria was present in 3 renal trauma patients and 1 patient who had undergone percutaneous nephrolithotomy (justifying surgical removal of the ipsilateral kidney in this patient). Two-year follow-up revealed an overall effective rate of 95.18 % (79/83) for emergency embolization. There were no serious complications. Emergency embolization is a safe, effective, minimally invasive treatment for renal hemorrhage. Because of the diversified arteriographic presentation of acute renal hemorrhage, proper selection of the embolic agent is a key to successful hemostasis. Preoperative renal CTA plays an important role in diagnosing and localizing the bleeding artery. PMID:26496273

  14. Embolic Protection Devices in Transcatheter Aortic Valve Replacement.

    PubMed

    Steinvil, Arie; Benson, Richard T; Waksman, Ron

    2016-03-01

    The initially reported periprocedural neurological events rates associated with transcatheter aortic valve replacement raised concerns that ultimately led to the development and to the clinical research of novel embolic protection devices. Although the reduction of clinical stroke is a desired goal, the current research design of embolic protection devices focuses on surrogate markers of the clinical disease, primarily on silent central nervous system lesions observed in postprocedural diffuse-weighted magnetic resonance imaging and cognitive function testing. As the mere presence of particulate debris in brain matter may not correlate with the extent of brain injury, cognitive function, or quality of life, the clinical significance of embolic protection devices has yet to be determined, and interpretation of study results with regard to real-life clinical use should be viewed accordingly. The purpose of this article is to provide an overview of the updated ongoing clinical research on embolic protection devices and present its major caveats. PMID:26951618

  15. Management of Severe Hemoptysis from Pulmonary Aspergilloma Using Endovascular Embolization

    SciTech Connect

    Corr, Peter

    2006-10-15

    Purpose. To determine the effectiveness of endovascular embolization as a temporizing measure in the management of severe hemoptysis caused by intracavitary pulmonary aspergilloma. Methods. Patients presenting with hemoptysis, estimated to be more than 300 ml in the preceding 24 hr, in whom a radiological diagnosis of pulmonary aspergilloma was made on chest radiographs and/or computed tomography of the chest were subjected to bronchial and systemic arteriography and embolization using triacryl microspheres. Results. Twelve patients with upper lobe intracavitary aspergillomas were managed with embolization. In 11 patients hemoptysis stopped within 24 hr and with no recurrence over the next 4 weeks. In 1 patient hemoptysis persisted and an upper lobe lobectomy was performed. Conclusion. Embolization of bronchial and systemic arteries is an effective method for treating acute severe hemoptysis from intracavitary aspergillomas, allowing the patient time to recover for definitive surgical management.

  16. Embolization of Spontaneous Hemarthrosis Post Total Knee Replacement

    SciTech Connect

    Given, M. F. Smith, P.; Lyon, S. M.; Robertson, D.; Thomson, K. R.

    2008-09-15

    Spontaneous nonhemophiliac hemarthrosis is an unusual entity, which has been little described. We present three cases of spontaneous recurrent hemarthrosis post total knee replacement (TKR) and successful management with embolization. Three male patients were referred to our service for angiography and treatment of recurrent hemarthrosis post TKR. In all three patients antegrade ipsilateral common femoral artery punctures and selective angiography of the geniculate branches were performed with a microcatheter. Abnormal vasculature was noted in all cases. Subsequent embolization was performed with Contour (Boston Scientific, Target Vascular, Cork, Ireland) embolization particles (150-250 and 250-355 {mu}m) in two patients and microcoils in the third (TornadoR; Cook Inc., Bloomington, IN, USA). Technical success was 100%. One patient had a recurrence of symptoms requiring a repeat procedure 6 months later. No complications were encountered. Selective angiography and particle embolization is an effective technique for management of this unusual but problematic postoperative sequelae.

  17. Fat embolism due to bilateral femoral fracture: a case report

    PubMed Central

    Porpodis, Konstantinos; Karanikas, Michael; Zarogoulidis, Paul; Konoglou, Maria; Domvri, Kalliopi; Mitrakas, Alexandros; Boglou, Panagiotis; Bakali, Stamatia; Iordanidis, Alkis; Zervas, Vasilis; Courcoutsakis, Nikolaos; Katsikogiannis, Nikolaos; Zarogoulidis, Konstantinos

    2012-01-01

    Fat embolism syndrome is usually associated with surgery for large bone fractures. Symptoms usually occur within 36 hours of hospitalization after traumatic injury. We present a case with fat embolism syndrome due to femur fracture. Prompt supportive treatment of the patient’s respiratory system and additional pharmaceutical treatment provided the positive clinical outcome. There is no specific therapy for fat embolism syndrome; prevention, early diagnosis, and adequate symptomatic treatment are very important. Most of the studies in the last 20 years have shown that the incidence of fat embolism syndrome is reduced by early stabilization of the fractures and the risk is even further decreased with surgical correction rather than conservative management. PMID:22287848

  18. Fat embolism syndrome.

    PubMed

    Williams, A G; Mettler, F A; Christie, J H; Gordon, R E

    1986-07-01

    The fat embolism syndrome is clinically evident in approximately 0.5-2.0% of patients with long bone fractures. The clinical signs and symptoms are evident in 60% of patients within 24 hours and 85% of patients within 48 hours after trauma. A patient is reported who complained of dyspnea and hemoptysis approximately 72 hours after sustaining a fracture to the distal tibia and fibula. Radionuclide ventilation/perfusion imaging was obtained to rule out pulmonary thromboemboli. Perfusion imaging demonstrated the characteristic diffuse, subsegmental ("mottled") appearance of fatty emboli to the lung. PMID:3731649

  19. Unrecognized stent embolization causing recurrent chest pain.

    PubMed

    Levisay, Justin P; Vaitkus, Paul

    2006-01-01

    Numerous methods have been described for retrieving or addressing stents that have embolized in the coronary arteries. Almost all of these prior reports address the "freshly" embolized stent with retrieval or deployment occurring during the same index procedure during which the embolization occurred. We describe a case of a thrombosed, chronically embolized coronary stent. PMID:16404788

  20. Postoperative hypoxemia due to fat embolism

    PubMed Central

    Bhalla, Tarun; Sawardekar, Amod; Klingele, Kevin; Tobias, Joseph D.

    2011-01-01

    Although the reported incidence of fat embolism syndrome (FES) is low (approximately 1%), it is likely that microscopic fat emboli are showered during manipulation of long bone fractures. Even though there continues to be debate regarding the etiology and proposed mechanism responsible for FES, significant systemic manifestations may occur. Treatment is generally symptomatic based on the clinical presentations. We report a 10-year-old girl who developed hypoxemia following treatment of a displaced Salter-Harris type II fracture of the distal tibia. The subsequent evaluation and hospital course pointed to fat embolism as the most likely etiology for the hypoxemia. We discuss the etiology for FES, review the proposed pathophysiological mechanisms responsible for its clinical manifestations, present currently accepted diagnostic criteria, and discuss its treatment. PMID:21957420

  1. Amniotic fluid embolism: Then and now

    PubMed Central

    Rafael, A

    2014-01-01

    Background The first case report to describe amniotic fluid embolism that appeared in 1926 in Basil-Medico is translated from Portuguese to English. Case A patient with a dead fetus for several weeks, presented in labor and died suddenly with fetal squames evident in the maternal pulmonary vasculature at autopsy. Conclusion As can be seen from the translation, this case report is remarkably similar in many of its features to some of the eight patients described 15 years later in the first English language discussion of the disease by Steiner and Luschbaugh in JAMA. An enigma presented by this first case remains today: fetal material in the maternal pulmonary vasculature appears specific for amniotic fluid embolism at autopsy but not in living patients. PMID:27512417

  2. [Fat embolism after total hip prosthesis replacement preserving the femoral stem].

    PubMed

    Messant, I; Ouardirhi, Y; Vernet, M; Lile, A; Girard, C

    2003-11-01

    Fat embolism is a known complication of traumatology, especially in long bone fractures. It may also occur in liposuction and articular surgery (0.1%). Fat embolic events are most often clinically insignificant and difficult to recognize since clinical manifestations are varied and there is no routine laboratory or radiographic diagnosis. Classically, fat embolism syndrome presents with the triad of pulmonary distress, mental status changes, and cutaneous manifestations. We report the case of a 33-year-old woman who developed acute respiratory distress 10 days after hip arthroplasty. Several aetiologies such as fibrinocruoric pulmonary embolism, pulmonary aspiration and bacterial pneumonia were discussed. Fat embolism was diagnosed, based on suggestive clinical manifestations, radiographic and laboratory findings, although fat embolism after hip arthroplasty without intramedullary pressurization is infrequent. PMID:14612171

  3. The diagnosis of pulmonary embolism

    PubMed Central

    Talbot, S.; Griffiths, P. D.

    1974-01-01

    A blind assessment of abnormalities of pulmonary scintiscans in patients with pulmonary emboli and other clinical conditions showed that there was no abnormality specific for pulmonary embolism. However, a normal lung scan virtually excluded pulmonary embolism and an area, or areas, of absent perfusion was confirmatory evidence of embolism, without infarction, if the chest radiograph was normal, and of embolism with infarction if the clinical and radiographic findings were compatible. A controlled analysis of biochemical and electrocardiographic abnormalities associated with pulmonary embolism showed that abnormalities of liver function and blood urea were more frequent than in a group of patients suspected of, but not having, emboli. A similar analysis of the electrocardiograms showed that a Q3R3S1 with T wave inversion over the right ventricular leads and lead III (±avf) that developed or regressed was pathognomonic of embolism, but other features were of little value. It is suggested that all hospital patients should have an electrocardiogram performed on admission so that serial changes may be assessed and that lung scanning should be used as a screening test in patients suspected of having pulmonary embolism. PMID:4467868

  4. Therapeutic embolization: enhanced radiolabeled monitoring.

    PubMed

    duCret, R P; Adkins, M C; Hunter, D W; Yedlicka, J W; Engeler, C M; Castaneda-Zuniga, W R; Amplatz, K; Sirr, S A; Boudreau, R J; Kuni, C C

    1990-11-01

    Radiolabeling of Ivalon (polyvinyl alcohol sponge) particles permits localization of injected particles during embolization through the use of a portable gamma camera and provides a means to prevent potentially fatal complications such as pulmonary embolization. A more efficient technique of labeling Ivalon particles with technetium-99m sulfur colloid was developed. An increase in labeling efficiency allowed more accurate determination of the distribution of injected Ivalon particles. Scanning electron microscopy demonstrated the stability of the Ivalon particles during this new labeling process. Two patients with arteriovenous malformations underwent therapeutic embolization with radiolabeled Ivalon particles; gamma camera imaging of the lesion and chest was performed throughout the procedure. PMID:2217800

  5. Percutaneous Direct Puncture Embolization with N-butyl-cyanoacrylate for High-flow Priapism.

    PubMed

    Tokue, Hiroyuki; Shibuya, Kei; Ueno, Hiroyuki; Tokue, Azusa; Tsushima, Yoshito

    2016-09-01

    There are many treatment options in high-flow priapism. Those mentioned most often are watchful waiting, Doppler-guided compression, endovascular highly selective embolization, and surgery. We present a case of high-flow priapism in a 57-year-old man treated by percutaneous direct puncture embolization of a post-traumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate. Erectile function was preserved during a 12-month follow-up. No patients with percutaneous direct puncture embolization for high-flow priapism have been reported previously. Percutaneous direct puncture embolization is a potentially useful and safe method for management of high-flow priapism. PMID:27164971

  6. Bilateral massive pulmonary embolism secondary to decompression sickness: a case report.

    PubMed

    Gaye, Ulubay; Sevinc, Sarinc Ulasli; Ozgur, Karacan; Tuna, Gumus; Fusun, Eyuboglu Oner

    2007-01-01

    This case report describes massive pulmonary embolism in a patient as a complication of decompression illness. Twenty-four hours after a scuba dive, a 50-year-old man developed acute pulmonary hypertension and decompression sickness that produced bilateral embolism in the lung at day 6 of hospitalization. He had no risk factor for pulmonary embolism earlier except smoking. Decompression sickness that RESULTS in formation of bubbles of inert gas is a risk for both aviators and divers. The present case strongly suggests that micro-bubbles may cause life-threatening massive pulmonary embolism. PMID:18005806

  7. Coronary Embolism After Iatrogenic Radial Endarterectomy.

    PubMed

    Rozado, Jose; Pascual, Isaac; Avanzas, Pablo; Moris, Cesar

    2016-06-01

    A 55-year-old man with double-vessel coronary artery disease was revascularized by percutaneous coronary intervention three years ago. Elective coronary angiography was indicated for angina with positive stress test. During the procedure, severe radial spasm occurred; after the first injection, we detected loss in pressure trace in the diagnostic catheter and acute distal circumflex occlusion. Suspecting catheter thrombosis with coronary embolization, the entire system was exchanged and inspected; inside, we discovered a 2 x 50 mm white biological cylinder. Histological study of this material was compatible with endarterectomy. We present a rare complication of severe radial artery spasm and endarterectomy, with occlusion of the diagnostic catheter and coronary embolization. PMID:27236012

  8. Embolic protection devices in saphenous percutaneous intervention.

    PubMed

    Morís, Cesar; Lozano, Iñigo; Martín, María; Rondán, Juán; Avanzas, Pablo

    2009-05-01

    Saphenous veins remain a source of conduit for use in surgical coronary bypass graft revascularisation procedures. Saphenous vein grafts have a progressive closure rate estimated to be 12% to 20% at the end of the first year, and approximately 50% by 10 years. Regarding secondary revascularisation in these cases, reoperation carries substantially increased morbidity and mortality rates, making saphenous coronary intervention, in particular stent implantation, a more attractive means of revascularisation. However, this procedure carries a significant risk of major adverse clinical events, predominantly myocardial infarction or reduced antegrade flow (non-reflow phenomenon), mainly due to distal embolisation of atherothrombotic debris and distal microvascular occlusion. Embolic protection devices are used to reduce the risk of distal embolisation. There are two different designs: filter and occlusion-aspiration devices. In this article we present the different systems of embolic protection devices in saphenous percutaneous intervention and the previously published information is reviewed. PMID:19736070

  9. Ovarian Artery: Angiographic Appearance, Embolization and Relevance to Uterine Fibroid Embolization

    SciTech Connect

    Pelage, J.P. Walker, W.J.; Le Dref, O.; Rymer, R.

    2003-06-15

    Purpose: To describe the angiographic appearance of the ovarian artery and its main variations that may be relevant to uterine fibroid embolization. Methods: The flush aortograms of 294 women who had been treated by uterine artery embolization for fibroids were reviewed. Significant arterial supply to the fibroid, and the origin and diameter of identified ovarian arteries were recorded. In patients with additional embolization of the ovarian artery, the follow-up evaluation also included hormonal levels and Doppler imaging of the ovaries. Results: A total of 75 ovarian arteries were identified in 59 women (bilaterally in 16 women and unilaterally in 43 women). All ovarian arteries originated from the aorta below the level of the renal arteries with a characteristic tortuous course. Fifteen women had at least one enlarged ovarian artery supplying the fibroids. Fourteen women (14/15, 93%) presented at least one of the following factors: prior pelvic surgery, tubo-ovarian pathology or large fundal fibroids. Conclusion: We advocate the use of flush aortography in women with prior tubo-ovarian pathology or surgery or in cases of large fundal fibroids. In the case of an ovarian artery supply to the fibroids, superselective catheterization and embolization of the ovarian artery should be considered.

  10. Arteriovenous Fistula Embolization in Suspected Parauterine Choriocarcinoma.

    PubMed

    Alturkistani, Husain; Almarzooqi, Mohamed-Karji; Oliva, Vincent; Gilbert, Patrick

    2016-01-01

    This is a case of choriocarcinoma that did not regress after chemotherapy treatment. A 30-year-old female patient (gravida 2, para 2), presented to our ER with stroke and persistent mild pelvic pain 2 months after a Caesarean section. Computed tomography (CT) revealed an ischemic left hemicerebellar region and a hypervascular mass in the pelvic region. This mass was not present on routine fetal ultrasound during pregnancy. The lesion was treated by chemotherapy after closure of a foramen ovale and insertion of an inferior vena cava (IVC) filter. After that, 2 courses of EMACO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Vincristine) chemotherapy regimen were given. Posttreatment CT showed the hypervascular mass without any changes. Arteriography showed the arteriovenous fistulae that were embolized successfully with plugs, coils, and glue. Embolization was considered due to the risk of acute hemorrhagic life-threatening complications. Eight chemotherapy courses were added after embolization. Treatment by endovascular approach and reduction of the hypervascular mass can be a valuable adjunct to chemotherapy treatment of choriocarcinoma. PMID:27403360

  11. Arteriovenous Fistula Embolization in Suspected Parauterine Choriocarcinoma

    PubMed Central

    Almarzooqi, Mohamed-Karji; Oliva, Vincent; Gilbert, Patrick

    2016-01-01

    This is a case of choriocarcinoma that did not regress after chemotherapy treatment. A 30-year-old female patient (gravida 2, para 2), presented to our ER with stroke and persistent mild pelvic pain 2 months after a Caesarean section. Computed tomography (CT) revealed an ischemic left hemicerebellar region and a hypervascular mass in the pelvic region. This mass was not present on routine fetal ultrasound during pregnancy. The lesion was treated by chemotherapy after closure of a foramen ovale and insertion of an inferior vena cava (IVC) filter. After that, 2 courses of EMACO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Vincristine) chemotherapy regimen were given. Posttreatment CT showed the hypervascular mass without any changes. Arteriography showed the arteriovenous fistulae that were embolized successfully with plugs, coils, and glue. Embolization was considered due to the risk of acute hemorrhagic life-threatening complications. Eight chemotherapy courses were added after embolization. Treatment by endovascular approach and reduction of the hypervascular mass can be a valuable adjunct to chemotherapy treatment of choriocarcinoma. PMID:27403360

  12. Amniotic fluid embolism after intrauterine fetal demise.

    PubMed

    Kristensen, Karl; Langdana, Fali; Clentworth, Howard; Hansby, Chu; Dalley, Paul

    2016-01-01

    We present a case of the successful treatment of severe amniotic fluid embolism in a 41-year-old woman undergoing emergency caesarean section at 36 weeks of gestation for placental abruption and intrauterine fetal demise. The treatment included prolonged cardiopulmonary resuscitation, emergency hysterectomy, re-operation with intra-abdominal packing and intra-aortic balloon pump insertion. The patient made a remarkable recovery and to date has minimal residual morbidity. Amniotic fluid embolism syndrome (AFES) is a rare and often fatal obstetric condition that remains one of the main causes of maternal mortality in developed countries. The incidence varies from 2 to 6 per 100,000 and suggested mortality rates exceed 60%.1-2 The classic triad of sudden hypoxia, hypotension and coagulopathy with acute onset during labour or immediately after delivery forms the hallmark of the AFES diagnosis, however AFES is primarily a clinical diagnosis of exclusion. We present a case of successful maternal outcome following severe amniotic fluid embolism after placental abruption and intrauterine fetal demise. PMID:27607089

  13. Amniotic fluid embolism

    PubMed Central

    Thongrong, Cattleya; Kasemsiri, Pornthep; Hofmann, James P.; Bergese, Sergio D.; Papadimos, Thomas J.; Gracias, Vicente H.; Adolph, Michael D.; Stawicki, Stanislaw P. A.

    2013-01-01

    Amniotic fluid embolism (AFE) is an unpredictable and as-of-yet unpreventable complication of maternity. With its low incidence it is unlikely that any given practitioner will be confronted with a case of AFE. However, this rare occurrence carries a high probability of serious sequelae including cardiac arrest, ARDS, coagulopathy with massive hemorrhage, encephalopathy, seizures, and both maternal and infant mortality. In this review the current state of medical knowledge about AFE is outlined including its incidence, risk factors, diagnosis, pathophysiology, and clinical manifestations. Special attention is paid to the modern aggressive supportive care that resulted in an overall reduction in the still alarmingly high mortality rate of this devastating entity. The key factors for successful management and resolution of this disease process continue to be sharp vigilance, a high level of clinical suspicion, and rapid all-out resuscitative efforts on the part of all clinicians involved in the medical care of the parturient. PMID:23724386

  14. Amniotic fluid embolism.

    PubMed

    Thongrong, Cattleya; Kasemsiri, Pornthep; Hofmann, James P; Bergese, Sergio D; Papadimos, Thomas J; Gracias, Vicente H; Adolph, Michael D; Stawicki, Stanislaw P A

    2013-01-01

    Amniotic fluid embolism (AFE) is an unpredictable and as-of-yet unpreventable complication of maternity. With its low incidence it is unlikely that any given practitioner will be confronted with a case of AFE. However, this rare occurrence carries a high probability of serious sequelae including cardiac arrest, ARDS, coagulopathy with massive hemorrhage, encephalopathy, seizures, and both maternal and infant mortality. In this review the current state of medical knowledge about AFE is outlined including its incidence, risk factors, diagnosis, pathophysiology, and clinical manifestations. Special attention is paid to the modern aggressive supportive care that resulted in an overall reduction in the still alarmingly high mortality rate of this devastating entity. The key factors for successful management and resolution of this disease process continue to be sharp vigilance, a high level of clinical suspicion, and rapid all-out resuscitative efforts on the part of all clinicians involved in the medical care of the parturient. PMID:23724386

  15. Amniotic fluid embolism: review.

    PubMed

    Pantaleo, Greco; Luigi, Nappi; Federica, Trezza; Paola, Storelli; Margherita, Neri; Tahir, Mahmood

    2014-01-01

    Amniotic fluid embolism is a rare but dreadful syndrome in Obstetrics, which happens, in most of the cases, in the peripartum period. The actual "embolisation" of the pulmonary vessels does not explain the whole picture of the syndrome. An immune mechanism, similar to an anaphylactic reaction, is more convincingly the background of the event, but the pathogenesis is still ill-defined. Similarly the initial symptoms are difficult to interpret and distinguish from other acute and life-threatening emergencies (i.e. pulmonary embolism, placental abruption, septic shock, stroke, myocardial ischemia, etc.), therefore the diagnosis is one of exclusion, very often on postmortem report. Thus the prevalence of the disease is difficult to establish, most of the reports being postmortem cases or National Registries data. These data, based either on autopsy series or on registries, are non representative of the true prevalence of the event and obviously confusing for the correct understanding of the disease process. Risk factors are all those conditions or manouvres, which contemplate a breech in the maternal-fetal barrier. Again, given the rarity of the syndrome, no single event is clearly identifiable as a case-effect risk factor. Prognosis, which is obviously biased by the reporting system, is particularly grim both in terms of survival and morbidity. The symptoms being often elusive at the beginning, but rapidly and progressively catastrophic, a multidisciplinary team approach is warranted in order to provide the best chance of survival both for mother and baby. Immediate and aggressive resuscitation is, therefore, advised whenever a mother in labour or in the early postpartum period experiences a sudden collapse. PMID:24804726

  16. Anticoagulant treatment for acute pulmonary embolism: a pathophysiology-based clinical approach.

    PubMed

    Agnelli, Giancarlo; Becattini, Cecilia

    2015-04-01

    The management of patients with acute pulmonary embolism is made challenging by its wide spectrum of clinical presentation and outcome, which is mainly related to patient haemodynamic status and right ventricular overload. Mechanical embolic obstruction and neurohumorally mediated pulmonary vasoconstriction are responsible for right ventricular overload. The pathophysiology of acute pulmonary embolism is the basis for risk stratification of patients as being at high, intermediate and low risk of adverse outcomes. This risk stratification has been advocated to tailor clinical management according to the severity of pulmonary embolism. Anticoagulation is the mainstay of the treatment of acute pulmonary embolism. New direct oral anticoagulants, which are easier to use than conventional anticoagulants, have been compared with conventional anticoagulation in five randomised clinical trials including >11 000 patients with pulmonary embolism. Patients at high risk of pulmonary embolism (those with haemodynamic compromise) were excluded from these studies. Direct oral anticoagulants have been shown to be as effective and at least as safe as conventional anticoagulation in patients with pulmonary embolism without haemodynamic compromise, who are the majority of patients with this disease. Whether these agents are appropriate for the acute-phase treatment of patients at intermediate-high risk pulmonary embolism (those with both right ventricle dysfunction and injury) regardless of any risk stratification remains undefined. PMID:25700388

  17. Crisis management during anaesthesia: embolism

    PubMed Central

    Williamson, J; Helps, S; Westhorpe, R; Mackay, P

    2005-01-01

    Background: Embolism with gas, thrombus, fat, amniotic fluid, or particulate matter may occur suddenly and unexpectedly during anaesthesia, posing a diagnostic and management problem for the anaesthetist. Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK" supplemented by a specific sub-algorithm for embolism, in the management of embolism occurring in association with anaesthesia. Methods: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. Results: Among the first 4000 incidents reported to AIMS, 38 reports of embolism were found. A sudden fall in end-tidal carbon dioxide and oxygen saturation were the cardinal signs of embolism, each occurring in about two thirds of cases, with hypotension and electrocardiographic changes each occurring in about one third of cases. Conclusion: The potential value of an explicit structured approach to the diagnosis and management of embolism was assessed in the light of AIMS reports. It was considered that, correctly applied, it potentially would have led to earlier recognition of the problem and/or better management in over 40% of cases. PMID:15933290

  18. Permcath Catheter Embolization: a Case Report

    PubMed Central

    Yousefshahi, Hadi; Bina, Payvand; Yousefshahi, Fardin

    2015-01-01

    Introduction: Nowadays, many types of intravascular devices and catheters are used in order to diagnose and treat diseases. Complications related to these instruments are the costs that doctors and patients have to pay to benefit from their advantages. Catheter embolization is one of these side effects. Patients with devices in their cardiopulmonary system are at risk for severe complications such as arrhythmias, pulmonary embolism, myocardial injuries, hemoptysis, thrombosis and perforation. Case Presentation: A 50-years-old woman, with a history of breast cancer, had a PermCath emplacement in right subclavian vein for a course of chemotherapy. The treatment for cancer seemed to be successful and the PermCath had remained in its position without complication, for a couple of years however, the catheter was founded broken and embolized to the right ventricle and the main left pulmonary artery, diagnosed by a chest X-ray study incidentally. Conclusions: It is better to remove the unused devices safely to prevent and decrease their possible complications. PMID:25964881

  19. [Fulminant course of amniotic fluid embolism].

    PubMed

    Bermejo-Alvarez, M A; Fervienza, P; Corte-Torres, M G; Cosío, F; Jiménez-Gómez, L J; Hevía, A

    2006-02-01

    Amniotic fluid embolism is an obstetric complication that can present during pregnancy or labor and is associated with high rates of morbidity and mortality. The incidence is low but the mortality rates for both mother and fetus are high. A 34-year-old woman in the 41st week of gestation was admitted for induction of labor. While still in the labor room, she complained of pruritus around the mouth and tongue. Tonic-clonic convulsions, hypotension, and loss of consciousness followed. Cardiopulmonary resuscitation maneuvers were started and an immediate cesarean section under general anesthesia was performed to deliver a live infant boy. The Apgar score at 5 minutes was 8. The mother was transferred for recovery to the intensive care unit (ICU), where rapid cardiocirculatory and pulmonary decline continued. After 2 episodes of electromechanical dissociation, exitus occurred 2 hours after ICU admission. The autopsy confirmed the diagnosis of amniotic fluid embolism. Keratin squames were found in the capillaries of both lungs and polymorphonuclear cells and proteinaceous material were observed in alveoli. Mechanical obstruction is not the only cause of amniotic fluid embolism. Circulating substances that affect myocardial contractility and coagulation are also implicated and the cause may even be an allergic reaction. The usual signs are acute respiratory failure, cardiovascular collapse, and occasionally convulsions and coagulopathy. Cardiac arrest occurs in 80% of the cases. Treatment is symptomatic to provide life-sustaining measures in response to the clinical picture as it develops. PMID:16553345

  20. Partial splenic artery embolization in cirrhotic patients

    PubMed Central

    Hadduck, Tyson A; McWilliams, Justin P

    2014-01-01

    Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in regards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications. PMID:24876920

  1. Patent Foramen Ovale: Is Stroke Due to Paradoxical Embolism?

    NASA Technical Reports Server (NTRS)

    Ranoux, D.; Cohen, A.; Cabanes, L.; Amarenco, P.; Bousser, M. G.; Mas, J. L.

    1993-01-01

    Background and Purpose: A patent foramen ovale has been reported to be significantly more frequent in young stroke patients than in matched control subjects, and paradoxical embolism has been suggested as the main mechanism of stroke in-this situation. The present study was designed to test this hypothesis. Methods: Sixty-eight consecutive patients under 55 years of age presenting with an ischemic stroke had an extensive workup, including transesophageal echocardiography with contrast. We compared the prevalence of criteria for the diagnosis of paradoxical embolism in patients with and without a patent foramen ovale. Results: A patent foramen ovale was found in 32 patients (47%). A Valsalva-provoking activity was present at stroke onset in six patients with a patent foramen ovale and in eight patients with no patent foramen ovale (X(sup 2)=0.1, nonsignificant). Clinical/radiological features suggestive of an embolic mechanism were not more frequent in patients with a patent foramen ovale. Clinical evidence of deep vein thrombosis was present in one patient with a patent foramen ovale and in none of the others. No occult venous thrombosis was found in a subgroup of patients with a patent foramen ovale and no definite cause for stroke who underwent venography (n=13). Conclusions. Our results do not support the hypothesis that paradoxical embolism is the primary mechanism of stroke in patients with a patent foramen ovale. (Stroke 1993;24:31-34) KEY WORDS e cerebral ischemia e embolism foramen ovale, patent

  2. Current Evidence on Uterine Embolization for Fibroids

    PubMed Central

    Spies, James B.

    2013-01-01

    Strong evidence for both safety and effectiveness of uterine fibroid embolization has been generated since the procedure's introduction. This review will focus on the key articles representing the best evidence to summarize the outcomes from uterine embolization. This review will attempt to answer three important questions associated with uterine embolization. First, does uterine embolization relieve symptoms caused by uterine fibroids? Second, how well does the improvement in symptoms and quality of life after uterine embolization compare with standard surgical options for fibroids? Finally, how durable is the improvement in fibroid-related symptoms and quality of life after embolization? PMID:24436560

  3. Histologically-Proven Efficacy of Bland Embolization in a Patient with Net Liver Metastasis.

    PubMed

    Monfardini, Lorenzo; Varano, Gianluca Maria; Foà, Riccardo; Della Vigna, Paolo; Bonomo, Guido; Bertani, Emilio; Guerini-Rocco, Elena; Spada, Francesca; Orsi, Franco

    2016-06-01

    We present a case of 57-year-old patient with three liver metastases from a primary neuroendocrine duodenal tumor, who underwent bland embolization with excellent response to therapy, followed by surgical resection. The purpose of our case report is to describe the histological characteristics of tumoral response to therapy after bland embolization focusing on intralesional necrosis and microsphere distribution. PMID:26714693

  4. Intractable Postpartum Hemorrhage Resulting from Uterine Artery Pseudoaneurysm: Superselective Arteriographic Embolization via the Collateral Route

    SciTech Connect

    Doenmez, Halil Oztuerk, M. Halil; Guergen, Fatma; Soylu, Serra O.; Hekimoglu, Baki

    2007-04-15

    We present a patient with intractable postpartum hemorrhage resulting from uterine artery pseudoaneurysm despite bilateral hypogastric artery ligation who was successfully treated by an endovascular approach via the collateral route. Although there is a good argument for postponing surgery until transcatheter embolization has been attempted, this case shows that embolization can still be successful even if the iliac vessels have been ligated.

  5. Fat embolism syndrome after liposuction: a case report and review of the literature.

    PubMed

    Laub, D R; Laub, D R

    1990-07-01

    There have been three previous case reports of fat embolism syndrome (FES) after lipectomy. We present a case of FES diagnosed by pulmonary angiography. It seems likely that there is an incidence of subclinical fat embolization after liposuction, but conservative patient selection and aggressive postoperative management can lessen the morbidity and mortality of FES. PMID:2198844

  6. Bladder Necrosis Associated with Placenta Accreta, Embolization, and Repair of Cystotomies

    PubMed Central

    Wu, Wayland J.; Smith, Arthur D.

    2015-01-01

    Abstract Bladder necrosis is an unusual and potentially devastating complication of embolization of the hypogastric arterial branches. The rich collateral blood supply makes this an extremely rare event. We present the case of a patient with bladder necrosis following placenta accreta that was treated with total abdominal hysterectomy and uterine artery embolization and cystotomy repairs.

  7. Fat embolism syndrome managed by non-invasive ventilation--a case report.

    PubMed

    Ashok, R; Kumar, R Vinoth; Saravanan, K; Kalaivani

    2012-02-01

    A 31-year-old male was struck by a motor cycle and diagnosed to have closed injury to the thigh involving right sided femur shaft fracture. Patient was operated on the next day by the orthopaedic surgeon. The patient did not have any signs of fat embolism syndrome before and after surgery. But the rare ECG change of S1Q3T3 (pulmonary embolism) was present before and after surgery. The presence of oedematous retina and cherry red spots in the macula was also present in the young patient. Patient developed all the classical signs of fat embolism syndrome 18 hours after surgery. The case had classic presentations of fat embolism syndrome managed by non-invasive ventilation. The role of steroids and albumin is also discussed as it was always a controversy in the management of fat embolism syndrome. PMID:23029849

  8. Absolute Ethanol Embolization of Arteriovenous Malformations in the Periorbital Region

    SciTech Connect

    Su, Li-xin; Jia, Ren-Bing; Wang, De-Ming Lv, Ming-Ming Fan, Xin-dong

    2015-06-15

    ObjectiveArteriovenous malformations (AVMs) involving the periorbital region are technically challenging clinical entities to manage. The purpose of the present study was to present our initial experience of ethanol embolization in a series of 16 patients with auricular AVMs and assess the outcomes of this treatment.MethodsTranscatheter arterial embolization and/or direct percutaneous puncture embolization were performed in the 16 patients. Pure or diluted ethanol was manually injected. The follow-up evaluations included physical examination and angiography at 1- to 6-month intervals.ResultsDuring the 28 ethanol embolization sessions, the amount of ethanol used ranged from 2 to 65 mL. The obliteration of ulceration, hemorrhage, pain, infection, pulsation, and bruit in most of the patients was obtained. The reduction of redness, swelling, and warmth was achieved in all the 16 patients, with down-staging of the Schobinger status for each patient. AVMs were devascularized 100 % in 3 patients, 76–99 % in 7 patients, and 50–75 % in 6 patients, according to the angiographic findings. The most common complications were necrosis and reversible blister. No permanent visual abnormality was found in any of the cases.ConclusionEthanol embolization is efficacious and safe in the treatment of AVMs in the periorbital region and has the potential to be accepted as the primary mode of therapy in the management of these lesions.

  9. Pulmonary fat and bone marrow embolism in aircraft accident victims.

    PubMed

    Bierre, A R; Koelmeyer, T D

    1983-04-01

    On 28 November 1979, an Air New Zealand DC10 aircraft crashed into Mt Erebus, Antarctica with the loss of 257 passengers and crew. Postmortem examinations were carried out on 231 victims in Auckland, 4641 kilometres north of the crash site, and lung tissue was present in 205 cases. Pulmonary fat emboli were present in 134 cases (65%), pulmonary bone marrow emboli in 60 (29%) and pulmonary edema in 76 cases (37%). Clear relationships were demonstrated, firstly between the extent of fat and bone marrow embolism, secondly between the extent of fat and bone marrow embolism and the presence of pulmonary edema, and thirdly between the extent of fat and bone marrow embolism and the extent of cardiovascular damage. It was apparent that death had occurred immediately following impact, and the extent of fat and bone marrow embolism varied inversely with the severity of the injuries found. The most severely injured victims were those seated in the rear cabin of the aircraft suggesting that this was the site of impact with the ground. Our studies show that pulmonary fat embolism occurs very rapidly after severe injury and is followed by increasing numbers of fat and bone marrow emboli depending on the nature of the mortal injuries. PMID:6888959

  10. Submassive pulmonary embolism.

    PubMed

    Piazza, Gregory

    2013-01-01

    The US Surgeon General estimates that 100,000 to 180,000 deaths occur annually from acute pulmonary embolism (PE) in the United States. The case of Ms A, a 60-year-old woman with acute PE and right ventricular dysfunction (submassive PE), illustrates the clinical challenge of identifying this high-risk patient population and determining when more aggressive immediate therapy should be pursued in addition to standard anticoagulation. The clinical examination, electrocardiogram, cardiac biomarkers, chest computed tomography, and echocardiography can be used to risk stratify patients with acute PE. Current options for more aggressive intervention in the treatment of patients with acute PE who are at increased risk of an adverse clinical course include systemic fibrinolysis, pharmacomechanical catheter-directed therapy, surgical pulmonary embolectomy, and inferior vena cava filter insertion. Determination of the optimal duration of anticoagulation and lifestyle modification to reduce overall cardiovascular risk are critical components of the long-term therapy of patients with acute PE. PMID:23299609

  11. Treatment of pulmonary embolism.

    PubMed

    Décousus, Hervé; Mismetti, Patrick; Couturaud, Francis; Ageno, Walter; Bauersachs, Rupert

    2015-12-01

    The treatment of pulmonary embolism is going to be deeply modified by the development of Direct Oral Anticoagulants (DOACs). There are currently three anti-Xa factors (rivaroxaban, apixaban, edoxaban) and one anti-IIa factor (dabigatran) labeled by the FDA and the EMA. All these drugs are direct anticoagulant, orally effective, without the need for adaptation to hemostasis test. As kidney excretion is involved for all of them, they are contra-indicated in patients with severe renal failure (creatinine clearance < 30 mL/min according to Cockcroft & Gault formula). All the anti-Xa factor drugs are metabolized by liver cytochromes and then contra-indicated in case of liver insufficiency. Of note, the four DOACS have been evaluated in non-inferiority trials, including one open-label trial (the EINSTEIN program with the rivaroxaban). Moreover, two of them (rivaroxaban and apixaban) were evaluated in a single drug approach (provided initial increased doses: 15 mg bid during 21 days for rivaroxaban and 10 mg bid during 7 days for apixaban) whereas the two others (edoxaban and dabigatran) were evaluated after at least 5 days of parenteral heparin. They were found to be non-inferior to the conventional treatment, but also seem to be associated with a decreased risk of major bleeding, in a quite young and without significant comorbidities population. The risk/benefit ratio of DOACs in specific subgroups deserves prospective validations. PMID:26547678

  12. Embolic retinopathy due to Corynebacterium minutissimum endocarditis.

    PubMed

    Herschorn, B J; Brucker, A J

    1985-01-01

    Infective embolic retinopathy as a sequela of bacterial endocarditis is described in a 31-year-old woman with mitral valve prolapse. The infective organism, Corynebacterium minutissimum, has not been previously found to cause ocular or multisystem diseases. It is a common mucocutaneous inhabitant which causes erythrasma. In our case report both ocular involvement and septicaemia were present. The infection was confirmed by positive serial blood cultures. Mitral valve prolapse was confirmed by echocardiography. On clinical examination the retinopathy consisted of white intraretinal lesions which resolved with antibiotic therapy. By fluorescein angiography focal areas of hypofluorescence corresponding to the white fundus lesions were present. Optic disc oedema was also seen. PMID:3965026

  13. [Amniotic fluid embolism: an update].

    PubMed

    Legrand, M; Rossignol, M; Muller, F; Payen, D

    2013-03-01

    Amniotic fluid embolism (AFE) results from the passage of fœtal and amniotic fragments into the maternal circulation, occurring mostly within minutes before or after delivery. Although maternal and fœtal mortality of AFE remains high (about 40%), AFE should no longer be considered as having an ineluctable fatal course. Diagnosis is often made upon clinical presentation but histological confirmation is difficult owing favorable outcome and because an autopsy has not been performed. Identification of squamous cells in the maternal circulation could not confirm the diagnosis because of their possible maternal origin. High plasma level of insulin-like growth factor-binding protein-1 (IGFBP-1) has recently been identified as a biomarker of amniotic fluid passage into the maternal circulation and might therefore be used to confirm the diagnosis when lung tissue histology is not available. Treatment of AFE remains supportive with a special focus on correction of the coagulopathy and search for acute core pulmonale. In this later case, physicians should consider initiating an extracorporeal life support when facing a patient with refractory shock. Finally, caution is needed with the use of recombinant factor VIIa in this context. PMID:23422343

  14. Right Gastric Artery Embolization Prior to Treatment with Yttrium-90 Microspheres

    SciTech Connect

    Cosin, Octavio; Bilbao, Jose Ignacio Alvarez, Sergio; Luis, Esther de; Alonso, Alberto; Martinez-Cuesta, Antonio

    2007-02-15

    Purpose. Intra-arterial infusion of yttrium-90 microspheres is a form of radiation treatment for unresectable hepatic neoplasms. Misdeposition of particles in the gastroduodenal area such as the right gastric artery (RGA) may occur with serious consequences. We present a series of patients who underwent a detailed vascular study followed by RGA embolization. Special emphasis is placed on anatomic variations and technical considerations .Methods. In a 1 year period, 27 patients were treated. Initial vascular evaluation was performed, with careful attention to anatomic variants or extrahepatic arterial supply, especially to the gastroduodenal area. Embolization of such arteries was planned if needed. RGA embolization was performed antegradely from the hepatic artery or retrogradely via the left gastric artery (LGA). Postprocedural follow-up included clinical interview and gastroscopy if necessary. Results. RGA embolization was performed in 9 patients presenting with primary (n = 3) or metastatic liver tumors (n 6). Six patients underwent antegrade RGA embolization and 3 had embolization done retrogradely via the LGA. Retrograde access was chosen for anatomic reasons. None of the patients complained of gastroduodenal symptoms. Conclusion. RGA embolization can help minimize the gastroduodenal deposition of radioactive particles. RGA embolization should routinely be carried out. The procedure can be performed, with similar technical success, by both anterograde and retrograde approaches.

  15. Reflex Anuria After Renal Tumor Embolization

    SciTech Connect

    Kervancioglu, Selim Sirikci, Akif; Erbagci, Ahmet

    2007-04-15

    We report a case of reflex anuria after transarterial embolization of a renal tumor. Anuria developed immediately after embolization and resolved 74 hr following the procedure. We postulate that reflux anuria in our case was related to mechanoreceptors, chemoreceptors, or both, as these are stimulated by the occluded blood vessels, ischemia, and edema of the normal renal tissue of an embolized kidney.

  16. Acute ischemic colitis secondary to air embolism after diving

    PubMed Central

    Payor, Austin Daniel; Tucci, Veronica

    2011-01-01

    Ischemic colitis (IC) secondary to air embolism from decompression sickness or barotrauma during diving is an extremely rare condition. After extensive review of the available literature, we found that there has been only one reported case of IC secondary to air embolism from diving. Although air embolization from diving and the various medical complications that follow have been well documented, the clinical manifestation of IC from an air embolism during diving is very rare and thus far unstudied. Common symptoms of IC include abdominal pain, bloody or non-bloody diarrhea or nausea or vomiting or any combination. Emergency physicians and Critical Care specialists should consider IC as a potential diagnosis for a patient with the above-mentioned symptoms and a history of recent diving. We report a case of IC from air embolism after a routine dive to 75 feet below sea level in a 53-year-old White female who presented to a community Emergency Department complaining of a 2-day history of diffuse abdominal pain and nausea. She was diagnosed by colonoscopy with biopsies and treated conservatively with antibiotics, bowel rest, and a slow advancement in diet. PMID:22096777

  17. Multidisciplinary management of placenta percreta complicated by embolic phenomena.

    PubMed

    Styron, A G; George, R B; Allen, T K; Peterson-Layne, C; Muir, H A

    2008-07-01

    Hemorrhage and thrombosis are major causes of maternal mortality. This case discusses the management of a woman with placenta percreta complicated by intraoperative pulmonary embolism. A 39-year-old gravida 3 with two previous cesarean deliveries presented at 34 weeks of gestation with an antepartum hemorrhage. Magnetic resonance imaging confirmed placenta percreta. The multidisciplinary group including obstetricians, gynecological oncologists, interventional radiologists and anesthesiologists developed a delivery plan. Cesarean delivery was performed with internal iliac artery occlusion and embolization catheters in place. After the uterine incision our patient experienced acute hypotension and hypoxia associated with a drop in the end-tidal carbon dioxide and sinus tachycardia. She was resuscitated and the uterus closed with the placenta in situ. Postoperatively, uterine bleeding was arrested by immediate uterine artery embolization. With initiation of embolization, hypotension and hypoxia recurred. Oxygenation and hemodynamics slowly improved, the case continued and the patient was extubated uneventfully at the end of the procedure. Computed tomography revealed multiple pulmonary emboli. The patient was anticoagulated with low-molecular-weight heparin and returned six weeks later for hysterectomy. Placenta percreta with invasion into the bladder can be catastrophic if not recognized before delivery. The chronology of events suggests that this may have been amniotic fluid emboli. An intact placenta with abnormal architecture, such as placenta percreta, may increase the risk of amniotic fluid embolus. The clinical findings and co-existing filling defects on computed tomography may represent a spectrum of amniotic fluid embolism syndrome. PMID:18501584

  18. Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome

    SciTech Connect

    Meneses, Luis Fava, Mario; Diaz, Pia; Andia, Marcelo; Tejos, Cristian; Irarrazabal, Pablo; Uribe, Sergio

    2013-02-15

    We present our experience with embolization of incompetent pelvic veins (IPV) in women with recurrence of varicose veins (VV) in lower limbs, as well as symptoms of pelvic congestion syndrome (PCS), after first surgery. In addition, we evaluated the effects of embolization in decreasing the symptoms of VV before surgery as well as its effects on PCS symptoms. We included 10 women who had consulted a vascular surgeon because of recurrent VV in lower limbs after surgery. All of these patients were included in the study because they also had symptoms of PCS, probably due to IPV. In patients who had confirmed IPV, we performed embolization before a second surgery. VV and PCS were assessed before and at 3 months after embolization (before the second surgery) using a venous clinical severity score (VCSS) and a visual analog pain scale (VAS), respectively. Patients were controlled between 3 and 6 months after embolization. Paired Student t test analysis was used for comparing data before and after embolization. Fifteen vein segments in 10 women were suitable for embolization. There was a significant (p < 0.001) decrease of VCSS after embolization, and recurrence of VV was not detected within a period of 6 months. There was also significant (p < 0.01) relief of chronic pelvic pain related to PCS evaluated using VAS at 3 months after embolization. Embolization decreases the risk of VV recurrence after surgery and also improves PCS symptoms in women with VV in lower limbs and IPV.

  19. Paradoxical brain embolism associated with Kimura disease mimics watershed infarction.

    PubMed

    Tanaka, Yasutaka; Ueno, Yuji; Shimada, Yoshiaki; Yamashiro, Kazuo; Tanaka, Ryota; Urabe, Takao; Hattori, Nobutaka

    2015-02-01

    Kimura disease (KD) is an uncommon chronic inflammatory disease presenting as subcutaneous lymphadenopathy with eosinophilia. To date, only a single case of brain embolism caused by fibroblastic endocarditis associated with KD has been reported. Watershed infarction was seen in patients with episodes of severe hypotension or cardiac surgery. We here report a young case of KD who developed ischemic stroke and showed multiple small infarcts in the border zones between the territories of major cerebral arteries, mimicking watershed infarction. Transesophageal echocardiography revealed patent foramen ovale and atrial septal aneurysm. Concurrently, deep venous thrombus in the femoral vein was found on duplex ultrasonography. Our case supports the notion that paradoxical brain embolism associated with KD can cause multiple small embolisms and mimic watershed infarction. PMID:25447210

  20. Pulmonary embolism in an immunocompetent patient with acute cytomegalovirus colitis

    PubMed Central

    Chou, Jen-Wei

    2016-01-01

    Acute cytomegalovirus (CMV) infection occurs commonly in immunocompromised and immunocompetent patients, but is usually asymptomatic in the latter. Vascular events associated with acute CMV infection have been described, but are rare. Hence, such events are rarely reported in the literature. We report a case of pulmonary embolism secondary to acute CMV colitis in an immunocompetent 78-year-old man. The patient presented with fever and diarrhea. Colonic ulcers were diagnosed based on colonoscopy findings, and CMV was the proven etiology on pathological examination. The patient subsequently experienced acute respiratory failure. Pulmonary embolism was diagnosed based on the chest radiography and computed tomography findings. A diagnosis of acute CMV colitis complicated by pulmonary embolism was made. The patient was successfully treated with intravenous administration of unfractionated heparin and intravenous ganciclovir. PMID:27175121

  1. Direct Percutaneous Embolization of Bleeding Stomal Varices

    SciTech Connect

    Naidu, Sailen G.; Castle, Erik P.; Kriegshauser, J. Scott; Huettl, Eric A.

    2010-02-15

    Stomal variceal bleeding can develop in patients with underlying cirrhosis and portal hypertension. Most patients are best treated with transjugular intrahepatic portosystemic shunt (TIPS) creation because this addresses the underlying problem of portal hypertension. However, some patients are not good candidates for TIPS creation because they have end-stage liver disease or encephalopathy. We describe such a patient who presented with recurrent bleeding stomal varices, which was successfully treated with percutaneous coil embolization. The patient had bleeding-free survival for 1 month before death from unrelated causes.

  2. Cerebral air embolism after pleural streptokinase instillation.

    PubMed

    Janisch, Thorsten; Siekmann, Ullrich; Kopp, Rüdger

    2013-12-01

    Iatrogenic pulmonary barotrauma and cerebral arterial gas embolism (CAGE) may complicate a variety of medical procedures, such as certain types of surgery, drug administration through thoracic drainage, pneumoperitoneum, cystoscopy, bronchoscopy, etc. Hyperbaric oxygen treatment following the guidelines for CAGE in diving is the treatment of choice. Pleural streptokinase instillation is a common treatment for parapneumonic pleural effusion and may lead to CAGE. We present such a complication in a 79-year-old woman with a left-sided empyema. Neurological recovery was reasonable, but a left hemiparesis persisted. Prompt treatment of CAGE is necessary to avoid permanent injury and severe disability. PMID:24510333

  3. Paradoxical coronary artery embolism - a rare cause of myocardial infarction.

    PubMed

    Hakim, Fayaz A; Kransdorf, Evan P; Abudiab, Muaz M; Sweeney, John P

    2014-01-01

    Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence. PMID:25774255

  4. Paradoxical Coronary Artery Embolism - A Rare Cause of Myocardial Infarction

    PubMed Central

    Hakim, Fayaz A.; Kransdorf, Evan P.; Abudiab, Muaz M.; Sweeney, John P.

    2014-01-01

    Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence. PMID:25774255

  5. Endovascular strategies for treatment of embolizing thoracoabdominal aortic lesions

    PubMed Central

    Jeyabalan, Geetha; Wallace, Justin R.; Chaer, Rabih Antoine; Leers, Steven A.; Marone, Luke Keith; Makaroun, Michel S.

    2014-01-01

    Objective Aortic sources of peripheral and visceral embolization remain challenging to treat. The safety of stent graft coverage continues to be debated. This study reports the outcomes of stent coverage of these complex lesions. Methods Hospital records were retrospectively reviewed for patients undergoing aortic stenting between 2006 and 2013 for visceral and peripheral embolic disease. Renal function, method of coverage, and mortality after stent grafting were reviewed. Results Twenty-five cases of embolizing aortic lesions treated with an endovascular approach were identified. The mean age was 65 ± 13 years (range, 45–87 years), and 64% were female. Sixteen (64%) patients presented with peripheral embolic events, six with concomitant renal embolization. Five patients presented with abdominal or flank pain, and two were discovered incidentally. Three patients had undergone an endovascular procedure for other indications within the preceding 6 months of presentation. Nineteen patients had existing chronic kidney disease (stage II or higher), but only three had stage IV disease. Of the eight patients tested, four had a diagnosed hypercoagulable state. Eight of the patients had lesions identified in multiple aortic segments, and aortic aneurysm disease was present in 24%. Coverage of both abdominal and thoracic sources occurred in eight patients, whereas 17 had only one segment covered. Minimal intraluminal catheter and wire manipulation was paired with the use of intravascular ultrasound in an effort to reduce embolization and contrast use. Intravascular ultrasound was used in the majority of cases and transesophageal echo in 28% of patients. Two patients with stage IV kidney disease became dialysis-dependent within 3 months of the procedure. No other patients had an increase in their postoperative or predischarge serum creatinine levels. No embolic events were precipitated during the procedure, nor were there any recurrent embolic events detected on follow

  6. Trans-arterial Onyx Embolization of a Functional Thoracic Paraganglioma

    PubMed Central

    Chacón-Quesada, Tatiana; Maud, Alberto; Ramos-Duran, Luis; Torabi, Alireza; Fitzgerald, Tamara; Akle, Nassim; Cruz Flores, Salvador; Trier, Todd

    2015-01-01

    Paragangliomas are rare tumors of the endocrine system. They are highly vascular and in some cases hormonally active, making their management challenging. Although there is strong evidence of the safety and effectiveness of preoperative embolization in the management of spinal tumors, only five cases have been reported in the setting of thoracic paragangliomas. We present the case of a 19-year-old man with a large, primary, functional, malignant paraganglioma of the thoracic spine causing a vertebral fracture and spinal cord compression. To our knowledge this is the first report of preoperative trans-arterial balloon augmented Onyx embolization of a thoracic paraganglioma. PMID:25763296

  7. [Postbiopsy giant pseudoaneurysm in renal transplant: treatment with embolization].

    PubMed

    Zaragozano Guillén, R; García Díez, A I; Cobos Hernández, M V; Yagüe Romeo, D

    1998-03-01

    Pseudoaneurism in renal grafts is a well known complication of the percutaneous biopsy. Colour Doppler has been shown to be the choice technique for their diagnosis and subsequent control, the most effective treatment being embolization. This paper presents an unusual form of pseudoaneurism in terms of its size (up to 8 cm diameter) in a renal graft, following performance of a percutaneous biopsy with automatic needle. The findings of the colour Doppler study and the angiography are shown and discussed, as well as the treatment by embolization with metal spirals which achieved the stable, complete occlusion of the lesion after six months control. PMID:9616940

  8. Pulmonary embolism following celiac plexus block and neurolysis.

    PubMed

    McAninch, Scott A; Raizada, Miles S; Kelly, Seth M

    2016-07-01

    Treatment of acute pain in chronic disease requires the physician to choose from an arsenal of pain management techniques tailored to the individual patient. Celiac plexus block and neurolysis are commonly employed for the management of chronic abdominal pain, especially in debilitating conditions such as cancer or chronic pancreatitis. The procedure is safe, well tolerated, and produces few complications. We present a case of pulmonary embolism following a celiac plexus block and neurolysis procedure. Further study is required to determine if celiac plexus ablation, alone or in combination with other risk factors, may contribute to increased risk for pulmonary embolism in patients seeking treatment for chronic upper abdominal pain conditions. PMID:27365890

  9. Pulmonary embolism following celiac plexus block and neurolysis

    PubMed Central

    Raizada, Miles S.; Kelly, Seth M.

    2016-01-01

    Treatment of acute pain in chronic disease requires the physician to choose from an arsenal of pain management techniques tailored to the individual patient. Celiac plexus block and neurolysis are commonly employed for the management of chronic abdominal pain, especially in debilitating conditions such as cancer or chronic pancreatitis. The procedure is safe, well tolerated, and produces few complications. We present a case of pulmonary embolism following a celiac plexus block and neurolysis procedure. Further study is required to determine if celiac plexus ablation, alone or in combination with other risk factors, may contribute to increased risk for pulmonary embolism in patients seeking treatment for chronic upper abdominal pain conditions. PMID:27365890

  10. Systemic Air Embolism Associated with Pleural Pigtail Chest Tube Insertion

    PubMed Central

    Alkhankan, Emad; Nusair, Ahmad; Mazagri, Rida

    2016-01-01

    Pleural pigtail catheter placement is associated with many complications including pneumothorax, hemorrhage, and chest pain. Air embolism is a known but rare complication of pleural pigtail catheter insertion and has a high risk of occurrence with positive pressure ventilation. In this case report, we present a 50-year-old male with bilateral pneumonia who developed a pneumothorax while on mechanical ventilation with continuous positive airway pressure mode. During the placement of the pleural pigtail catheter to correct the pneumothorax, the patient developed a sudden left sided body weakness and became unresponsive. An air embolism was identified in the right main cerebral artery, which was fatal.

  11. Periprocedural Bleeding Complications of Brain AVM Embolization with Onyx

    PubMed Central

    Liu, L.; Jiang, C.; He, H.; Li, Y.; Wu, Z.

    2010-01-01

    Summary The advent of Onyx has provided a new method for neurointerventional therapists to treat brain AVMs. Although some retrospective studies have reported complications for AVM embolization with Onyx, periprocedural bleeding complications with Onyx embolization have not yet been described in detail. The aim of this retrospective study was to analyze the factors of Onyx-related bleeding complications and to find a way to avoid and manage these complications. From January 2003, patients with AVMs recruited in our institution started to be treated by Onyx embolization. From January 2007 to July 2009, 143 consecutive interventions were performed in 126 patients using flow-independent microcatheters and Onyx as embolic agents. Seven patients encountered bleeding complications (5.4% per patients and 4.7% per procedures) during or after the endovascular procedures. Among them, five bleeding episodes occurred during procedures, the other two after procedures. Details of the seven patients' clinical presentations, imaging presentations, speculative reasons and management of these complications were recorded. Follow-up data, including postoperative course, clinical symptoms and duration of follow-up were documented. The five active bleedings discovered in procedures were managed in time, and the patients recovered without any new neurological symptoms compared with preoperation. However, of the two bleeding episodes that occurred after interventional procedures, one was detected half an hour later: the patient was remained comatose two months later after resection of right occipital hematoma; the other who encountered intraventricular and midbrain hemorrhage was treated conservatively and suffered Parinaud syndrome and hemianesthesia. Conclusion: Periprocedural bleeding of AVMs embolization is considered a severe and devastating complication. The clinical course and prognosis of bleeding mostly depends on prompt detection and management. Interventional embolization is an

  12. Adult respiratory distress syndrome due to fat embolism in the postoperative period following liposuction and fat grafting.

    PubMed

    Costa, André Nathan; Mendes, Daniel Melo; Toufen, Carlos; Arrunátegui, Gino; Caruso, Pedro; de Carvalho, Carlos Roberto Ribeiro

    2008-08-01

    Fat embolism is defined as mechanical blockage of the vascular lumen by circulating fat globules. Although it primarily affects the lungs, it can also affect the central nervous system, retina, and skin. Fat embolism syndrome is a dysfunction of these organs caused by fat emboli. The most common causes of fat embolism and fat embolism syndrome are long bone fractures, although there are reports of its occurrence after cosmetic procedures. The diagnosis is made clinically, and treatment is still restricted to support measures. We report the case of a female patient who developed adult respiratory distress syndrome due to fat embolism in the postoperative period following liposuction and fat grafting. In this case, the patient responded well to alveolar recruitment maneuvers and protective mechanical ventilation. In addition, we present an epidemiological and pathophysiological analysis of fat embolism syndrome after cosmetic procedures. PMID:18797748

  13. [Cyanoacrylate pulmonary embolism after embolization of a cerebral arteriovenous malformation. Report of one case].

    PubMed

    Fernández, Patricia; Loayza, Patricio; Sabbagh, Eduardo; Badilla, Lautaro; Rojas, David; Verschae, Gregorio; Milet, Beatriz

    2004-04-01

    Arterial embolization with cyanoacrylate is commonly used for the treatment of arteriovenous malformations. We report the case of a 40 years old man who four days after an embolization with cyanoacrylate, begins with cough, bloody sputum, and right hemithorax pleuritic pain. Pulmonary embolism was confirmed with chest X ray, CT scan and scyntigraphy. The patient received anticoagulation, with adequate response. The most common complications of cerebral embolization are related to central nervous system and pulmonary embolism is exceptional. Considering the high number of embolization procedures done nowadays, this complication must be borne in mind. PMID:15382522

  14. Embolized meningiomas: risk of overgrading and neo-angiogenesis.

    PubMed

    Barresi, Valeria; Branca, Giovanni; Granata, Francesca; Alafaci, Concetta; Caffo, Maria; Tuccari, Giovanni

    2013-06-01

    Pre-operative embolization (POE) of meningiomas may induce histological changes which simulate malignancy, possibly resulting in overgrading. Aims of the present study were to identify clues to distinguish malignancy-related features from POE-related changes and to test for overgrading the grading scheme currently in use, in embolized meningiomas. In addition, we aimed to analyze whether the POE procedure may stimulate neo-angiogenesis in meningiomas. The histological features of a series of embolized meningiomas were evaluated and considered for grading assessment. In the same cases neo-angiogenesis was quantified by the evaluation of microvessel density (MVD) and correlated with the interval between POE and surgery. Necrosis and macronucleoli represented common findings in embolized meningiomas. Nonetheless, in most of the cases, necrosis showed an abrupt line of demarcation from the viable tumour tissue, and macronucleoli were restricted to peri-necrotic areas. Suggesting that these were POE-associated changes, exclusion of necrotic areas with an abrupt line of transition and focal macronucleoli from grading assessment resulted in increased specificity and positive predictive value in the identification of recurring meningiomas. In our cohort, MVD significantly increased with the time between POE and surgery, suggesting that POE procedure may induce neo-angiogenesis in meningiomas. In conclusion, a risk of overgrading there exists in embolized meningiomas, as a consequence of the frequent evidence of necrosis and prominent nucleoli in these tumours. In order to avoid overgrading, we suggest that necrosis showing an abrupt line of demarcation and focal peri-necrotic macronucleoli are not included in grading assessment. Also, caution should be used in the interpretation of MVD as a prognostic factor in embolized meningioma, as it may also result from POE procedure. PMID:23504284

  15. Direct transcranial puncture for Onyx embolization of a cerebellar hemangioblastoma.

    PubMed

    Ding, Dale; Starke, Robert M; Evans, Avery J; Liu, Kenneth C

    2014-06-01

    Intracranial hemangioblastomas are benign but hypervascular tumors, most commonly located in the cerebellum, which are difficult to resect without significant operative blood loss. While preoperative embolization may decrease the amount of operative bleeding, the vascular supply of cerebellar hemangioblastomas frequently precludes safe embolization by an endovascular route due to the risk of thromboembolic vertebrobasilar infarction. Direct puncture embolization overcomes many of the limitations of endovascular embolization but its safety and feasibility for intracranial tumors is unknown. We report a 48-year-old man who was diagnosed with a large cerebellar mass after presenting with headaches and gait ataxia. Based on diagnostic angiography, which demonstrated a highly vascular tumor supplied by the posterior inferior cerebellar and posterior meningeal arteries, we decided to embolize the tumor by a direct transcranial puncture approach. After trephinating the skull in a standard fashion, a catheter-needle construct, composed of an Echelon 10 microcatheter (ev3 Endovascular, Plymouth, MN, USA) placed into a 21-gauge spinal needle, was inserted into the tumor under biplanar angiographic guidance. Using continuous angiographic monitoring, 9cc of Onyx 34 (ev3 Endovascular) was injected through the catheter, resulting in 75% tumor devascularization without evidence of complications. The patient was taken directly to surgery where a gross total resection of the hemangioblastoma was achieved with an acceptable operative blood loss. At his 2 year follow-up, the patient was neurologically intact without neuroimaging evidence of residual tumor. We describe, to our knowledge, the first case of direct transcranial puncture for preoperative embolization of a cerebellar hemangioblastoma. PMID:24370504

  16. Application of the Liquid Coil as an Embolic Material for Arteriovenous Malformations

    PubMed Central

    Kurata, A.; Suzuki, S.; Ozawa, H.; Yuzawa, I.; Yamda, M.; Fujii, K.; Kan, S.; Kitahara, T.; Ohmomo, T.; Miyasaka, Y.

    2005-01-01

    Summary The purpose of this paper is to clarify advantages and disadvantages of platinum liquid coils as an embolic material for AVMs. During the last eight years, 50 endovascular procedures using liquid coils were conducted in our institute for 19 cases with AVMs, 15 of which were located in the eloquent area. All but one presented with haemorrhage, the exception demonstrating repeated ischemic symptoms. Only liquid coils were used as the embolic material to obliterate the nidus and feeders. In ten of the 15 patients with AVMs located in the eloquent area and one case rejecting surgery, liquid coil embolization was applied one to 11 times (average 3.5 times) to achieve decrease in size and this was then followed by radiosurgery. The remaining eight AVM patients underwent total removal after liquid coil embolization. No complications were encountered during the peri-embolization period. In all cases, the purpose of embolization was to diminish the size to facilitate radiosurgery and decrease bleeding during surgery. The liquid coil has advantages as a material for embolization of AVMs; it is non-toxic and bioinart material; it seldom occludes normal minute vascular channels; when it used in a nidus, it seldom to migrates in the venous direction, and it has good radio-opacity and offers good marking for surgery. Appropriate applications include preoperative embolization or pre-radiosurgical embolization of AVMs, especially when staged embolizations are performed to reduce risk of perfusion pressure breakthrough in patients which are large or located in the eloquent area. PMID:20584489

  17. Percutaneous and Endovascular Embolization of Ruptured Hepatic Artery Aneurysm

    SciTech Connect

    Little, Andrew F.; Lee, Wai Kit

    2002-06-15

    A 72-year-old woman presented with an intraperitoneal hemorrhage from a ruptured intrahepatic arteryaneurysm, with an associated pseudoaneurysm developing a high-flow arteriovenous fistula. Persistent coagulopathy and a median arcuate ligament stenosis of the celiac axis further complicated endovascular management. Aneurysm thrombosis required percutaneous embolization with coils, a removable core guidewire and polyvinyl alcohol particles.

  18. Fat embolism after liposuction in Klippel-Trenaunay syndrome.

    PubMed

    Zeidman, Michael; Durand, Paul; Kundu, Neilendu; Doumit, Gaby

    2013-07-01

    Fat embolism syndrome (FES) is a rare but potentially fatal postoperative complication from liposuction. We present the case of a 24-year-old woman with Klippel-Trenaunay syndrome who developed FES as a complication of lower extremity liposuction. There may be an increased risk of FES in patients with vascular malformations undergoing liposuction. PMID:23851798

  19. Antepartum embolization in management of labor induction in placenta previa.

    PubMed

    Huang, L L; Tang, H; Awale, R; Zeng, Z S; Li, F R; Chen, Y

    2013-01-01

    The authors present a case of a 29-year-old woman, gravid 2 para 1, who experienced complete placenta previa and underwent vaginal delivery, after performing antepartum uterine artery embolization and rivanol amniotic injection due to contraindication of obstetric surgery. In this case, treatment was successful despite thromboembolism. Hypercoagulability in pregnancy needs to be addressed. PMID:24283189

  20. A Pregnant Woman with Acute Massive Pulmonary Embolism

    PubMed Central

    Yang, Yuan Po; Lin, Li-Sian

    2014-01-01

    A 30-year-old pregnant woman who suffered from massive pulmonary embolism presented in an unstable hemodynamic status. Angiojet catheter embolectomy and extracorporeal membrane oxygenation (ECMO) were performed, which caused the patient’s condition to improve. Use of ECMO was continued during the weaning program, but the patient died of intracranial hemorrhage, a complication of ECMO. PMID:27122772

  1. Stent-Assisted Coil Embolization of a Traumatic Wide-Necked Renal Segmental Artery Pseudoaneurysm

    SciTech Connect

    Schlunz-Hendann, Martin; Wetter, Axel; Landwehr, Peter; Brassel, Friedhelm

    2011-10-15

    We present the case of an Afghan woman with a renal segmental artery false aneurysm of the right kidney due to a shell splinter injury. Stent-assisted coil embolization of the aneurysm is described in detail.

  2. Nonfatal air embolism during shoulder arthroscopy.

    PubMed

    Pandey, Vivek; Varghese, Elsa; Rao, Madhu; Srinivasan, Nataraj M; Mathew, Neethu; Acharya, Kiran K V; Rao, P Sripathi

    2013-06-01

    An air embolism is a rare but potentially fatal complication of shoulder arthroscopy. In this article, we report the case of a patient who developed a nonfatal air embolism during shoulder arthroscopy for an acute bony Bankart lesion and a greater tuberosity avulsion fracture. The venous air embolism occurred immediately after the joint was insufflated with air for diagnostic air arthroscopy. The diagnosis was based on a drop in end-tidal carbon dioxide and blood pressure and presence of mill wheel (waterwheel) murmur over the right heart. Supportive treatment was initiated immediately. The patient recovered fully and had no further complications of air embolism. This patient's case emphasizes the importance of being aware that air embolisms can occur during shoulder arthroscopy performed for acute intra-articular fractures of the shoulder. Monitoring end tidal carbon dioxide can be very useful in early detection of air embolisms. PMID:23805421

  3. Septic Pulmonary Embolism Following Appendectomy Surgery.

    PubMed

    Lardo, Soroy; Ariane, Anna; Chen, Khie

    2015-07-01

    Septic Pulmonary embolism is a rare condition where there were numerous pulmonary infarcts resulting from blood clot emboli that also contains microorganism. This disorder is insidious onset, Its clinical features usually unspecific and the diagnosis usually difficult to establish. A 43 old woman who underwent an appendicitis surgery, reentered the hospital at the sixth day after surgery presented with fever, pain at the surgical site, progressive severe dyspnea and chest tightness. From the physical examination finding there were tachycardia, tachypneu, wet rough basal rhonki on the right rear and tenderness at right lower region of the abdomen. The thorax-abdomen CT scan result was pleuropneumonial with minimal effusion in the right side. A CT angiography scan of the chest and abdomen showed intralumen emboli in medial lobe segmen of right pulmonary artery, right pleuropneumonia with segmental lession in segmen 10 right lobe and inflammation process along right lateral wall of the abdomen. Laboratory results that also supported diagnosis were D dimer 3442 ng/mL and culture result from surgical site pus showed E. Coli ESBL (+). Base on these findings, this case was established as a septic pulmonary embolism. PMID:26586389

  4. Successful thrombo-embolectomy in long-standing thrombo-embolic pulmonary hypertension 1

    PubMed Central

    Nash, E. S.; Shapiro, S.; Landau, A.; Barnard, C. N.

    1968-01-01

    The operative removal of thrombo-emboli from the pulmonary arteries in acute pulmonary embolism is an accepted method of treatment. The removal of thrombi that have been present for many months has been attempted less often. This case report covers the operative treatment and the pre- and post-operative physiological studies in a patient with long-standing thrombo-embolic pulmonary hypertension, in whom a large thrombus was removed under cardiopulmonary bypass from the left pulmonary artery. Dramatic clinical improvement resulted. A plea is made for a more radical approach to thrombo-embolic pulmonary hypertension when a local obstruction can be demonstrated. Images PMID:5654068

  5. Fatal Pulmonary Tumor Embolic Microangiopathy in Young Lady without Known Primary Malignancy

    PubMed Central

    Al-Azem, M. Ali; Hanafy, Ahmed; Nakkar, Talal

    2014-01-01

    Pulmonary embolism (PE) is a common cause of morbidity and mortality in hospitalized patients. Malignancy, prolonged recumbence, and chemotherapy are renowned risk factors for development of clinically significant PE. Cancer exerts a multitude of pathophysiological processes, for example, hypercoagulability and abnormal vessels with sluggish circulation that can lead to PE. One of the peculiar characteristics of tumor cells is their ability to reach the circulation and behave as blood clot—not a metastasis-occluding the pulmonary circulation. We present a case of fatal pulmonary embolism diagnosed histologically to be due to tumor cell embolism. PMID:25478243

  6. Middle meningeal artery: Gateway for effective transarterial Onyx embolization of dural arteriovenous fistulas.

    PubMed

    Griessenauer, Christoph J; He, Lucy; Salem, Mohamed; Chua, Michelle H; Ogilvy, Christopher S; Thomas, Ajith J

    2016-09-01

    Curative transarterial embolization of noncavernous sinus dural arteriovenous fistulas (dAVFs) is challenging. We sought to evaluate the role of the middle meningeal artery (MMA) in endovascular treatment of these lesions. We performed a retrospective cohort study on patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVFs with contribution from the MMA at a major academic institution in the United States from January 2009 to January 2015. Twenty consecutive patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVF were identified. One patient was excluded as there was no MMA contribution to the dAVF. All of the remaining 19 patients (61.3 ± 13.8 years of age) underwent transarterial embolization through the MMA. Six patients (31.6%) presented with intraparenchymal or subarachnoid hemorrhage from the dAVF. The overall angiographic cure rate was 73.7% upon last follow up. In 71.4% of successfully treated patients transarterial embolization of the MMA alone was sufficient to achieve angiographic cure. When robust MMA supply was present, MMA embolization resulted in angiographic cure even after embolization of other arterial feeders had failed in 92.9% of patients. A robust contribution of the MMA to the fistula was the single most important predictor for successful embolization (P = 0.00129). We attribute our findings to the fairly straight, non-tortuous course of the MMA that facilitates microcatheter access, navigation, and Onyx penetration. Noncavernous sinus dAVF can be successfully embolized with transarterial Onyx through the MMA, as long as supply is robust. A transvenous approach is rarely necessary. Clin. Anat. 29:718-728, 2016. © 2016 Wiley Periodicals, Inc. PMID:27148680

  7. Pulmonary Embolism following Cessation of Infliximab for Treatment of Miliary Tuberculosis

    PubMed Central

    Moosavy, Farid

    2014-01-01

    We report a case of a 41-year-old male who presented with tachycardia and swelling of his left arm six weeks after he started antituberculosis treatment and stopped his rheumatoid arthritis infliximab treatment. He was diagnosed with pulmonary embolism by chest CT and initially treated with warfarin, which interacted with his antituberculosis treatment. This presentation of deep vein thrombosis and pulmonary embolism as part of immune reconstitution inflammatory syndrome has not been previously reported for infliximab treated patients. PMID:25530902

  8. Multiple Intrahepatic Artery Aneurysms in a Patient with Behcet's Disease: Use of Transcatheter Embolization for Rupture

    SciTech Connect

    Ahmed, Irfan; Fotiadis, Nikolas I. Dilks, Phil; Kocher, Hemant M.; Fotheringham, Tim; Matson, Matthew

    2010-04-15

    Intrahepatic artery aneuryms are a rare and potentially life-threatening condition. We present the first case in the English literature of multiple intrahepatic artery aneuryms in a patient with Behcet's disease who presented acutely with rupture. The ruptured aneurysm was treated successfully with transcatheter arterial coil embolization-CT and clinical follow-up confirming a good result. We discuss the management dilemma with regard to prophylactic embolization of the numerous other small asymptomatic intrahepatic aneurysms in this same patient.

  9. Fat embolism: a clinical diagnosis.

    PubMed

    Miller, J D

    1987-01-01

    Fat embolism causes a distinctive clinical syndrome usually seen in trauma victims with long bone fractures. Clinical findings include hyperthermia, respiratory distress, petechiae and retinal fat emboli. Neurologic changes include decreased sensorium, decerebrate posturing and seizure activity. Chest radiographs commonly demonstrate bilateral fluffy infiltrates. Laboratory abnormalities include hypoxemia, respiratory alkalosis, anemia and hypocalcemia. Treatment consists of general supportive care with vigorous pulmonary therapy. Most patients have a good recovery. PMID:3799415

  10. 21 CFR 882.5950 - Neurovascular embolization device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... embolization device. (a) Identification. A neurovascular embolization device is an intravascular implant intended to permanently occlude blood flow to cerebral aneurysms and cerebral ateriovenous...

  11. Hepatic Artery Angiography and Embolization for Hemobilia Following Laparoscopic Cholecystectomy

    SciTech Connect

    Nicholson, Tony; Travis, Simon; Ettles, Duncan; Dyet, John; Sedman, Peter; Wedgewood, Kevin; Royston, Christopher

    1999-01-15

    Purpose: The effectiveness of angiography and embolization in diagnosis and treatment were assessed in a cohort of patients presenting with upper gastrointestinal hemorrhage secondary to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Methods: Over a 6-year period 1513 laparoscopic cholecystectomies were carried out in our region. Nine of these patients (0.6%) developed significant upper gastrointestinal bleeding, 5-43 days after surgery. All underwent emergency celiac and selective right hepatic artery angiography. All were treated by coil embolization of the right hepatic artery proximal and distal to the bleeding point. Results: Pseudoaneurysms of the hepatic artery adjacent to cholecystectomy clips were demonstrated in all nine patients at selective right hepatic angiography. In three patients celiac axis angiography alone failed to demonstrate the pseudoaneurysm. Embolization controlled hemorrhage in all patients with no further bleeding and no further intervention. One patient developed a candidal liver abscess in the post-procedure period. All patients are alive and well at follow-up. Conclusion: Selective right hepatic angiography is vital in the diagnosis of upper gastrointestinal hemorrhage following laparoscopic cholecystectomy. Embolization offers the advantage of minimally invasive treatment in unstable patients, does not disrupt recent biliary reconstruction, allows distal as well as proximal control of the hepatic artery, and is an effective treatment for this potentially life-threatening complication.

  12. Preoperative Uterine Artery Embolization (PUAE) Before Uterine Fibroid Myomectomy

    SciTech Connect

    Dumousset, E.; Chabrot, P.; Rabischong, B.; Mazet, N.; Nasser, S.; Darcha, C.; Garcier, J.M.; Mage, G.; Boyer, L.

    2008-05-15

    Purpose. To evaluate the potential of uterine artery embolization to minimize blood loss and facilitate easier removal of fibroids during subsequent myomectomy. Methods. This retrospective study included 22 patients (median age 37 years), of whom at least 15 wished to preserve their fertility. They presented with at least one fibroid (mean diameter 85.6 mm) and had undergone preoperative uterine artery embolization (PUAE) with resorbable gelatin sponge. Results. No complication or technical failure of embolization was identified. Myomectomies were performed during laparoscopy (12 cases) and laparotomy (9 cases). One hysterectomy was performed. The following were noted: easier dissection of fibroids (mean 5.6 per patient, range 1-30); mean intervention time 113 min (range 25-210 min); almost bloodless surgery, with a mean peroperative blood loss of 90 ml (range 0-806 ml); mean hemoglobin pretherapeutically 12.3 g/dl (range 5.9-15.2 g/dl) and post-therapeutically 10.3 g/dl (range 5.6-13.3 g/dl), with no blood transfusion needed. Patients were discharged on day 4 on average and the mean sick leave was 1 month. Conclusion. Preoperative embolization is associated with minimal intraoperative blood loss. It does not increase the complication rate or impair operative dissection, and improves the chances of performing conservative surgery.

  13. [Acute upper limb embolism in a severely burned patient].

    PubMed

    Wiebringhaus, P; Pierson, T; Menke, H

    2014-12-01

    Thrombosis and pulmonary embolisms are the most common complications in the hospital. The need for anticoagulation during hospital stay is obligatory. Arterial embolisms are rare. They often take place in patients with a pre-existing peripheral artery occlusive disease or in patients with atrial fibrillation. The most common complications in burn patients are wound infection, pneumonia, catheter-associated infections and paralytic ileus. There are almost no data available regarding arterial embolism in burn patients. Therefore we would like to present the case of a 60-year-old woman who was injured by a fire at home and was transported to our special burn unit. She sustained partial thickness burns of both legs and buttocks. The TBSA was 15%. During the first days of clinical stay the patient suffered from a pain induced movement reduction of the left hand. There were no peripheral pulses palpable or by pulsed-wave Doppler detectable. An urgent selected angiography of the left arm was performed and a arterial embolism of the proximal part of the a. brachialis was detected. The patient was operated immediately. After debridement and split-skin graft of the burn wounds the patient was taken to rehabiliation after 35 days. PMID:25564950

  14. Experimental research of Fuaile medical adhesive for portal vein embolization in white rabbit models

    PubMed Central

    JIANG, TIANPENG; WANG, LIZHOU; LI, XING; SONG, JIE; WU, XIAOPING; AN, TIANZHI; ZHOU, SHI

    2015-01-01

    The aim of the present study was to investigate the feasibility and efficacy of Fuaile medical adhesive for portal vein embolization in the treatment of a rabbit model. This study used 26 white rabbits, 14 of which were selected and assigned into seven groups (n=2) for the preliminary experiment. Fuaile medical adhesive was mixed with lipiodol at different ratios of 1:0, 1:1, 1:2, 1:3, 1:4, 1:5 and 0:1, respectively, and administered via the portal trunk. The remaining 12 white rabbits were randomly divided into two groups (n=6). The evaluation of the results included the degree of adhesion to the vessels, the extent of embolization and the reaction of the rabbit. Hepatic and renal functions were detected prior to and at 1, 7 and 14 days post-embolization, respectively. Angiography, CT scans and pathological examinations were conducted at post-embolization. Histological examinations revealed that the topical swollen lesions were darker. Light microscopy showed embolic agents in the portal venous blood vessels and the formation of a secondary thrombus. Hepatic necrosis appeared surrounding the embolization area. Inflammatory cell infiltration of different degrees occurred in the early stage and inflammatory fibroplasia occurred in the late stage. Alanine aminotransferase and aspartate aminotransferase levels increased at 1 day post-embolization, peaked at 7 days and was in the normal range at 14 days. The levels of blood urea nitrogen and ceruloplasmin were elevated at 1 day post-embolization and lowered to normal at 7 days. Fuaile medical adhesive is an effective, safe and inexpensive agent, used for effectively inducing embolization in the portal trunk, and the first and second branches of rabbit portal veins. The use of Fuaile therefore merits widespread application in clinical practice. PMID:26137115

  15. Pulmonary Bone Cement Embolism: CT Angiographic Evaluation with Material Decomposition Using Gemstone Spectral Imaging

    PubMed Central

    Huh, Sun

    2014-01-01

    We report a case of pulmonary bone cement embolism in a female who presented with dyspnea following multiple sessions of vertebroplasty. She underwent spectral CT pulmonary angiography and the diagnosis was made based on enhanced visualization of radiopaque cement material in the pulmonary arteries and a corresponding decrease in the parenchymal iodine content. Here, we describe the CT angiography findings of bone cement embolism with special emphasis on the potential benefits of spectral imaging, providing additional information on the material composition. PMID:25053903

  16. Pulmonary bone cement embolism: CT angiographic evaluation with material decomposition using gemstone spectral imaging.

    PubMed

    Huh, Sun; Lee, Heon

    2014-01-01

    We report a case of pulmonary bone cement embolism in a female who presented with dyspnea following multiple sessions of vertebroplasty. She underwent spectral CT pulmonary angiography and the diagnosis was made based on enhanced visualization of radiopaque cement material in the pulmonary arteries and a corresponding decrease in the parenchymal iodine content. Here, we describe the CT angiography findings of bone cement embolism with special emphasis on the potential benefits of spectral imaging, providing additional information on the material composition. PMID:25053903

  17. Portal Vein Embolization Before Extended Hepatectomy in a Toddler With Mesenchymal Hamartoma.

    PubMed

    Terraz, Sylvain; Ronot, Maxime; Breguet, Romain; Anooshiravani, Mehrak; Rubbia-Brandt, Laura; Becker, Christoph D; Wildhaber, Barbara E

    2015-10-01

    Portal vein embolization is widely used to induce hypertrophy of the future liver remnant before extended hepatectomy, decreasing the risk of postoperative liver failure. However, this percutaneous procedure has not been previously reported in a young child. The present report describes the case of a 14-month-old patient with a large multifocal mesenchymal hamartoma of the entire right liver, successfully resected after induction of future liver remnant hypertrophy by portal vein embolization. PMID:26391943

  18. Recurrent Embolic Strokes of Undetermined Source in a Patient with Extreme Lipoprotein(a) Levels

    PubMed Central

    Bulwa, Zachary; Kim, Audrey; Singh, Karandeep; Kantorovich, Alexander; Suhail, Faten

    2016-01-01

    Lipoprotein(a) is a plasma lipoprotein and known cardiovascular risk factor, most recently implicated in the development of high-risk carotid atherosclerotic plaques without significant carotid stenosis. We present a case of a young African-American female with recurrent embolic strokes of undetermined source. After our thorough investigation, we identified the link between a small, irregular plaque in the right internal carotid artery, and an extremely elevated plasma level of lipoprotein(a) as the source of her embolic strokes.

  19. Transcatheter Coil Embolization of Splenic Artery Aneurysm

    SciTech Connect

    Yamamoto, Satoshi Hirota, Shozo; Maeda, Hiroaki; Achiwa, Sachiko Arai, Keisuke; Kobayashi, Kaoru; Nakao, Norio

    2008-05-15

    The purpose of this study was to evaluate clinical results and technical problems of transcatheter coil embolization for splenic artery aneurysm. Subjects were 16 patients (8 men, 8 women; age range, 40-80 years) who underwent transcatheter embolization for splenic artery aneurysm (14 true aneurysms, 2 false aneurysms) at one of our hospitals during the period January 1997 through July 2005. Two aneurysms (12.5%) were diagnosed at the time of rupture. Multiple splenic aneurysms were found in seven patients. Aneurysms were classified by site as proximal (or strictly ostial) (n = 3), middle (n = 3), or hilar (n = 10). The indication for transcatheter arterial embolization was a false or true aneurysm 20 mm in diameter. Embolic materials were fibered coils and interlocking detachable coils. Embolization was performed by the isolation technique, the packing technique, or both. Technically, all aneurysms were devascularized without severe complications. Embolized aneurysms were 6-40 mm in diameter (mean, 25 mm). Overall, the primary technical success rate was 88% (14 of 16 patients). In the remaining 2 patients (12.5%), partial recanalization occurred, and re-embolization was performed. The secondary technical success rate was 100%. Seven (44%) of the 16 study patients suffered partial splenic infarction. Intrasplenic branching originating from the aneurysm was observed in five patients. We conclude that transcatheter coil embolization should be the initial treatment of choice for splenic artery aneurysm.

  20. [Polycitemia vera and pulmonary embolism: case report].

    PubMed

    Nugara, Cinzia; Carità, Patrizia; Coppola, Giuseppe; Mignano, Antonino; Ajello, Laura; Rotolo, Antonino; Assennato, Pasquale; Novo, Salvatore; Corrado, Egle

    2013-12-01

    Pulmonary embolism is a rare clinical onset of chronic myeloproliferative diseases. Early diagnosis is very important because medical therapy reduces both mortality and morbility. We describe a case of pulmonary embolism as clinical onset of an unknown myeloproliferative disorder. On the basis of our experience is very important early diagnosis and therapy to reduce incidence of later major thrombotic complications. PMID:24362834

  1. Fat embolism syndrome in a patient demonstrating only neurologic symptoms.

    PubMed

    Bardana, D; Rudan, J; Cervenko, F; Smith, R

    1998-10-01

    Fat embolism syndrome (FES) is a recognized complication of both long bone fractures and intramedullary orthopedic procedures. The usual presenting features are respiratory failure, neurologic dysfunction and petechiae. In this report, a 25-year-old woman with FES presented with serious neurologic symptoms and signs in the absence of respiratory dysfunction. The diagnosis is essentially a clinical one, but nuclear magnetic resonance imaging of the brain revealed distinctive lesions that may help future diagnosis of FES. PMID:9793509

  2. Fat embolism syndrome in a patient demonstrating only neurologic symptoms

    PubMed Central

    Bardana, David; Rudan, John; Cervenko, Frank; Smith, Roger

    1998-01-01

    Fat embolism syndrome (FES) is a recognized complication of both long bone fractures and intramedullary orthopedic procedures. The usual presenting features are respiratory failure, neurologic dysfunction and petechiae. In this report, a 25-year-old woman with FES presented with serious neurologic symptoms and signs in the absence of respiratory dysfunction. The diagnosis is essentially a clinical one, but nuclear magnetic resonance imaging of the brain revealed distinctive lesions that may help future diagnosis of FES. PMID:9793509

  3. Systemic thrombolysis for acute pulmonary embolism.

    PubMed

    Bartel, Billie

    2015-01-01

    Acute pulmonary embolism is a frequent cause of hospitalization and is associated with a wide range of symptom severity. Anticoagulants are the mainstay of treatment for acute pulmonary embolism; however, in patients with massive or submassive pulmonary embolism, advanced therapy with thrombolytics may be considered. The decision to use thrombolytic therapy for acute pulmonary embolism should be based on careful risk-benefit analysis for each patient, including risk of morbidity and mortality associated with the embolism and risk of bleeding associated with the thrombolytic. Alteplase is currently the thrombolytic agent most studied and with the most clinical experience for this indication, although the most appropriate dose remains controversial, especially in patients with low body weight. When considering thrombolysis, unfractionated heparin is the preferred initial anticoagulant due to its short duration of action and its reversibility should bleeding occur. PMID:25559613

  4. A case of panic to pulmonary embolism.

    PubMed

    Ng, Mansum; Pandya, Nikila; Conry, Brendon; Gale, Richard

    2015-01-01

    Pulmonary embolism (PE) is a rare paediatric diagnosis, but its presence is likely to be underestimated due to the subtle and non-specific nature of its symptoms. Common clinical features of PE include shortness of breath, pleuritic chest pain and acute cardiovascular collapse. Less common symptoms can include persistent unexplained tachycardia, fever or deep vein thrombosis. Rarely do patients present with abdominal pain and self-resolving shortness of breath; symptoms our patient experienced. However, in contrast to popular belief, having normal vital signs does not necessarily lower the probability of PE. D-dimer, a specific fibrin degradation product, has a good negative predictive value for venous thromboembolism diagnosis but its use in children is less clear, with up to 40% of children with PE having a normal D-dimer level. CT pulmonary angiography remains the gold standard in diagnosis. PMID:26071441

  5. Usefulness of selective renal artery embolization for urinary fistula following partial nephrectomy: Two case reports

    PubMed Central

    NOHARA, TAKAHIRO; MATSUYAMA, SATOKO; KAWAGUCHI, SHOHEI; MIYAGI, TOHRU; SETO, CHIKASHI; MOCHIZUKI, KENTARO

    2016-01-01

    The present study reported two cases in which selective artery embolization were identified to assist in resolving urinary fistulae following partial nephrectomies. The first case involved a 51-year-old male who received a mini-incision partial nephrectomy with renorrhaphy. Following the operation, urine continued to discharge from the retroperitoneal drain. Selective renal artery embolization of the upper calyx at post-operation day 20 was highly effective and urine output from the drain stopped immediately. Case 2 involved a 66-year-old male, who also suffered from a urinary fistula following a partial nephrectomy. Selective renal artery embolization performed at post-operation day 21 was again effective. In each case, the upper calyx was separated from the renal pelvis. These cases demonstrated that suturing of the collecting system and renal parenchyma may result in the separation of the urine pathway, and that selective renal artery embolization appears to be a highly effective treatment in such cases.

  6. [A case of posterior reversible encephalopathy syndrome associated with coil embolization of a basilar apex aneurysm].

    PubMed

    Naito, Hiroyuki; Yamazaki, Yu; Takahashi, Tetsuya; Ochi, Kazuhide; Kiura, Yoshihiro; Matsumoto, Masayasu

    2013-01-01

    About three weeks after successful coil embolization of a basilar apex aneurysm, a 66-year-old woman developed occipital headaches. T2 and FLAIR MRI brain images demonstrated multiple new hyperintense lesions in the posterior circulation territory including cerebellum, right superior cerebellar peduncle, left thalamus and bilateral temporo-occipital lobes and she was subsequently hospitalized. Findings suggestive of other underlying disease were not observed, although an increased protein level was noted in cerebrospinal fluid (69 mg/dl). Headache and clinical findings improved approximately 12 weeks after coil embolization. MRI findings also showed improvement. These clinical and radiological findings made this patient a distinctive case of posterior reversible encephalopathy syndrome (PRES) associated with coil embolization suggesting that clinicians should be aware that PRES can present as comparatively mild symptoms several weeks after coil embolization. PMID:23892962

  7. Embolization Therapy for Traumatic Splenic Lacerations

    SciTech Connect

    Dasgupta, Niloy; Matsumoto, Alan H. Arslan, Bulent; Turba, Ulku C.; Sabri, Saher; Angle, John F.

    2012-08-15

    Purpose: This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma. Methods: A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes. Results: Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16-80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies. Conclusions: Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.

  8. Paradoxical cerebral air embolism causing large vessel occlusion treated with endovascular aspiration.

    PubMed

    Belton, Patrick J; Nanda, Ashish; Alqadri, Syeda L; Khakh, Gurpreet S; Chandrasekaran, Premkumar Nattanmai; Newey, Christopher; Humphries, William E

    2016-01-01

    Cerebral air embolism is a dreaded complication of invasive medical procedures. The mainstay of therapy for patients with cerebral air embolism has been hyperbaric oxygen therapy, high flow oxygen therapy, and anticonvulsants. We present a novel therapeutic approach for treatment of cerebral air embolism causing large vessel occlusion, using endovascular aspiration. Our patient developed a cerebral air embolism following sclerotherapy for varicose veins. This caused near total occlusion of the superior division of the M2 segment of the right middle cerebral artery. Symptoms included unilateral paralysis, unintelligible speech, and hemianopia; National Institutes of Health Stroke Scale (NIHSS) on presentation was 16. The air embolism was treated using a distal aspiration technique. Angiography following aspiration showed Thrombolysis in Cerebral Infarction 2B reperfusion. Following aspiration, the patient was re-examined; NIHSS at that time was 4. At 1 month follow-up, the modified Rankin Scale score was 1 and NIHSS was 1. Treatment of cerebral air embolism is discussed. PMID:27435840

  9. Traversing boundaries: thrombus in transit with paradoxical embolism.

    PubMed

    Miriyala, Varun; Awan, Muhammad Umer; Faraj, Kirmanj; Nagra, Bipinpreet

    2016-01-01

    A 72-year-old male is diagnosed with paradoxical embolus after he presented with concurrent deep vein thrombosis, stroke, and multiple arterial emboli in the presence of a patent foramen ovale (PFO). Paradoxical embolus requires the passage of a thrombus from the venous into the arterial circulation through a right-to-left shunt leading to systemic embolism. But, despite the high incidence of PFO (27.3% across all age groups by autopsy), paradoxical embolism (PDE) is uncommon, representing <2% of all arterial emboli. We present a case report where a thrombus has been directly observed passing through the PFO during an echocardiogram study; thus, clearly delineating the true cause of multiple thromboemboli and stoke in our patient. Subsequent Transesophageal Echocardiography (TEE) also interestingly showed the thrombus in transit in the aorta and pulmonary artery. PMID:27609716

  10. Transcatheter Embolization for Delayed Hemorrhage Caused by Blunt Splenic Trauma

    SciTech Connect

    Krohmer, Steven J. Hoffer, Eric K.; Burchard, Kenneth W.

    2010-08-15

    Although the exact benefit of adjunctive splenic artery embolization (SAE) in the nonoperative management (NOM) of patients with blunt splenic trauma has been debated, the role of transcatheter embolization in delayed splenic hemorrhage is rarely addressed. The purpose of this study was to evaluate the effectiveness of SAE in the management of patients who presented at least 3 days after initial splenic trauma with delayed hemorrhage. During a 24-month period 4 patients (all male; ages 19-49 years) presented with acute onset of pain 5-70 days after blunt trauma to the left upper quadrant. Two had known splenic injuries that had been managed nonoperatively. All had computed axial tomography evidence of active splenic hemorrhage or false aneurysm on representation. All underwent successful SAE. Follow-up ranged from 28 to 370 days. These cases and a review of the literature indicate that SAE is safe and effective for NOM failure caused by delayed manifestations of splenic arterial injury.

  11. Massive pulmonary embolism in a patient undergoing Cesarean delivery.

    PubMed

    Ayad, Sabry; Tetzlaff, John E

    2012-11-01

    A case of a 40 year old, 86 kg, G7P1 woman with a history of hypercoagulability, at 39.1 weeks' gestation, who presented for elective Cesarean section during spinal anesthesia, is presented. During closure of the uterus, she became unresponsive and went into asystolic cardiac arrest. During resuscitation, clinical signs suggested pulmonary embolism, as confirmed by transesophageal echocardiogram. She was anticoagulated and taken to the Cardiac Catheterization Laboratory; there, clot lysis was performed, resulting in massive bleeding. Embolization of the uterine arteries was attempted and was only partially successful in reducing the bleeding. She then underwent Cesarean hysterectomy to control the bleeding. She had a full recovery and was discharged on the sixth postoperative day. PMID:23101774

  12. Tips and Tricks for Difficult Prostatic Artery Embolization.

    PubMed

    Bagla, Sandeep; Isaacson, Ari J

    2016-09-01

    Prostatic artery embolization (PAE) is a promising, new, safe, minimally invasive procedure for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. However, it can be a one of the most technically difficult interventional radiology procedures because of the challenging anatomy involved. To help achieve technical success and limit complications, the authors present here a series of tips and tricks that have been proven useful from prior PAE experience. PMID:27582612

  13. Sequential changes in gas exchange following traumatic fat embolism.

    PubMed

    Burnstein, R M; Newell, J P; Jones, J G

    1998-04-01

    We present a young man who developed fat embolism syndrome following a fractured femoral shaft. By intermittently measuring oxygen saturation with a pulse oximeter and varying the inspired partial pressure of oxygen we were able to quantify the development of shunt and ventilation/perfusion (V/Q) mismatch over the course of his illness. Shunt and low V/Q gradually improved in the week following admission but deteriorated following general anaesthesia for nailing of the femur. PMID:9613303

  14. Pulmonary embolism as the first manifestation of multiple myeloma.

    PubMed

    Vallianou, N; Lazarou, V; Tzangarakis, J; Barounis, R; Sioula, E

    2013-01-01

    Multiple myeloma is considered a hypercoagulable state due to several mechanisms such as the increased IL-6 and immunoglobulins production, the defective fibrinolytic mechanism, and the acquired resistance to activated protein C that are involved in the pathogenesis and clinical futures of the disease. We describe a case of a female patient who presented to the hospital with pulmonary embolism as the first manifestation of the hypercoagulability of multiple myeloma. PMID:24151508

  15. Pulmonary Embolism as the First Manifestation of Multiple Myeloma

    PubMed Central

    Vallianou, N.; Lazarou, V.; Tzangarakis, J.; Barounis, R.; Sioula, E.

    2013-01-01

    Multiple myeloma is considered a hypercoagulable state due to several mechanisms such as the increased IL-6 and immunoglobulins production, the defective fibrinolytic mechanism, and the acquired resistance to activated protein C that are involved in the pathogenesis and clinical futures of the disease. We describe a case of a female patient who presented to the hospital with pulmonary embolism as the first manifestation of the hypercoagulability of multiple myeloma. PMID:24151508

  16. Pulmonary embolism in the setting of HELLP syndrome.

    PubMed

    Prin, M; Gaffney, A; Mankowitz, S W

    2015-05-01

    HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) complicates 0.5-0.9% of pregnancies and is frequently associated with multiorgan dysfunction. Treatment relies on prompt diagnosis, delivery and supportive care. The clinical presentation may make the concurrent diagnosis and management of other disease entities challenging. This case report describes a patient with postpartum HELLP syndrome complicated by severe multiorgan dysfunction and pulmonary embolism. PMID:25794414

  17. Pulmonary Artery Cement Embolism after a Vertebroplasty

    PubMed Central

    Nooh, Anas; Abduljabbar, Fahad H.; Abduljabbar, Ahmed H.; Jarzem, Peter

    2015-01-01

    Background Context. Vertebroplasty is a minimally invasive procedure most commonly used for the treatment of vertebral compression fractures. Although it is relatively safe, complications have been reported over time. Among those complications, massive cement pulmonary embolism is considered a rare complication. Here we report a case of massive diffuse cement pulmonary embolism following percutaneous vertebroplasty for a vertebral compression fracture. Study Design. Case report. Methods. This is a 70-year-old female who underwent vertebroplasty for T11 and T12 vertebral compression fracture. Results. CT-scan revealed an incidental finding of cement embolism in the pulmonary trunk and both pulmonary arteries. Since the patient was asymptomatic, she was monitored closely and she did not need any intervention. Conclusion. Vertebroplasty is a minimally invasive procedure used for treatment of vertebral compression fracture. Despite the low rate of complications, a pulmonary cement embolism can occur. The consequences of cement embolism range widely from being asymptomatic to embolism that can cause paralysis, radiculopathy, or a fatal pulmonary embolism. PMID:26221556

  18. Endovascular Management of Visceral Artery Pseudoaneurysms: Transcatheter Coil Embolization Using the Isolation Technique

    SciTech Connect

    Ikeda, Osamu Nakasone, Yutaka; Tamura, Yoshitaka; Yamashita, Yasuyuki

    2010-12-15

    PurposeTo describe our experiences with treatment of visceral artery pseudoaneurysms (VAPA) by transcatheter coil embolization using an isolation technique and to propose indications for treating VAPA with this method.Materials and MethodsWe treated 37 patients with VAPA endovascularly: There were 15 pancreaticoduodenal arcade, 10 hepatic, 5 renal, 3 splenic, and 1 each left gastric, gastroepiploic, adrenal, and superior mesenteric artery pseudoaneurysms. Preprocedure computed tomography (CT) and/or angiographic studies confirmed the presence of VAPA in all 37 patients. Using the isolation technique, we embolized vessels at sites distal and proximal to the pseudoaneurysm.ResultsTranscatheter coil embolization with the isolation technique was technically successful in 33 (89%) of 37 patients, and angiogram confirmed the complete disappearance of the VAPA in 32 patients. No major complications occurred during the procedures. In a patient with a pancreaticoduodenal arcade artery pseudoaneurysm, we were unable to control hemorrhage. In 30 of 32 patients who recovered after transcatheter coil embolization using the isolation technique, follow-up CT scan showed no flow in VAPA; they survived without rebleeding. Two of the 32 patients (6%) with confirmed complete disappearance of VAPA on angiogram and CT scan obtained the day after the procedure manifested rebleeding during follow-up.ConclusionTranscatheter coil embolization using the isolation technique is an effective alternative treatment in patients with VAPA. In combination with coil embolization, the isolation technique is particularly useful in patients whose pseudoaneurysms present surgical difficulties.

  19. Onyx removal after embolization of a superior sagittal sinus dural arteriovenous fistula involving scalp artery

    PubMed Central

    Watanabe, Jun; Maruya, Jun; Nishimaki, Keiichi; Ito, Yasushi

    2016-01-01

    Background: Most dural arteriovenous fistula (DAVF) in superior sagittal sinus (SSS) requires multimodal treatment. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Case Description: A 59-year-old male presented with involuntary movements of both legs and progressive dementia. Cerebral angiography demonstrated the DAVF in the SSS fed by bilateral superficial temporal, occipital, and middle meningeal arteries. The posterior SSS was thrombosed, and the main drainers were cortical veins. Combined treatment with transarterial embolization using Onyx and transvenous embolization using coils was performed. Although symptoms were improved, a small DAVF remained. Two months later, Onyx cast extrusion through the scalp was observed, requiring removal and debridement because of infection at the extrusion sites. Surgery for the residual DAVF would be difficult because of scalp condition; therefore, an additional endovascular treatment was conducted, completely occluding DAVF. Conclusion: Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Therefore, scalp infection should be considered because it may preclude additional surgical procedures. PMID:27313969

  20. Microcatheter Embolization of Intractable Idiopathic Epistaxis

    SciTech Connect

    Leppaenen, Martti; Seppaenen, Seppo; Laranne, Jussi; Kuoppala, Katriina

    1999-11-15

    Purpose: To assess the efficacy and safety of microcatheter embolization in the treatment of intractable idiopathic epistaxis. Methods: Thirty-seven patients underwent microcatheter embolization in 1991-1998. We evaluated retrospectively the technical and clinical outcome, the number of complications, the duration of embolization in each case, and the number of blood transfusions needed. All embolizations were done with biplane digital subtraction angiography (DSA) equipment. The procedure was carried out under local anesthesia using transfemoral catheterization, except in one case where the translumbar route was used. Tracker 18 or 10 microcatheters were advanced as far as possible to the distal branches of the sphenopalatine artery. Polyvinyl alcohol (PVA) particles were used for embolization in most cases, while platinum coils or a combination of these two materials were occasionally used. The primary outcome was always assessed immediately by angiography. Follow-up data were obtained from patient records, by interviewing patients on the telephone or by postal questionnaires when necessary. The mean follow-up time was 21 months. Results: The embolization was technically successful in all 37 cases. A curative outcome was achieved in 33 cases (89%). The mean duration of the procedure was 110 min. Four patients (8%) had mild transient complications, but no severe or persistent complications were encountered. Twenty-three patients needed a blood transfusion. Slight rebleeding occurred in three patients during the follow-up; all responded to conservative treatment. One patient suffered two episodes of rebleeding within 2 months after primary embolization. Re-embolizations successfully stopped the bleeding. Conclusion: Embolization is the primary invasive modality for treating intractable idiopathic epistaxis. It proved both safe and effective over a relatively long follow-up.

  1. Complications after selective embolization in the bilateral internal iliac arteries and the median sacral artery with gelfoam particles in dogs

    PubMed Central

    Li, Yetian; Wang, Wei; Wang, Guangye; Yin, Zongsheng

    2014-01-01

    Objective: The study aimed to observe the complications after the bilateral internal iliac arteries and the median sacral artery embolization by different severity and combinations of gelfoam particles. Methods: Sixteen healthy adult dogs were randomly divided into five groups. Under the monitoring of digital subtraction angiography (DSA), gelfoam particles with diameter of 50-150 μm were applied. In group A, embolization was performed up to the trunk of bilateral internal iliac arteries and the median sacral artery; in group B, embolization was up to the trunk of bilateral internal iliac arteries; in group C, embolization was up to the first branch of bilateral internal iliac arteries and the median sacral artery; in group D, embolization was up to the trunk of unilateral internal iliac artery and the median sacral artery; in group E embolization was performed up to the trunk of unilateral internal iliac artery. Results: Seven dogs died within 48 hours after embolization. In the dead animals of groups A, C and D, there were rectum necrosis and lamellar obfuscation and hemorrhage edema in bladder. In the histological examination, there are rectum and bladder cell dissociation, inflammatory cell infiltration and epithelial cell ablating in the dead animals. The embolization mainly presented in arterioles with a diameter of 100-200 μm. Conclusion: When gelfoam particles of 50-150 μm in diameter were applied for embolization in the internal iliac artery and median sacral artery, at least unilateral internal iliac artery should be preserved when embolization is performed in the proximal artery and the trunk. PMID:25356191

  2. [Hydatid disease diagnosed following a pulmonary embolism].

    PubMed

    Menassa-Moussa, L; Braidy, C; Riachy, M; Tabet, G; Smayra, T; Haddad-Zebouni, S; Ghossain, M; Aoun, N

    2009-11-01

    Hydatidosis is a parasitic disease found worldwide, particularly in Mediterranean countries, caused by Echinococcus granulosis infection. Humans are an intermediate and accidental host in the cycle of this parasite. The hydatid pulmonary arterial embolism is extremely rare, usually arising in the heart or the liver. We report a case of hydatid pulmonary embolism explored with multidetector scanner and MRI, and confirmed at pathology of the operative specimen. To our knowledge, this is the first case of inaugural hydatid pulmonary arterial embolism found on CT scan establishing the diagnosis of the disease in a patient who had no other location of hydatid cyst. PMID:19615835

  3. Role of Embolization for Cerebral Arteriovenous Malformations

    PubMed Central

    Ellis, Jason A.; Lavine, Sean D.

    2014-01-01

    Cerebral arteriovenous malformations (AVMs) are complex high-flow lesions that can result in devastating neurological injury when they hemorrhage. Embolization is a critical component in the management of many patients with cerebral AVMs. Embolization may be used as an independent curative therapy or more commonly in an adjuvant fashion prior to either micro- or radiosurgery. Although the treatment-related morbidity and mortality for AVMs—including that due to microsurgery, embolization, and radiosurgery—can be substantial, its natural history offers little solace. Fortunately, care by a multidisciplinary team experienced in the comprehensive management of AVMs can offer excellent results in most cases. PMID:25624978

  4. Bilateral Pulmonary Embolism Following a Viper Envenomation in France

    PubMed Central

    Bart, Géraldine; Pineau, Samuel; Biron, Charlotte; Connault, Jérôme; Artifoni, Mathieu

    2016-01-01

    Abstract Complications following snake bites are not common in France. We report the case of a bilateral pulmonary embolism following a viper envenomation in France. A healthy 72-year-old female presented with a lower limb hematoma following a viper bite. She was admitted at the hospital 2 days later and received low-molecular-weight heparin because of bed rest. Seven days later, she complained of thoracic pain and respiratory failure, and a bilateral pulmonary was diagnosed, without biological sign of neither disseminated intravascular coagulation nor coagulation trouble. Repeated lower limbs Doppler ultrasound were normal. This case is particularly interesting because it is only the 7th reported case of pulmonary embolism following a snake envenomation; moreover, it happened in France where poisonous snakes are very rare. Several hypotheses have been made to explain this late localized coagulopathy: an increased level of unstable fibrin produced by thrombin-like glycoproteins from the venom is one of them. PMID:27175626

  5. A Case of Acinetobacter Septic Pulmonary Embolism in an Infant

    PubMed Central

    Ananthan, Anitha; David, Jane; Ghildiyal, Radha

    2016-01-01

    Case Characteristics. An 11-month-old girl presented with fever and breathlessness for 5 days. Patient had respiratory distress with bilateral coarse crepitations. Chest radiograph revealed diffuse infiltrations in the right lung with thick walled cavities in mid and lower zone. Computed tomography showed multiple cystic spaces and emboli. Blood culture grew Acinetobacter species. Intervention. Patient was treated with Meropenem and Vancomycin. Outcome. Complete clinical and radiological recovery was seen in child. Message. Blood cultures and CT of the chest are invaluable in the evaluation of a patient with suspected septic pulmonary embolism. With early diagnosis and appropriate antimicrobial therapy, complete recovery can be expected in patients with septic pulmonary embolism. PMID:27529040

  6. Coil Embolization for Intracranial Aneurysms

    PubMed Central

    2006-01-01

    Executive Summary Objective To determine the effectiveness and cost-effectiveness of coil embolization compared with surgical clipping to treat intracranial aneurysms. The Technology Endovascular coil embolization is a percutaneous approach to treat an intracranial aneurysm from within the blood vessel without the need of a craniotomy. In this procedure, a microcatheter is inserted into the femoral artery near the groin and navigated to the site of the aneurysm. Small helical platinum coils are deployed through the microcatheter to fill the aneurysm, and prevent it from further expansion and rupture. Health Canada has approved numerous types of coils and coil delivery systems to treat intracranial aneurysms. The most favoured are controlled detachable coils. Coil embolization may be used with other adjunct endovascular devices such as stents and balloons. Background Intracranial Aneurysms Intracranial aneurysms are the dilation or ballooning of part of a blood vessel in the brain. Intracranial aneurysms range in size from small (<12 mm in diameter) to large (12–25 mm), and to giant (>25 mm). There are 3 main types of aneurysms. Fusiform aneurysms involve the entire circumference of the artery; saccular aneurysms have outpouchings; and dissecting aneurysms have tears in the arterial wall. Berry aneurysms are saccular aneurysms with well-defined necks. Intracranial aneurysms may occur in any blood vessel of the brain; however, they are most commonly found at the branch points of large arteries that form the circle of Willis at the base of the brain. In 85% to 95% of patients, they are found in the anterior circulation. Aneurysms in the posterior circulation are less frequent, and are more difficult to treat surgically due to inaccessibility. Most intracranial aneurysms are small and asymptomatic. Large aneurysms may have a mass effect, causing compression on the brain and cranial nerves and neurological deficits. When an intracranial aneurysm ruptures and bleeds

  7. Clinical update on pulmonary embolism

    PubMed Central

    Keleşoğlu, Arif; Ardıç, Sadık

    2013-01-01

    Pulmonary embolism (PE) is a major cause of cardiovascular mortality and financial burden that affects the community. The diagnosis of PE can be difficult because of the nonspecific symptoms, which include cough, dyspnea, hemoptysis and pleuritic chest pain. Hereditary and acquired risk factors are associated with PE. Incidence of PE is increasing, associated with the development in the diagnostic methods. Evidence-based algorithms can help clinicians diagnose PE. Serum D-dimer level, computed tomography pulmonary angiogram (CTPA), ventilation-perfusion scintigraphy or echocardiography help to establish clinical probability and the severity of PE. Anticoagulation is the standard treatment for PE. However, thrombolytic treatment is a significant alternative in high risk of PE as it provides rapid clot resolution. This article reviews the risk factors, diagnostic algorithms, and methods of treatment in PE in the light of current information. PMID:25097588

  8. Pathophysiology of spontaneous venous gas embolism

    NASA Technical Reports Server (NTRS)

    Lambertsen, C. J.; Albertine, K. H.; Pisarello, J. B.; Flores, N. D.

    1991-01-01

    The use of controllable degrees and durations of continuous isobaric counterdiffusion venous gas embolism to investigate effects of venous gas embolism upon blood, cardiovascular, and respiratory gas exchange function, as well as pathological effects upon the lung and its microcirculation is discussed. Use of N2O/He counterdiffusion permitted performance of the pathophysiologic and pulmonary microstructural effects at one ATA without hyperbaric or hypobaric exposures.

  9. Mortality and Embolic Potential of Cardiac Tumors

    PubMed Central

    Dias, Ricardo Ribeiro; Fernandes, Fábio; Ramires, Félix José Alvarez; Mady, Charles; Albuquerque, Cícero Piva; Jatene, Fábio Biscegli

    2014-01-01

    Background Cardiac tumors are rare, mostly benign with high embolic potential. Objectives To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Methods Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination. Results Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity. Conclusion Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event. PMID:25029470

  10. [Acute massive pulmonary embolism in a patient using clavis panax].

    PubMed

    Yüksel, Isa Oner; Arslan, Sakir; Cağırcı, Göksel; Yılmaz, Akar

    2013-06-01

    In recent years, the use of herbal combinations, plant extracts or food supplements has increased in our country and all over the world. However, there is not enough data to determine the effective doses of these substances in the composition of herbal preparations, or their effects on metabolism and drug interactions. With the widespread use of herbal combinations, life-threatening side effects and clinical manifestations that arise from them have been reported. Herein we present a case with acute massive pulmonary embolism while using an herbal combination in the context of Tribulus terrestris, Avena sativa and Panax ginseng. A 41-year-old man was admitted to the emergency department with the complaint of sudden onset of dyspnea and syncope. As a result of investigations (blood gases, echocardiography, ventilation-perfusion scintigraphy) he was diagnosed with an acute massive pulmonary embolism. The patient's use of panax did not pose as a risk factor for the pulmonary embolism. He was given thrombolytic therapy and shortness of breath improved. At the pre-discharge the patient was informed of the risks associated with the herbal combination, especially panax. Coumadin was started and he was discharged for the INR checks to come. PMID:23760126

  11. Not only a clinical nightmare: amniotic fluid embolism in court.

    PubMed

    Busardo, Francesco P; Gulino, Matteo; Di Luca, Natale M; Vergallo, Gianluca M; Pacchiarotti, Arianna; Frati, Paola

    2014-01-01

    Amniotic fluid embolism (AFE) is an uncommon obstetric condition involving usually women in labour or in the early post-partum period. Clinical consequences of this unpredictable and unpreventable pathology may be extremely serious with high morbidity and mortality rates. Data obtained from the US Amniotic Fluid Embolism Registry show that the process is more similar to anaphylaxis than to embolism, and the term anaphylactoid syndrome of pregnancy has been suggested because foetal tissue or amniotic fluid components are not universally found in women who present signs and symptoms related to AFE. The first aim of this paper has been to focus on the medico-legal aspects concerning the misdiagnosis and the treatment of the AFE and the Authors, with this purpose in mind, reviewed the main national law cases on medical malpractice claims involving both physicians and hospitals. The second aim has been to highlight the need to introduce a National register as a useful tool to raise the awareness of this disease among physicians and to improve the quality of care, which can be achieved through a proper identification and reporting of AFE cases. The application of a national register may limit the number of medico-legal litigations, which according to the national and foreign Jurisprudence are not currently based in favour of the predictability of AFE, but they focus their discussion on the importance of a prompt medical assistance when the effects of this disorder occur. PMID:24804728

  12. Ischemic stroke related to an amniotic fluid embolism during labor.

    PubMed

    Woo, Yeon-Sun; Hong, Soon-Cheol; Park, Seong-Mi; Cho, Kyung-Hee

    2015-04-01

    We report a young woman who survived multiple cerebral infarctions related to an amniotic fluid embolism (AFE) during labor. To our knowledge, an embolic stroke due to the coexistence of an AFE and patent foramen ovale (PFO) has not been reported. We describe the patient's clinical and radiological features and discuss the stroke mechanism in relation to our AFE hypothesis. A 32-year-old woman presented to the emergency room after experiencing convulsions during labor (blood pressure, 64/28mmHg; oxygen saturation, 67%). She was in a stupor, and her response to painful stimuli on the right side was weaker than on the left side. Acute stroke was considered as a possible cause. Additionally, an AFE was suspected due to cardiopulmonary arrest during labor. Brain MRI revealed multiple territory embolic infarctions. The transcranial Doppler with bubble study demonstrated a right-to-left shunt during the Valsalva maneuver. A transesophageal echocardiogram revealed a PFO with a right-to-left shunt. The elevated intrathoracic pressure during labor may have caused blood to flow backward through the heart, shunting blood from the right side to the left through the PFO. In cases such as this, an amniotic fluid embolus may travel directly from the venous to the arterial circulation via the PFO, leading to multiple cerebral infarctions. PMID:25709056

  13. Anti-neutrophil cytoplasmic antibodies in cholesterol embolism: A case report and literature review

    PubMed Central

    Zhang, Jun; Zhang, Heng-Yuan; Chen, Shi-Zhi; Huang, Ji-Yi

    2016-01-01

    Cholesterol embolism is a multisystemic disorder with clinical manifestations that resemble vasculitis. Anti-neutrophil cytoplasmic antibodies (ANCA) are a defining feature of ANCA-associated vasculitis, and the presence of ANCA in cholesterol embolism complicates its differential diagnosis and treatment. At present, the role of ANCA in cholesterol embolism remains unclear and no effective treatment is currently available. The present study reports the case of an Asian male who presented with spontaneous cholesterol embolism with proteinase 3 (PR3)-specific ANCA, subacute interstitial nephritis and late-developing skin lesions. The 69-year-old patient was admitted to The First Affiliated Hospital of Xiamen University (Xiamen, China) complaining of chest tightness, fatigue, progressive renal failure and refractory hypertension. In addition, transient eosinophilia was detected. Following immunosuppressive therapy with steroids and cyclophosphamide for 6 months, hemodialysis treatment was initiated. Skin lesions appeared at >1 month following hemodialysis initiation; however, they were gradually improved following treatment with atorvastatin and anti-platelet aggregation therapy for 5 months. The patient was maintained on hemodialysis for ~2 years and exhibited general good health at the most recent follow-up. In addition, 11 cases of cholesterol embolism associated with ANCA reported in the literature were discussed in the present study. PMID:27446313

  14. Microballoon Occlusion Test to Predict Colonic Ischemia After Transcatheter Embolization of a Ruptured Aneurysm of the Middle Colic Artery

    SciTech Connect

    Tajima, Tsuyoshi Yoshimitsu, Kengo; Inokuchi, Hiroyuki; Irie, Hiroyuki; Nishie, Akihiro; Hirakawa, Masakazu; Ishigami, Kousei; Ushijima, Yasuhiro; Okamoto, Daisuke; Honda, Hiroshi; Itoh, Hiroyuki; Morita, Masaru; Kakeji, Yoshihiro

    2008-07-15

    A 76-year-old woman presented with sudden massive melena, and superior mesenteric arteriography showed an aneurysm in the middle colic artery (MCA). Because she had a history of right hemicolectomy and ligation of the inferior mesenteric artery (IMA) during open abdominal aortic aneurysm repair, embolization of the MCA aneurysm was considered to pose a risk comparable to that of colonic ischemia. A microballoon occlusion test during occlusion of the MCA confirmed retrograde visualization of the IMA branches through the collateral arteries by way of the left internal iliac artery, and embolization was successfully performed using microcoils. No colonic ischemia or aneurysm rupture occurred after embolization.

  15. [Preparation and in vitro embolic efficiency evaluation of hydroxycamptothecine-loaded liquid embolic agent].

    PubMed

    Qin, Ling-Zhen; Zhang, Xuan; Wu, Lin-Na; Zhang, Jin; Pan, Xin; Li, Ge; Wu, Chuan-Bin

    2014-07-01

    The purpose of this study is to investigate the preparation of hydroxycamptothecine (HCPT)-loaded cubic crystal liquid embolic precursor solution, and evaluate its in vitro embolic efficiency. Phytantriol was used as cubic crystal liquid embolic material, and the optimal formulation was selected according to ternary phase diagram. Polarized light microscopy, differential scanning calorimetry, and small angle X-ray scattering (SAXS) were used to characterize the cubic crystal structure. High performance liquid chromatography and X-ray diffraction analysis were used to investigate the lactone ring of HCPT. In vitro dissolution was preliminary evaluated, and the simulation embolic model was constructed to evaluate the embolic efficiency of precursor solution. Meanwhile, the gelation time and adhesion force were investigated. The results showed that HCPT-loaded precursor solution for embolization had been successfully prepared with low viscosity which was injectable. The precursor solution could transform into Pn3m structure liquid crystal phase gel rapidly when contracting with excess water. The formed HPCT gel remained its lactone form as the same in precursor solution, and expressed the good ability to block the saline flow, and HCPT could keep sustained releasing drug over 30 days. The prepared drug-loaded embolic precursor solution showed a promising potential for vascular embolization and application in clinical treatment of tumor. PMID:25233642

  16. Novel Hydrogel Material as a Potential Embolic Agent in Embolization Treatments.

    PubMed

    Zhou, Feng; Chen, Liming; An, Qingzhu; Chen, Liang; Wen, Ying; Fang, Fang; Zhu, Wei; Yi, Tao

    2016-01-01

    We report a novel graphene-oxide (GO) enhanced polymer hydrogel (GPH) as a promising embolic agent capable of treating cerebrovascular diseases and malignant tumors, using the trans-catheter arterial embolization (TAE) technique. Simply composed of GO and generation five poly(amidoamine) dendrimers (PAMAM-5), our rheology experiments reveal that GPH exhibits satisfactory mechanical strength, which resist the high pressures of blood flow. Subcutaneous experiments on Sprague-Dawley (SD) rats demonstrate the qualified biocompatibility of GPH. Finally, our in vivo experiments on New Zealand rabbits, which mix GPH with the X-ray absorbing contrast agent, Iohexol, reveal complete embolization of the artery. We also note that GPH shortens embolization time and exhibits low toxicity in follow-up experiments. Altogether, our study demonstrates that GPH has many advantages over the currently used embolic agents and has potential applications in clinical practice. PMID:27561915

  17. Novel Hydrogel Material as a Potential Embolic Agent in Embolization Treatments

    PubMed Central

    Zhou, Feng; Chen, Liming; An, Qingzhu; Chen, Liang; Wen, Ying; Fang, Fang; Zhu, Wei; Yi, Tao

    2016-01-01

    We report a novel graphene-oxide (GO) enhanced polymer hydrogel (GPH) as a promising embolic agent capable of treating cerebrovascular diseases and malignant tumors, using the trans-catheter arterial embolization (TAE) technique. Simply composed of GO and generation five poly(amidoamine) dendrimers (PAMAM-5), our rheology experiments reveal that GPH exhibits satisfactory mechanical strength, which resist the high pressures of blood flow. Subcutaneous experiments on Sprague-Dawley (SD) rats demonstrate the qualified biocompatibility of GPH. Finally, our in vivo experiments on New Zealand rabbits, which mix GPH with the X-ray absorbing contrast agent, Iohexol, reveal complete embolization of the artery. We also note that GPH shortens embolization time and exhibits low toxicity in follow-up experiments. Altogether, our study demonstrates that GPH has many advantages over the currently used embolic agents and has potential applications in clinical practice. PMID:27561915

  18. Alveolar hemorrhage in a case of fat embolism syndrome: A case report with short systemic review

    PubMed Central

    Dash, Sananta Kumar; Bansal, Avdesh; Wankhade, Bhushan Sudhakar; Sharma, Rakesh

    2013-01-01

    Fat embolism and fat embolism syndrome (FES) are well-known complications of long bone fracture and surgery involving manipulation of skeletal elements. Many non-traumatic causes of FES have been suggested but they constitute only a small portion. FES presents with classical symptoms of petechiae, hypoxemia, central nervous system symptoms along with other features such as tachycardia and pyrexia. Diagnosis of FES relies on clinical judgment rather than objective findings such as emboli present in the retinal vessels on fundoscopy, fat globules present in urine and sputum, a sudden inexplicable drop in hematocrit or platelet values, increasing erythrocyte sedimentation rate. PMID:23741098

  19. Ovarian Artery Embolization in Patients With Collateral Supply to Symptomatic Uterine Leiomyomata

    SciTech Connect

    Scheurig-Muenkler, C. Poellinger, A. Wagner, M. Hamm, B. Kroencke, T. J.

    2011-12-15

    Purpose: To evaluate the safety and outcome of ovarian artery embolization (OAE) in patients with collateral supply to symptomatic uterine leiomyomata. Materials and Methods: Thirteen patients with relevant leiomyoma perfusion by way of enlarged ovarian arteries underwent additional OAE during the same (N = 10) or a second procedure (N = 3). Uterine artery embolization (UAE) was performed bilaterally in 10 and unilaterally in 2 patients with a single artery. One patient had no typical uterine arteries but bilaterally enlarged ovarian arteries, prompting bilateral OAE. OAE was accomplished with coil embolization in one and particle embolization in 12 patients. Symptoms before therapy and clinical outcome were assessed using a standardized questionnaire. Contrast-enhanced magnetic resonance (MR) imaging after embolization was available in 11 of 13 patients and was used to determine the percentage of fibroid infarction. Results: UAE and OAE were technically successful in all patients. One patient experienced prolonged irritation at the puncture site. Median clinical follow-up time was 16 months (range 4-37). Ten of 13 patients showed improvement or complete resolution of clinical symptoms. One patient reported only slight improvement of her symptoms. These women presented with regular menses. Two patients (15%), 47 and 48 years, both with unilateral OAE, reported permanent amenorrhea directly after embolization. Their symptoms completely resolved. Seven patients showed complete and 4 showed >90% fibroid infarction after embolization therapy. Conclusions: OAE is technically safe and effective in patients with ovarian artery collateral supply to symptomatic uterine leiomyomata. The risk of permanent amenorrhea observed in this study is similar to the reported incidence after UAE.

  20. [Efficiency of Embosphere in the Pre-Operative Embolization of Meningioma:Clinical Experience].

    PubMed

    Shimoda, Yusuke; Osanai, Toshiya; Terasaka, Syunsuke; Kobayashi, Hiroyuki; Yamaguchi, Shigeru; Endo, Shogo; Hatanaka, Kanako; Houkin, Kiyohiro

    2016-07-01

    Embosphere® was approved in Japan for embolizing intracranial arteries for the reduction of intraoperative bleeding in January 2014. Until August 2015, we performed embolization for four meningiomas using Embosphere®. We performed an initial evaluation of all the cases, including evaluation of the clinical courses, change in the maximum tumor diameters and volumes, alteration in the appearance on magnetic resonance imaging(MRI), amount of intraoperative bleeding, complications, and histopathological findings. After embolization, the maximum tumor diameters and volumes slightly decreased on MRI, whereas the signal change on diffusion-weighted imaging(DWI)or fluid-attenuated inversion recovery(FLAIR)varied in each case. One case demonstrated a partial signal change on DWI one day after the initial procedure, and another case demonstrated a decrease in perifocal edema on FLAIR. Among our patients, least bleeding was recorded at 6 days after the embolization. Histopathological analysis revealed coagulative necrotic lesions in two cases. The von Kossa stain was used to distinguish Embosphere® from the psammoma body. One case involved a thromboembolic complication of the retinocentral artery caused by an Embosphere® of 100-300 μm. Our early-stage experience suggests that an Embosphere® of 300-500 μm should be used for safe embolization before resection to avoid thromboembolic complications because an Embosphere® of 100-300 μm can pass through the dangerous anastomosis. Our present strategy was to resect the tumor approximately seven days after the embolization using Embosphere®. However, further studies and discussion on the size of Embosphere®, and the interval between pre-operative embolization and surgical removal are needed. PMID:27384115

  1. Timely embolectomy in acute massive pulmonary embolism prevents catastrophe: An experience from two cases

    PubMed Central

    Ramesh, Dwarakaprasad; Setty, Huliyurdurga Srinivasasetty Natraj; Kumarswamy; Kumar, Sunil; Jayanth; Manjunath, Cholenahalli Nanjappa

    2016-01-01

    Acute massive pulmonary embolism is a life-threatening emergency that must be promptly diagnosed and managed. Over the last several years, the use of computed tomography scanning has improved the clinician's ability to diagnose acute pulmonary embolism. We report two cases of acute massive pulmonary embolism who presented with sudden onset of dyspnea and underwent successful open pulmonary embolectomy. The first case presented with acute onset of dyspnea of 2 days duration, in view of hemodynamic deterioration and two-dimensional echocardiography, it revealed clot in right ventricular (RV) apex and right pulmonary artery; the patient underwent cardiopulmonary bypass and open pulmonary embolectomy with RV clot extraction. The second case presented with a sudden onset of dyspnea on the 15th postoperative day for traumatic rupture of urinary bladder, in view of recent surgery, the patient was subjected to surgical embolectomy. Following surgical intervention, both the patients made a prompt recovery. PMID:27433070

  2. Isolated Pulmonary Embolism following Shoulder Arthroscopy

    PubMed Central

    Goldhaber, Nicole H.; Lee, Christopher S.

    2014-01-01

    Pulmonary embolism (PE) following shoulder arthroscopy is a rare complication. We present a unique case report of a 43-year-old right-hand dominant female who developed a PE 41 days postoperatively with no associated upper or lower extremity DVT. The patient had minimal preoperative and intraoperative risk factors. Additionally, she had no thromboembolic symptoms postoperatively until 41 days following surgery when she developed sudden right-hand swelling, labored breathing, and abdominal pain. A stat pulmonary computed tomography (CT) angiogram of the chest revealed an acute PE in the right lower lobe, and subsequent extremity ultrasounds showed no upper or lower extremity deep vein thrombosis. After a thorough review of the literature, we present the first documented isolated PE following shoulder arthroscopy. Although rare, sudden development of an isolated PE is possible, and symptoms such as sudden hand swelling, trouble breathing, and systemic symptoms should be evaluated aggressively with a pulmonary CT angiogram given the fact that an extremity ultrasound may be negative for deep vein thrombosis. PMID:25548699

  3. It Is Not Always the Pulmonary Embolism.

    PubMed

    Daheshpour, Sepehr; Shenoy, Sundeep

    2016-01-01

    One of the leading reasons for emergency department visits happens to be chest pain and shortness of breath with estimated 6.3 million visits for chest pain and 3 million visits for shortness of breath. Over the years, there has been an upward trend in these demographics. The primary workup is usually toward cardio pulmonary causes. Paraesophageal hernia is a term to describe the herniation of gastroesophageal junction and the gastric fundus through the paraesophageal membrane. Paraesophageal hernias account for 5% of all the hiatal hernias, and patients are usually asymptomatic or have complaints of gastroesophageal reflux. However, on rare occasions, they are notorious to develop complications such as incarceration, gangrene, obstruction of intrathoracic stomach, collapse of the lung, and even death. We take this opportunity to present a 49-year-old man who presented with shortness of breath and chest pain. The initial workup revealed a pulmonary embolism on a computerized tomography scan. However, with better clinical judgment and more imaging, he was diagnosed with a paraesophageal hernia with gastric obstruction and early strangulation causing his symptoms. PMID:25789913

  4. Preoperative Embolization of Hypervascular Thoracic, Lumbar, and Sacral Spinal Column Tumors: Technique and Outcomes from a Single Center

    PubMed Central

    Nair, Sreejit; Gobin, Y. Pierre; Leng, Lewis Z.; Marcus, Joshua D.; Bilsky, Mark; Laufer, Ilya; Patsalides, Athos

    2013-01-01

    Summary The existing literature on preoperative spine tumor embolization is limited in size of patient cohorts and diversity of tumor histologies. This report presents our experience with preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors in the largest series to date. We conducted a retrospective review of 228 angiograms and 188 pre-operative embolizations for tumors involving thoracic, lumbar and sacral spinal column. Tumor vascularity was evaluated with conventional spinal angiography and was graded from 0 (same as normal adjacent vertebral body) to 3 (severe tumor blush with arteriovenous shunting). Embolic materials included poly vinyl alcohol (PVA) particles and detachable platinum coils and rarely, liquid embolics. The degree of embolization was graded as complete, near-complete, or partial. Anesthesia records were reviewed to document blood loss during surgery. Renal cell carcinoma (44.2%), thyroid carcinoma (9.2%), and leiomyosarcoma (6.6%) were the most common tumors out of a total of 40 tumor histologies. Hemangiopericytoma had the highest mean vascularity (2.6) of all tumor types with at least five representative cases followed by renal cell carcinoma (2.0) and thyroid carcinoma (2.0). PVA particles were used in 100% of cases. Detachable platinum coils were used in 51.6% of cases. Complete, near-complete, and partial embolizations were achieved in 86.1%, 12.7%, and 1.2% of all cases, respectively. There were no new post-procedure neurologic deficits or other complications with long-term morbidity. The mean intra-operative blood loss for the hypervascular tumors treated with pre-operative embolization was 1745 cc. Preoperative embolization of hypervascular thoracic, lumbar, and sacral spine tumors can be performed with high success rates and a high degree of safety at high volume centers. PMID:24070089

  5. Pulmonary Artery Perforation Repair During Thrombectomy Using Microcoil Embolization

    SciTech Connect

    Tajima, Hiroyuki Murata, Satoru; Kumazaki, Tatsuo; Abe, Yutaka; Takano, Teruo

    2006-02-15

    A distal pulmonary artery perforation was successfully occluded by percutaneous microcoil embolization via a microcatheter. Microcoil embolization is a reasonable alternative therapeutic approach for this rare complication of pulmonary interventional procedures.

  6. Bleeding Scrotal Vascular Lesions: Interventional Management with Transcatheter Embolization

    SciTech Connect

    Jaganathan, Sriram; Gamanagatti, Shivanand Mukund, Amar; Dhar, Anita

    2011-02-15

    Vascular lesions of the scrotum are uncommon; the most common among them are varicocele lesions. The other vascular lesions that may involve the scrotum are hemangioma, lymphangioma, and arteriovenous malformations, which are exceedingly rare. The imaging modalities useful in the diagnosis and management of scrotal vascular lesions are grayscale sonography, color Doppler sonography, magnetic resonance imaging, magnetic resonance angiography, and digital subtraction angiography. We present two cases of scrotal vascular lesions involving the extratesticular scrotal soft tissues. Patients presented with bleeding and were treated by radiological interventional technique. We emphasize the importance of superselective catheterization and distal embolization.

  7. Endovascular Preoperative Embolization of Orbital Hemangiopericytoma With n-Butyl Cyanoacrylate Glue

    PubMed Central

    Wallace, Kaitlyn M.; Alaraj, Ali; Aakalu, Vinay K.; Aletich, Victor; Setabutr, Pete

    2014-01-01

    Hemangiopericytoma is an uncommon neoplasm that may present in myriad locations, including the lower extremities, pelvic area, and the head and neck area, including the orbit.1 Orbital hemangiopericytoma is often described as synonymous with orbital solitary fibrous tumor, giant cell angiofibroma, and fibrous histiocytoma, as they all belong to a spectrum of collagen-rich fibroblastic tumors that are often CD34-positive and have overlapping histopathologic features.2 Many cases of orbital hemangiopericytoma have been reported in the literature along with various surgical approaches, long-term outcomes, and techniques to manage recurrence; however, few have discussed preoperative embolization.1,3-5 Intraoperative hemorrhage is a concern in both the congenital and the adult form of these cases6,7 and may be an indication for preoperative embolization. A unique case of preoperative embolization was presented with n-butyl cyanoacrylate for surgical resection of a large orbital hemangiopericytoma in a 58-year-old woman. PMID:24317100

  8. Hyperfibrinolysis diagnosed by rotational thromboelastometry in a case of suspected amniotic fluid embolism.

    PubMed

    Collins, N F; Bloor, M; McDonnell, N J

    2013-01-01

    Rotational thromboelastometry is a viscoelastomeric, point-of-care method for testing haemostasis in whole blood which can be visualised rapidly, in real time, in the operating theatre. Advantages over traditional coagulation tests relate to the rapid feedback of results and the ability to visualise hyperfibrinolysis. We present a case of suspected amniotic fluid embolism that presented with sudden respiratory arrest associated with haemodynamic compromise during a non-elective caesarean delivery. Soon after the collapse, coagulopathy developed. Rotational thromboelastometry showed hyperfibrinolysis and hypofibrinogenaemia, which allowed targeted coagulation factor replacement therapy and the use of tranexamic acid. Hyperfibrinolysis may be a contributor to the coagulopathy associated with amniotic fluid embolism but has been infrequently reported, perhaps due to limited diagnosis with traditional coagulation tests. Treatment of the coagulopathy associated with a suspected amniotic fluid embolism with antifibrinolytic agents may deserve greater consideration. PMID:23159521

  9. Distal Embolic Protection for Renal Arterial Interventions

    SciTech Connect

    Dubel, Gregory J. Murphy, Timothy P.

    2008-01-15

    Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices.

  10. Incidence of pulmonary embolism during COPD exacerbation*, **

    PubMed Central

    Akpinar, Evrim Eylem; Hoşgün, Derya; Akpýnar, Serdar; Ataç, Gökçe Kaan; Doğanay, Beyza; Gülhan, Meral

    2014-01-01

    OBJECTIVE: Because pulmonary embolism (PE) and COPD exacerbation have similar presentations and symptoms, PE can be overlooked in COPD patients. Our objective was to determine the prevalence of PE during COPD exacerbation and to describe the clinical aspects in COPD patients diagnosed with PE. METHODS: This was a prospective study conducted at a university hospital in the city of Ankara, Turkey. We included all COPD patients who were hospitalized due to acute exacerbation of COPD between May of 2011 and May of 2013. All patients underwent clinical risk assessment, arterial blood gas analysis, chest CT angiography, and Doppler ultrasonography of the lower extremities. In addition, we measured D-dimer levels and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels. RESULTS: We included 172 patients with COPD. The prevalence of PE was 29.1%. The patients with pleuritic chest pain, lower limb asymmetry, and high NT-pro-BNP levels were more likely to develop PE, as were those who were obese or immobile. Obesity and lower limb asymmetry were independent predictors of PE during COPD exacerbation (OR = 4.97; 95% CI, 1.775-13.931 and OR = 2.329; 95% CI, 1.127-7.105, respectively). CONCLUSIONS: The prevalence of PE in patients with COPD exacerbation was higher than expected. The association between PE and COPD exacerbation should be considered, especially in patients who are immobile or obese. PMID:24626268