A 41-year-old woman presents to the emergency department with a sudden onset of dyspnea and pleuritic chest pain for two hours. She appears mildly anxious and diaphoretic. She denies fever, cough, trauma, or recent illness. She takes oral contraceptives and has no significant past medical history.
POCUS Findings The PSSA view demonstrates a flattened interventricular septum, creating a D-shaped left ventricle instead of the normal circular contour. In addition, the right ventricle (RV) appears enlarged relative to the left ventricle on this view. The RV cavity occupies a larger proportion of the image than expected. The…
Objective: Pulmonary embolism (PE) is the third leading cause of cardiovascular death. The objective of this study was to examine the current management of pulmonary embolism at a single academic institution. Methods: With institutional review board approval, we conducted a retrospective chart review of 805 encounters among 775 patients presenting…
Objectives: Atrial fibrillation (AF) has been suggested as a cause for pulmonary embolism (PE). We aimed to explore the prevalence and clinical impact of AF in patients with PE.Methods: Using the 2012–2014 National (Nationwide) Inpatient Sample database, we identified “adult patients with PE” as the principal discharge diagnosis. The identified…
Objectives: Approximately one in six patients hospitalized with syncope have pulmonary embolism (PE), according to the PE in Syncope Italian Trial study. Subsequent studies using administrative data have reported a PE prevalence of <3%. The aim of the study was to determine the prevalence and predictors of PE in hospitalized…
Objectives: Guidelines have recommended that risk stratification be performed in patients diagnosed with an acute pulmonary embolism (PE). No study has described the use of risk stratification in routine clinical practice. The purpose of this study was to measure the frequency and impact of risk stratification on treatment decisions and…
In the last decade, parenteral anticoagulants have proven to be effective in the prevention of venous thromboembolism (VTE) in patients admitted to hospitals. Despite this, some registry studies have shown that pharmacological prophylaxis is still widely underused. We performed a literature search to identify important knowledge gaps in the use…
Objectives: Compressive ultrasonography (CUS) of the lower limbs is the first choice for identifying deep venous thrombosis (DVT) in patients with symptomatic pulmonary embolism (PE). The aim of this study was to uncover clinical characteristics and CUS findings in patients with proven PE and their correlations with PE extent. Methods:…
Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea and arterial deoxygenation, which is exacerbated in an upright position and relieved with recumbency. We report a case of platypnea-orthodeoxia in a 56-year-old male who was found to have bilateral lower-lobe pulmonary emboli. He did not have any evidence of an intracardiac…
Pulmonary embolism is a common and sometimes devastating disease caused by many factors, most commonly deep venous thrombosis. Treatment is typically systemic anticoagulation depending on patient clinical presentation. For patients with life threatening pulmonary embolism, IV tPA (Activase, Genentech, South San Francisco, CA) is the most common medication given emergently…
While the combination of a patent foramen ovale (PFO) and thromboembolic disease is thought to portend increased morbidity and mortality, PFO presence in the setting of major pulmonary embolism (PE) may serve as a means to rescue patients from immediate hemodynamic collapse and death. We present two patients with major…
A 35-year-old woman was admitted to the intensive care unit with heart failure and chest pain. Echocardiography had shown dilated cardiomyopathy, with a preponderance of right heart findings and pulmonary hypertension. In a woman with multiple prior uncomplicated pregnancies and deliveries, and no other known risk factors of developing pulmonary…
Deep venous thrombosis and pulmonary embolism are potentially life-threatening problems that present diagnostic challenges. To employ objective diagnostic tests in an efficient, safe, and cost-effective manner, the clinical probability of these disorders should be estimated before testing. A number of clinical prediction rules are available for suspected deep venous thrombosis,…
Anaphylaxis, acute coronary syndrome and pulmonary embolism are conditions commonly seen in the acute medical setting which can be difficult to diagnose. Delay in establishing the correct diagnosis can result in either delayed or inappropriate treatment, and subsequent morbidity and mortality. The cases we present highlight the necessity of good…
Patients at risk of pulmonary embolism usually receive anticoagulants, which are contraindicated in trauma victims. A woman with extensive deep venous thrombosis after a vehicle accident had a nitinol Recovery Filter inserted prophylactically. After her recovery, she requested filter removal because of her intention to become pregnant. The filter was…
Even with the benefit of cardiopulmonary resuscitation, the prognosis of cardiac arrest remains poor. Multiple case series describe survival with the use of thrombolytic therapy for refractory cardiac arrest. Presumably thrombolysis treats that subset of cardiac arrest cases resulting from fulminant pulmonary embolism, or perhaps massive myocardial infarctions. Published reports…
We describe two unusual cases of platypnea. The first patient had chronic obstructive pulmonary disease, but platypnea did not respond to chronic obstructive pulmonary disease therapy. He was found to have multiple pulmonary emboli, and symptoms rapidly improved on anticoagulation therapy. The second patient had Parkinson disease and developed severe…
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