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Developmental Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James H. Tonsgard, Nikolas Mata-Machado
Pulmonary AVM: High-resolution helical CT and contrast echocardiography are effective screening tools, and all patients with HHT should be screened for pulmonary AVMs.Pulmonary angiography.
The Respiratory System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Pulmonary scintiphotography is a technique that provides a visual image of the distribution of blood flow and ventilation in the lungs. Pulmonary angiography permits visualization of the pulmonary vessels and is frequently used to detect emboli or lesions.
Respiratory system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Patient and equipment positioning using a C-arm DDR system are similar to that described for the bronchial artery embolisation procedure. Access is usually obtained via the femoral vein. An angled pigtail catheter is advanced into the main pulmonary artery. Pulmonary angiography is performed by hand injecting contrast (high-pressure pump injection in a patient with significantly elevated right heart pressures [>20 mmHg] from a PE can cause cardiac arrest). The angiogram will confirm the location of the thrombus. The pigtail catheter is advanced into the right and left pulmonary arteries in turn and rotated rapidly to macerate the thrombus and embolise it into the more peripheral pulmonary artery branches. This will result in a reduction in right heart pressure and improve perfusion in the lungs. Thrombolysis using a low-dose infusion via the angiographic catheter is commenced. The progress of thrombolysis can be monitored either by serial pulmonary angiograms or by measuring improvement in right heart pressure.
Filler-induced non-thrombotic pulmonary embolism after genital aesthetic injection
Published in Journal of Cosmetic and Laser Therapy, 2022
Regarding the clinical manifestations, the main presenting symptoms were dyspnea (n = 10) and chest pain (n = 4) (Figure 2). Three patients presented the symptoms during the operation, five presented the symptoms during the operation within 12 hours post-operation, three presented 12–24 hours post-operation, and two patients presented more than 24 hours post-operation (Figure 3). The onset of one male patient’s embolism was unknown. The diagnostic examinations of pulmonary embolism mainly were arterial blood gas analysis (ABG) and imaging examinations, including X-ray (n = 1), chest computer tomography (n = 3), and computer tomography pulmonary angiography (CTPA) (n = 4). To confirm the emboli, six patients received autopsy, and three patients received biopsies.
Impact of renal function on the prognosis of acute pulmonary embolism patients: a systematic review and meta-analysis
Published in Expert Review of Respiratory Medicine, 2022
Xiqian Xing, Jie Liu, Yishu Deng, Shuanglan Xu, Li Wei, Mei Yang, Xiaohua He, Bing Cao, Xiaoxian Huang, Qiaoning Yue, Jiao Yang, Zhaowei Teng
There are many limitations in our study. First, due to inadequate data, we could not divide the APE cases into APE with hemodynamic stability and APE without hemodynamic instability and perform separate analyses. However, when adverse outcomes served as the endpoints, we conducted an analysis based on mixed patients and patients with hemodynamic stability. Second, the assessment of renal function is based on the original definition rather than the pre-set indicators and threshold values, and some studies did not provide a special indicator. Thus, the indicators used in evaluating renal function may vary and cause bias. Third, almost half of the included studies were retrospective, which influenced the quality of this analysis. Finally, contrast computerized tomography pulmonary angiography, a common diagnosis method used in APE patients, could cause contrast-induced nephropathy and transient RI [25], which would be one of the sources of bias and overestimate the effect of renal function in APE patients.
How should a physician approach the pharmacological management of chronic thromboembolic pulmonary hypertension?
Published in Expert Opinion on Pharmacotherapy, 2021
Zhuang Tian, Xin Jiang, Zhi-Cheng Jing
Furthermore, the residual or recurrent PH is also not rare in patients who received PEA and BPA procedures. In the international CTEPH registry, persistent PH after PEA surgery occurred in 16.7% of the operated patients [18]. Recently, a meta-analysis enrolled 4686 patients who underwent PEA surgery and revealed 25% of them were diagnosed as residual PH [27]. For patients who received BPA procedure, the extent of hemodynamic improvement was highly dependent on the unique characteristics of the patients and the experience of the interventional teams. In Japanese centers, average mPAP after BPA decreased to 22–24 mmHg, which is under the current diagnostic criteria of PH. In contrast, the average mPAP after BPA in German centers and French centers was 33 mmHg and 32 mmHg, respectively. Furthermore, poor subpleural perfusion in the capillary phase of pulmonary angiography is believed to reflect the existence of small pulmonary vessel disease with diffuse distal thrombosis [30]. Consequently, poor subpleural perfusion was related to worse outcomes for CTEPH patients who underwent PEA [31] and BPA [32]. All these data suggested that PAH medical therapy was still important and a necessity in patients with CTEPH in spite of the presence of PEA and BPA.