Article

Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC).

Department of Chest Medicine, Institute for Tuberculosis and Lung Diseases, Warsaw, Poland.
European Heart Journal (Impact Factor: 14.72). 09/2008; 29(18):2276-315.
Source: PubMed

ABSTRACT Non-thrombotic PE does not represent a distinct clinical syndrome. It may be due to a variety of embolic materials and result in a wide spectrum of clinical presentations, making the diagnosis difficult. With the exception of severe air and fat embolism, the haemodynamic consequences of non-thrombotic emboli are usually mild. Treatment is mostly supportive but may differ according to the type of embolic material and clinical severity.

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Available from: Daniel Ferreira, Jul 07, 2015
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    • "Until today, a large percentage of pulmonary embolisms go either undetected or the proper diagnosis is not made in time. International guidelines for the evaluation of pulmonary embolism recommend highdefinition computed tomography for first-line diagnosis (Torbicki et al. 2008, 2009), but its use is limited by availability and radiation exposure, particularly in young patients and when follow-up examinations are needed. Mortality has slightly decreased during the last decades probably because of the use of CT. "
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    ABSTRACT: The value of ultrasound techniques in examination of the pleurae and lungs has been underestimated over recent decades. One explanation for this is the assumption that the ventilated lungs and the bones of the rib cage constitute impermeable obstacles to ultrasound. However, a variety of pathologies of the chest wall, pleurae and lungs result in altered tissue composition, providing substantially increased access and visibility for ultrasound examination. It is a great benefit that the pleurae and lungs can be non-invasively imaged repeatedly without discomfort or radiation exposure for the patient. Ultrasound is thus particularly valuable in follow-up of disease, differential diagnosis and detection of complications. Diagnostic and therapeutic interventions in patients with pathologic pleural and pulmonary findings can tolerably be performed under real-time ultrasound guidance. In this article, an updated overview is given presenting not only the benefits and indications, but also the limitations of pleural and pulmonary ultrasound.
    Ultrasound in Medicine & Biology 02/2015; 41(2). DOI:10.1016/j.ultrasmedbio.2014.10.002 · 2.10 Impact Factor
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    • "Guidelines of the European Society of Cardiology [4] recommend that IVC filters may be used when there are absolute contraindications to anticoagulation and a high risk of venous thromboembolism recurrence (Class IIb, Level of Evidence B). Kadner et al. [19] do not routinely place IVC filters after surgical embolectomy and have also demonstrated no evidence of long-term recurrences of PE in absence of these filters. "
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    ABSTRACT: Objective: Acute massive pulmonary embolism (PE) is associated with significant mortality rate despite diagnostic and therapeutic advances. The aim of this study was to analyze our clinical outcomes of patients with acute massive PE who underwent emergency surgical pulmonary embolectomy. Methods: This retrospective study included 13 consecutive patients undergoing emergency surgical pulmonary embolectomy for acute massive PE at our institution from March 2000 to November 2013. The medical records of all patients were reviewed for demograhic and preoperative data and postoperative outcomes. All patients presented with cardiogenic shock with severe right ventricular dysfunction confirmed by echocardiography, where 4 (30.8%) of the patients experienced cardiac arrest requiring cardiopulmonary resuscitation before surgery. Results: The mean age of patients was 61.8 ± 14 years (range, 38 to 82 years) with 8 (61.5%) males. The most common risk factors for PE was the history of prior deep venous thrombosis (n = 9, 69.2%). There were 3 (23.1%) in-hospital deaths including operative mortality of 7.7% (n = 1). Ten (76.9%) patients survived and were discharged from the hospital. The mean follow-up was 25 months; follow-up was 100% complete in surviving patients. There was one case (7.7%) of late death 12 months after surgery due to renal carcinoma. Postoperative echocardiographic pressure measurements demonstrated a significant reduction (P < 0.001). At final follow-up, all patients were in New York Heart Association class I and no readmission for a recurrent of PE was observed. Conclusion: Surgical pulmonary embolectomy is a reasonable option and could be performed with acceptable results, if it is performed early in patients with acute massive PE who have not reached the profound cardiogenic shock or cardiac arrest.
    International Journal of Clinical and Experimental Medicine 12/2014; 7(12):5362-5375. · 1.42 Impact Factor
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    • "Some patients present with shock, requiring urgent thrombolysis [1], while others can be safely treated on an outpatient basis with anticoagulation alone [2]. Guidelines propose tailoring management of PE depending on the risk of adverse outcomes, which depends on hemodynamic status (presence of shock or hypotension), biomarkers (brain natriuretic peptide or cardiac troponin levels), and imagery [1] [3]. Among normotensive patients, right-ventricular dysfunction (RVD) has been shown to carry a higher mortality [4] [5] [6]. "
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    ABSTRACT: Pulmonary embolism (PE) induces an acute increase in the right ventricle afterload that can lead to right-ventricular dysfunction (RVD) and eventually to circulatory collapse. Hemodynamic status and presence of RVD are important determinants of adverse outcomes in acute PE. Technologic progress allows computed tomography angiography (CTA) to give more information than accurate diagnosis of PE. It may also provide an insight into hemodynamics and right-ventricular function. Proximal localization of emboli, reflux of contrast medium to the hepatic veins, and right-to-left short-axis ventricular diameter ratio seem to be the most relevantCTApredictors of 30-daymortality.These elements require little postprocessing time, an advantage in the emergency room. We herein review the prognostic value of RVD and other CTA mortality predictors for patients with acute PE.
    BioMed Research International 06/2014; 2014. DOI:10.1155/2014/363756 · 2.71 Impact Factor