CT Diagnosis of Pulmonary Embolus
Charles White in New Techniques in Thoracic Imaging, 2002
Pulmonary embolus ePE) and deep venous thrombosis (DVT) are two interrelated components of pulmonary thromboembolic disease (PTE). Both are difficult to diagnose clinically and there are many competing tests, some clinical, some laboratory, and some imaging, used for PTE diagnosis. All have strengths and all have drawbacks. As imagers, it is our task to individualize these exams, or combination of exams, to fit the particular patient. A "one approach fits all" strategy is an inefficient use of resources.
Etienne
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner in The Integrated Nervous System, 2017
The middle cerebral artery (MCA) tends to be the preferential end point for emboli originating from the internal carotid artery, but the anterior cerebral artery (ACA) or both the MCA and ACA can be occluded if the embolus is large. The presenting symptoms at that time, localizing to the right frontal area, suggest that there was a transient disturbance of flow in a branch of the right MCA probably due to a small embolus originating in the right internal carotid artery. In Etienne's case, it is unlikely that a hemiplegic migraine attack would occur for the first time at age 57; the disorder is primarily seen in children and young adults. In Etienne's case, the first embolus probably formed over complex plaque at the origin of the right internal carotid artery and travelled to the MCA, where it transiently blocked a small branch artery serving the motor strip on the right.
The patient with chest pain
Andrew Stewart in Pocket On Call, 2015
Patients may experience acid in the back of their mouths and often relate symptoms to particular types of food. Aortic dissections classically give rise to central burning/tearing chest pain that is sudden in onset and radiates through to the patient’s back. Patients usually have either hypertension or a connective tissue disorder. This is a common disorder resulting from dysfunction of the lower oesophageal sphincter, giving rise to symptoms that can be similar in nature to acute coronary syndromes (ACS). As a symptom, chest pain may originate from any structure within the chest wall, thoracic cavity, or mediastinum. The chapter provides chest pain may reflect pathology arising from any organ or structure within the thoracic cavity, mediastinum or chest wall. Whilst the initial focus should be to investigate for the presence of ACS or Pulmonary embolus it is important to consider other potential causes when assessing patients with chest pain.
Acute myocardial infarction due to coronary artery embolus associated with atrial fibrillation
Published in Acute Cardiac Care, 2013
Bo Xu, Paul Williams, Andrew T. Burns
Coronary artery embolus is a rare and potentially under- recognised cause of acute myocardial infarction. We describe the case of an 80-year-old woman presenting with an acute coronary syndrome secondary to coronary artery embolus associated with atrial fibrillation, which was successfully treated with the use of a thrombectomy aspiration catheter.
Segmental arteriolar sheathing: A sign of retinal emboli
Published in Neuro-Ophthalmology, 1986
Michael L. Slavin, Joel S. Glaser
In five patients with amaurosis fugax and visible retinal emboli, an additional finding was observed, consisting of focal arteriolar mural opacification. Typical atheromatous emboli were observed in each case, either in proximity to the vascular sheathing, or in the fellow eye. One case demonstrated the occurrence of an embolus, followed by focal progressive arteriolar opacification ensuing over the next few months. We believe that focal arteriolar sheathing is due to local arteriole wall reaction provoked at the time of embolus impaction, and that this sign in isolation is as useful a ‘calling card’ of embolic retinal disease as the appearance of the cholesterol embolus itself.
Accidental, Intravenous Infusion of a Peanut Oil-Based Medication
Published in Journal of Toxicology: Clinical Toxicology, 1998
Steven A. Seifert, Richard C. Dart, Edward H. Kaplan
Objectives: To describe a case of fat embolus syndrome with lipoid pneumonia resulting from intravenous infusion of lipid and to illustrate the potential for accidental intravenous administration of vegetable oil-based progesterone preparations in the treatment of oncology patients. Case Report: A patient with recurrent ovarian carcinoma accidentally received approximately 20 mL (0.29mL/kg) of a peanut oil-based methylprogesterone product intravenously via infusion pump over 24 hours. The patient developed a lipoid pneumonia with dyspnea, cough, hypoxia, radiographic infiltrates, and a pleural effusion. She was hospitalized for 4 days, and signs and symptoms resolved over 2 weeks following steroids and supportive care. Discussion: Experience with accidental or intentional intravenous lipid overdose in humans is limited. Typical findings of fat embolus syndrome are similar to lipid aspiration, with respiratory distress, hypoxia, and pulmonary infiltrates. In contrast to aspiration, however, fat embolus syndrome results in lipogranulomas surrounding blood vessels, rather than air passages, and potentially produces cerebrovascular, accident-like symptoms. Management of fat embolus syndrome is similar to that for lipid aspiration. However, as seen in this case, fat embolus syndrome typically resolves over several weeks as opposed to the 3-month to 1-year period seen with aspiration lipoid pneumonias. Conclusions: Accidental intravenous infusion of vegetable oil-based products is a potential complication of the increased use of intravenous progesterones.