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3.
Arq. bras. cardiol ; 118(2): 525-529, 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364338

ABSTRACT

Resumo A doença de coronavírus 2019 (COVID-19) foi relatada em quase todos os países do mundo desde dezembro de 2019. A infecção por SARS-CoV-2 é frequentemente assintomática ou com sintomas leves, mas também pode levar à hipóxia, um estado hiperinflamatório e coagulopatia. Os parâmetros de coagulação anormais estão associados a complicações trombóticas, incluindo embolia pulmonar na COVID-19, mas pouco se sabe sobre os mecanismos. A semelhança dos sintomas iniciais de ambas as doenças também pode ser confusa, portanto, os médicos devem estar cientes do potencial para condições concomitantes. Apresentamos aqui um caso que não apresentava opacidades em vidro fosco nos pulmões, mas apresentava embolia pulmonar e derrame pleural em associação com infecção por COVID-19.


Abstract Coronavirus disease 2019 (COVID-19) has been reported in almost every country in the world since December 2019. Infection with SARS-CoV-2 is often asymptomatic or with mild symptoms, but it may also lead to hypoxia, a hyperinflammatory state, and coagulopathy. The abnormal coagulation parameters are associated with thrombotic complications, including pulmonary embolism in COVID-19, but little is known about the mechanisms. The similarity of initial symptoms of both diseases can also be confusing, therefore the physicians should be aware of the potential for concurrent conditions. Herein, we present a case who did not have ground-glass opacities in the lungs, yet presented with pulmonary embolism and pleural effusions in association with COVID-19 infection.


Subject(s)
Humans , Pulmonary Embolism/etiology , Pulmonary Embolism/diagnostic imaging , COVID-19/complications , SARS-CoV-2 , Lung
5.
Rev. bras. ter. intensiva ; 33(3): 346-352, jul.-set. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1347293

ABSTRACT

RESUMO Objetivo: Avaliar a incidência de embolia pulmonar, seu relacionamento com os níveis de dímero D e outros possíveis fatores associados, além dos efeitos adversos da anticoagulação e meios de contraste. Métodos: Conduziu-se um estudo de coorte retrospectiva em um hospital público chileno. Foram incluídos os pacientes com idade acima de 18 anos com COVID-19, mecanicamente ventilados na unidade de terapia intensiva, admitidos entre março e junho de 2020. Todos os pacientes receberam tromboprofilaxia com heparina, que foi aumentada até uma dose de anticoagulação com níveis de dímero D acima de 3µg/mL. Resultados: Foram acompanhados 127 pacientes, dos quais 73 foram submetidos à angiografia por tomografia computadorizada (média de idade de 54 ± 12 anos; 49 homens). Sessenta e dois dos 73 pacientes (84,9%) receberam anticoagulação total antes da angiografia por tomografia computadorizada. Além disso, 18 dos 73 pacientes tiveram embolia pulmonar (24,7%). Na comparação entre pacientes com e sem embolia pulmonar, não se observaram diferenças significantes em termos de idade, sexo, obesidade, tabagismo, escores de Wells e Genebra revisado, dímero D ou mortalidade. O uso de anticoagulantes foi similar em ambos os grupos. O número de dias desde o início da anticoagulação até a angiografia por tomografia computadorizada foi significantemente menor no grupo com embolia pulmonar (p = 0,002). Três pacientes tiveram lesão renal aguda após o contraste (4,1%), e um paciente teve sangramento importante. Conclusão: Apesar da anticoagulação, um em cada quatro pacientes com COVID-19 submetidos à ventilação mecânica e avaliados com angiografia por tomografia computadorizada apresentou embolia pulmonar. Com uma maior demora para realização da angiografia por tomografia computadorizada após início de anticoagulação empírica, identificou-se um número significantemente menor de embolias


Abstract Objective: To assess pulmonary embolism incidence, its relationship with D-dimer levels and other possible associated factors in addition to anticoagulation and contrast medium adverse effects. Methods: A retrospective observational cohort study at a Chilean public hospital was performed. Intensive care unit mechanically ventilated COVID-19 patients older than 18 years old between March and June 2020 were included. All patients received heparin thromboprophylaxis, which was increased to the anticoagulation dose with D-dimer greater than 3µg/mL. Results: A total of 127 patients were followed up, of whom 73 underwent pulmonary computed tomography angiography (mean age, 54 ± 12 years; 49 men). Sixty-two of the 73 patients (84.9%) received full anticoagulation before computed tomography angiography. In addition, 18 of the 73 patients had pulmonary embolism (24.7%). When comparing patients with and without pulmonary embolism, no significant differences were observed in age, sex, obesity, smoking, Wells and revised Geneva scores, D-dimer or mortality. Anticoagulant use was similar in both groups. Days from the start of anticoagulation until computed tomography angiography were significantly lower in the pulmonary embolism group (p = 0.002). Three patients presented post contrast-acute kidney injury (4.1%), and one patient had major bleeding. Conclusion: Despite anticoagulation, one in four COVID-19 patients connected to mechanical ventilation and evaluated with pulmonary computed tomography angiography had pulmonary embolism. With a longer the delay in performing computed tomography angiography once empirical anticoagulation was started, significantly less pulmonary embolism was identified.


Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Aged , Pulmonary Embolism/epidemiology , Pulmonary Embolism/diagnostic imaging , Venous Thromboembolism/epidemiology , COVID-19 , Retrospective Studies , Risk Factors , Computed Tomography Angiography , SARS-CoV-2 , Intensive Care Units , Anticoagulants/adverse effects
6.
Rev. Assoc. Med. Bras. (1992) ; 67(2): 218-223, Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287830

ABSTRACT

SUMMARY OBJECTIVE: To investigate the correlation of D-dimer levels and computed tomography properties of pulmonary embolism. METHODS: A total of 58 treated patients with diagnosis of properties of pulmonary embolism were retrospectively studied. All patients underwent a D-dimer blood test. In computed tomography images, septal angle, interventricular septal thickness, and the diameters of all cardiac chambers and pulmonary arteries were measured. The thrombus volume (load) and density at all pulmonary arteries (main, right, left pulmonary arteries, and segmental arteries) were calculated. RESULTS: A significant correlation was found between D-dimer and total thrombus volume (p=0.009, r=0.342). Total thrombus volume and total thrombus density were calculated with mean value of 23.40±60.63 ml and 66.16±38.48 hounsfield unit (HU), respectively. Right ventricle/left ventricle ratio showed positive correlation with the D-dimer level (p=0.02). CONCLUSION: Increased D-dimer levels with RV/LV ratio and their correlation with total thrombus volume suggest that it may be a prognostic factor.


Subject(s)
Humans , Pulmonary Embolism/diagnostic imaging , Thrombosis/diagnostic imaging , Fibrin Fibrinogen Degradation Products , Tomography, X-Ray Computed , Retrospective Studies
8.
Article in English | WPRIM | ID: wpr-921884

ABSTRACT

Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) associated vasculitis is an autoimmune disease usually with severe multiple dysfunction syndrome, especially prominent acute renal failure. A 65-year-old woman was admitted with progressive dyspnoea for six months and fever, sputum with blood, pain of the lower extremities and intermittent claudication for two days, indicating multiple organ involvement (respiratory system, blood vessels). The renal involvement was relatively mild, presenting with microscopic haematuria. The chest computed tomography demonstrated multiple pulmonary embolisms. Ultrasound and computed tomography angiography for the lower extremity vessels showed venous and arterial thrombosis. Exclusion of other diseases that can cause multiple organ damage and thrombosis, the positive perinuclear ANCA and MPO-ANCA strongly support the diagnosis of MPO-ANAC-associated vasculitis. The patient's physical condition has been greatly improved by treatment with corticosteroids and anticoagulation.


Subject(s)
Aged , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Female , Humans , Lower Extremity/diagnostic imaging , Peroxidase , Pulmonary Embolism/diagnostic imaging , Thrombosis
10.
Arq. bras. cardiol ; 115(5): 809-818, nov. 2020. tab, graf
Article in Portuguese | LILACS, SES-SP | ID: biblio-1142259

ABSTRACT

Resumo Fundamento: A embolia pulmonar aguda (EPA) tem desfecho clínico variável. A angiotomografia computadorizada (angio-CT) é considerada o padrão-ouro para o diagnóstico. Objetivo: Avaliar se o volume vascular pulmonar (VVP) quantificado por software automatizado é um preditor de mortalidade após EPA. Métodos: Estudo de coorte retrospectivo no qual a imagem da angio-CT de 61 pacientes com EPA foi reanalisada. O VVP e o volume pulmonar (VP) foram estimados automaticamente pelo software Yacta. Calculamos o VVP ajustado pela razão: VVP(cm3)/VP(litros). Parâmetros prognósticos clássicos da angio-CT (carga embólica; razão do diâmetro do ventrículo direito/ventrículo esquerdo; razão do diâmetro da artéria pulmonar/aorta; desvio do septo interventricular; infarto pulmonar e refluxo de contraste na veia hepática) foram avaliados. A mortalidade em 1 mês foi o desfecho analisado. Consideramos um valor de p <0,05 como estatisticamente significativo. Resultados: Sete mortes (11%) ocorreram entre os 61 pacientes durante 1 mês de seguimento. O VVP ajustado <23cm3/L foi um preditor independente de mortalidade na análise univariada (odds ratio [OR]: 26; intervalo de confiança de 95% [IC95%]: 3-244; p=0,004) e na análise multivariada (OR ajustado: 19 [IC95%: 1,3-270]; p=0,03). Os parâmetros clássicos da angio-CT não foram associados à mortalidade em 1 mês nesta amostra. O VVP ajustado <23cm3/L apresentou sensibilidade de 86%, especificidade de 82%, valor preditivo negativo de 94% e valor preditivo positivo de 64% para identificação dos pacientes que morreram. Conclusão: VVP ajustado <23cm3/L foi um preditor independente de mortalidade após EPA. Esse parâmetro mostrou melhor desempenho prognóstico do que os outros achados clássicos da angio-CT. (Arq Bras Cardiol. 2020; 115(5):809-818)


Abstract Background: Acute pulmonary embolism (APE) has a variable clinical outcome. Computed tomography pulmonary angiography (CTPA) is the gold standard for this diagnosis. Objective: To evaluate if the pulmonary vascular volume (PVV) quantified by automated software is a mortality predictor after APE. Methods: Retrospective cohort study where the CTPA imaging of 61 patients with APE was reanalyzed. Pulmonary vascular volume (PVV) and pulmonary volume (PV) were automatically estimated using the Yacta software. We calculated the adjusted PVV by the ratio: PVV(cm3)/PV(liters). Classical prognostic CTPA parameters (clot load index, right ventricle/left ventricle diameter ratio, pulmonary artery/aorta diameter ratio, ventricular septal bowing, pulmonary infarction and reflux of contrast into the hepatic vein) were assessed. The outcome assessed was one-month mortality. We considered a p-value <0.05 as statistically significant. Results: Seven deaths (11%) occurred at one month among these 61 patients. PVV<23cm3/L was an independent predictor of one-month mortality in the univariate [odds ratio (OR): 26; 95% confidence interval (CI): 3-244; p=0.004] and multivariate analyses [adjusted OR: 19; 95%CI: 1.3-270; p=0.03]. The classical CTPA parameters were not associated with one-month mortality in this sample. The PVV<23cm3/L showed a sensitivity of 86%, a specificity of 82%, a negative predictive value of 94% and a positive predictive value of 64% to identify the patients who died. Conclusion: PVV<23cm3/L was an independent predictor of one-month mortality after APE. This parameter showed better prognostic performance than other classical CTPA findings. (Arq Bras Cardiol. 2020; 115(5):809-818)


Subject(s)
Humans , Pulmonary Embolism/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Software , Angiography , Acute Disease , Retrospective Studies
11.
Rev. chil. cardiol ; 39(2): 133-146, ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138526

ABSTRACT

INTRODUCCIÓN: El tromboembolismo pulmonar (TEP) es una causa frecuente de morbimortalidad cardiovascular y la trombolisis local asistida por ultrasonido (TLUS) constituye una alternativa de tratamiento validada para pacientes de riesgo intermedio. No existen reportes del uso de esta tecnología en el ámbito nacional. MÉTODOS: Análisis descriptivo, prospectivo, sobre una serie de pacientes con TEP agudo, de riesgo intermedio, tratados en forma percutánea con trombolisis local asistida por catéter de ultrasonido terapéutico (EKOSonic®). Se analiza la eficacia y seguridad del procedimiento mediante variables clínicas, hemodinámicas y radiológicas, así como desenlaces intra hospitalarios. Se reporta, además, el seguimiento a 30 días. RESULTADOS: Entre Junio de 2019 y Marzo de 2020, 4 pacientes con TEP de riesgo intermedio fueron tratados con esta técnica. El score PESI (Pulmonary Embolism severity Index) promedio era de 79,5 + 6,1. Dos pacientes requirieron la instalación de 2 catéteres para efectuar terapia bilateral. Se observó una reducción promedio en la presión sistólica de arteria pulmonar de 29% y en 3 de los 4 enfermos se logró revertir la dilatación ventricular derecha presente al ingreso. La carga trombótica se redujo en un 20% medido por score CTOI. No hubo complicaciones intraoperatorias ni intrahospitalarias asociadas a la intervención. CONCLUSIONES: En esta serie inicial, el uso de la trombolisis local con catéter de ultrasonido en pacientes con TEP de riesgo intermedio fue segura y efectiva. Los resultados perioperatorios y a 30 días fueron comparables a los descritos en experiencias internacionales; sin embargo, aún se requieren de estudios con mayor número de pacientes para confirmar los beneficios de esta técnica en nuestro medio.


BACKGROUND: Pulmonary thromboembolism (PE) is a common cause of cardiovascular morbidity and mortality and local ultrasound-assisted thrombolysis (USAT) is a validated alternative treatment for intermediate-risk patients. There are no reports on the use of this technology in our country. METHODS: Prospective series of patients with acute, intermediate-risk PE treated percutaneously with therapeutic ultrasound catheter-assisted local thrombolysis (EKOSonic®). The efficacy and safety of the procedure were analyzed using clinical, hemodynamic, and radiological variables, as well as intra-hospital outcomes. The 30-day follow-up is also reported. RESULTS: between June 2019 and March 2020, a total of 4 patients with intermediate-risk PE were treated with this technique. The average PESI score was 79.5 + 6.1. Two out of 4 patients required the use of 2 catheters for bilateral therapy. The average reduction in systolic pressure of the pulmonary artery was 29% and 3 patients reversed the right ventricular dilation present at admission. The thrombotic burden was reduced by 20% according to the Computed Tomography Obstruction Index (CTOI). There were no intraoperative or in hospital complications associated with the intervention. CONCLUSION: In this initial series, the use of local thrombolysis with an ultrasound catheter in patients with intermediate-risk PE was safe and effective. The perioperative and 30-day outcomes were similar to those previously reported in international series. However, larger randomized trials are needed to confirm this potential benefit.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pulmonary Embolism/therapy , Ultrasonic Therapy , Catheters , Mechanical Thrombolysis , Pulmonary Artery , Pulmonary Embolism/physiopathology , Pulmonary Embolism/diagnostic imaging , Safety , Severity of Illness Index , Acute Disease , Prospective Studies , Follow-Up Studies , Ventricular Function , Treatment Outcome , Ultrasonography, Interventional , Hemodynamics , Length of Stay
13.
Medicina (B.Aires) ; 80(3): 285-288, jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1125081

ABSTRACT

La tromboembolia pulmonar aguda (TEPA) sigue siendo una importante causa de morbilidad y mortalidad a nivel mundial. Su diagnóstico, estratificación de riesgo y tratamiento precoz son fundamentales, siendo su pilar la anticoagulación. En pacientes de bajo riesgo cardiovascular, el pronóstico es excelente y solo basta con la administración de anticoagulantes. No obstante, debido al pobre pronóstico de los pacientes con riesgo elevado (descompensación hemodinámica), el enfoque terapéutico es más agresivo, utilizándose trombolíticos sistémicos que disminuyen la mortalidad pero incrementan el riesgo de complicaciones hemorrágicas mayores. En el TEPA de riesgo intermedio (evidencia de falla de ventrículo derecho, sin descompensación hemodinámica), la relación riesgo-beneficio del tratamiento con trombolíticos es más equilibrada por lo que la decisión es controvertida. La fragmentación mecánica con trombólisis dirigida por catéter es una alternativa con potenciales beneficios. Presentamos dos casos de TEPA de riesgo intermedio, en los que se realizó fragmentación mecánica y trombólisis dirigida por catéter.


Acute pulmonary thromboembolism remains a significant cause of morbidity and mortality worldwide. Its diagnosis, risk stratification and early treatment are essential. The mainstay of treatment is anticoagulation. In patients with low cardiovascular risk, the prognosis is excellent and the treatment consists only of the administration of anticoagulants. Due to the poor prognosis of patients with high risk (hemodynamic decompensation), the approach is more aggressive using systemic thrombolytics, which reduce mortality but increase the risk of major hemorrhagic complications. In the intermediate-risk patients (evidence of right ventricular failure, without hemodynamic decompensation), the risk-benefit relationship of thrombolytic treatment is more balanced, so the choice is controversial. Mechanical fragmentation with catheter-directed thrombolysis is an alternative with potential benefits. We present two cases of intermediate-risk acute pulmonary thromboembolism to whom mechanical fragmentation and catheter-directed thrombolysis was applied.


Subject(s)
Humans , Male , Female , Middle Aged , Pulmonary Embolism/therapy , Catheterization, Swan-Ganz/methods , Mechanical Thrombolysis/methods , Pulmonary Embolism/diagnostic imaging , Echocardiography, Doppler , Acute Disease , Risk Factors , Treatment Outcome , Risk Assessment , Heart Ventricles/physiopathology
14.
Neumol. pediátr. (En línea) ; 15(1): 267-269, Mar. 2020. ilus
Article in English | LILACS | ID: biblio-1088095

ABSTRACT

Presenting the case of a previously healthy eleven-year-old girl, diagnosed with septic arthritis of the left knee as a result of stabbing trauma, which subsequently develops respiratory distress and fever. Septic pulmonary embolism is diagnosed radiologically and by pathological study. Receive adequate antibiotic treatment, recovering completely. Septic pulmonary embolism, although frequently described in the adult population, is a condition rarely described in pediatric literature.


Se presenta el caso de una niña de once años previamente sana, con diagnóstico de artritis séptica de rodilla izquierda como resultado de un traumatismo punzante, que posteriormente desarrolla dificultad respiratoria y fiebre. Se diagnostica embolia pulmonar séptica documentada radiológicamente y por estudio anatomopatológico. Recibe tratamiento antibiótico adecuado, recuperándose completamente. La embolia pulmonar séptica, aunque frecuentemente descrita en población adulta, es una condición raramente descrita en la literatura pediátrica.


Subject(s)
Humans , Female , Child , Pulmonary Embolism/etiology , Arthritis, Infectious/complications , Pulmonary Embolism/drug therapy , Pulmonary Embolism/diagnostic imaging , Radiography, Thoracic , Tomography, X-Ray Computed , Sepsis , Anti-Bacterial Agents/therapeutic use
16.
Rev. Assoc. Med. Bras. (1992) ; 66(3): 263-267, Mar. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136213

ABSTRACT

SUMMARY OBJECTIVES Acute pulmonary embolism (APE) is an important cause of cardiovascular mortality, due mainly to hemodynamic instability. In these cases, the recommendation is to perform some reperfusion procedure, with systemic thrombolysis being the main therapy used. However, national data evaluating the efficacy and safety of thrombolysis are scarce. METHODS Retrospective analysis of a case series. We included 13 patients diagnosed with high-risk APE and 4 patients with intermediate-high risk from a single-center, who were treated with alteplase 100mg. RESULTS The mean age of the patients was 55 years, most of them female (76.4%). Among the risk factors for VTE were immobilization (41.17%), contraceptive use (35.29%), cancer (17.63%), and previous history of DVT (11.76%). The most frequent clinical manifestations of APE were dyspnea (88.23%), hypoxia (82.35%), hypotension (82.35%), and tachycardia (64.70%). 82.35% of the patients had echocardiographic signs of right ventricular dysfunction, and 52.94% had increased troponin and BNP. Severe bleeding associated with thrombolysis occurred in 17.54% of cases. No patient died due to bleeding. There were 8 deaths from right ventricular failure (47%), 6 in the cases of patients presenting as high-risk APE (35.3%), and 2 in the cases of intermediate-high risk (11.8%). CONCLUSION Thrombolysis in patients with high-risk APE or intermediate-high risk had a severe bleeding rate of 17.6%. However, the high mortality of this population (47%) due to right ventricular failure justifies the use of this therapeutic modality.


RESUMO OBJETIVOS A embolia pulmonar aguda (EAP) é uma causa importante de mortalidade cardiovascular ao causar instabilidade hemodinâmica. Nesses casos, a recomendação é a realização de algum procedimento de reperfusão, sendo a trombólise sistêmica a principal terapia utilizada. No entanto, dados nacionais avaliando a eficácia e a segurança da trombólise são escassos. MÉTODO Análise retrospectiva de uma série de casos. Foram incluídos 13 pacientes com o diagnóstico de EAP de alto risco e quatro pacientes de risco intermediário-alto, de um único centro, e que foram tratados com alteplase 100 mg. RESULTADOS A média de idade dos pacientes foi 55 anos, sendo a maioria do gênero feminino (76,4%). Dos fatores de risco para TEV, estavam presentes a imobilização (41,17%), o uso de anticonceptivos (35,29%), câncer (17,63%) e história prévia de TVP (11,76%). As manifestações clínicas mais frequentes da EAP foram dispneia (88,23%), hipóxia (82,35%), hipotensão (82,35%) e taquicardia (64,70%); 82,35% dos pacientes apresentaram sinais ecocardiográficos de disfunção ventricular direita e 52,94% apresentaram aumento da troponina e BNP. Sangramento grave associado à trombólise ocorreu em 17,54% dos casos. Nenhum paciente faleceu em decorrência de sangramento. Houve oito mortes por insuficiência ventricular direita (47%): seis nos casos de paciente que se apresentaram como EAP de alto risco (35,3%) e duas nos casos de risco intermediário-alto (11,8%). CONCLUSÃO A trombólise nos pacientes com EAP de alto risco ou risco intermediário-alto apresentou uma taxa de sangramento grave de 17,6%. No entanto, a alta mortalidade dessa população (47%) por insuficiência ventricular direita justifica o uso desta modalidade terapêutica.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Pulmonary Embolism/drug therapy , Thrombolytic Therapy/methods , Ventricular Dysfunction, Right/drug therapy , Fibrinolytic Agents/therapeutic use , Antifibrinolytic Agents/therapeutic use , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Acute Disease , Retrospective Studies , Risk Factors , Treatment Outcome , Tissue Plasminogen Activator/therapeutic use , Ventricular Dysfunction, Right/complications , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/mortality , Risk Assessment , Fibrinolytic Agents/adverse effects , Hemorrhage/chemically induced , Middle Aged , Antifibrinolytic Agents/adverse effects
18.
Rev. méd. Minas Gerais ; 30(supl.4): S53-S60, 2020.
Article in Portuguese | LILACS | ID: biblio-1177118

ABSTRACT

Introdução. O tromboembolismo pulmonar (TEP) é uma doença que apresenta uma clínica inespecífica, o que induz a necessidade de solicitar exames complementares, como a angiotomografia computadorizada (angioTC) de tórax. Com o objetivo de evitar a sua solicitação desnecessária, foram criados sistemas de probabilidade pré-teste, como o escore de Wells, que direcionam a propedêutica. Objetivo. Avaliar a prevalência de tromboembolismo pulmonar (TEP) em dois hospitais de uma cidade de médio porte e verificar o padrão de solicitação da angiotomografia computadorizada de tórax (angioTC). Métodos. Estudo transversal a partir de dados de prontuários de pacientes submetidos à angioTC de tórax no Hospital Regional de Barbacena e no Hospital Ibiapaba no período de janeiro de 2014 até junho de 2018. Resultados. A prevalência de TEP foi de 29,70% (N=259) no período de 54 meses e a mediana de idade, 66 anos (intervalo interquartil: 24). Nos pacientes com o diagnóstico de TEP, o sintoma mais frequente foi dor torácica (38,81%), seguido por hemoptise (33,33%) e tosse (32,99%). Nos prontuários analisados foi observado que a utilização do escore de Wells foi de 2,70%. A probabilidade de TEP, pelo escore de Wells, realizada pelos pesquisadores com base nos dados dos prontuários, em pacientes diagnosticados com TEP pela angioTC foi alta em 45%, moderada em 34,42% e baixa em 9,23%. Conclusão. A prevalência foi de 29,70% no período de 54 meses de diagnóstico de TEP em pacientes que realizaram a angioTC de tórax nos hospitais mencionados. O escore de Wells é um importante instrumento propedêutico. (AU)


Background. Pulmonary embolism (PE) is a disease presented with nonspecific symptoms that requires additional tests such as pulmonary angiography by computadorized tomography. To avoid unnecessary tests, pre-test probability tools were created, such as Wells Score, which guides the propaedeutics. Objective. To evaluate the prevalence of pulmonary embolism (PE) in two hospitals in a medium-sized city and to verify computed tomography pulmonary angiography imaging exam orders. Methods. Cross-sectional study based on data from the hospital records evolving patients underwent computed tomography pulmonary angiography at Hospital Regional de Barbacena and Hospital Ibiapaba through January 2014 and June 2018. Results. The prevalence of PE was 29.70% (259 patients) in the 54-month period and the median age, 66 years (interquartile range, 24). In patients with the diagnosis of PE, the most frequent symptom was chest pain (38.81%) followed by hemoptysis (33.33%), and cough (32.99%). In the analyzed hospital records it was observed that the use of the Wells score was 2.70%. The probability of PE according to the Wells score, performed by the researchers based on data from the medical records, in patients diagnosed with PE by computed tomography pulmonary angiography was high in 45%, moderate in 34.42%, and low in 9.23%. Conclusion. The prevalence of PE was 29.70% (N = 259) in the 54-month period from PE diagnosis in patients who underwent computed tomography pulmonary angiography in the mentioned hospitals. The Wells score is an important diagnostic tool(8)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pulmonary Embolism/diagnostic imaging , Early Diagnosis , Pulmonary Embolism , Venous Thrombosis , Propensity Score , Clinical Decision-Making , Computed Tomography Angiography
19.
Rev. Soc. Bras. Med. Trop ; 53: e20200267, 2020. graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136848

ABSTRACT

Abstract The full spectrum of COVID-19 is still emerging, although several studies have highlighted that patients infected with the novel coronavirus can potentially develop a hypercoagulable state. However, several aspects related to the incidence and pathophysiology of the association between COVID-19 and pulmonary embolism are not well established. Here, we present a case of a patient with COVID-19 who developed acute pulmonary embolism. Clinical and laboratory data and findings of non-enhanced CT indicate possibility of acute pulmonary embolism, and support the decision to proceed with computed tomography pulmonary angiography that can objectively identify filling defects in pulmonary arterial branches.


Subject(s)
Humans , Male , Pulmonary Embolism/virology , Pulmonary Embolism/diagnostic imaging , Betacoronavirus , Pulmonary Embolism/drug therapy , Acute Disease , Rivaroxaban/therapeutic use , Computed Tomography Angiography , Middle Aged
20.
Rev. bras. cir. cardiovasc ; 34(6): 783-787, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057491

ABSTRACT

Abstract Pulmonary endarterectomy is a curative procedure for chronic thromboembolic Pulmonary Hypertension. As usual, cardiopulmonary bypass circuit is required. However, there are several complications attributed to extracorporeal circulation. Hemodilution, systemic inflammatory response syndrome and leukocyte sequestration are circulation related complications. The severe forms include Acute Respiratory Distress Syndrome, Acute Lung Injury, myocardial stunning, dysfunction of the right ventricle, coagulopathy, postoperative stroke or renal dysfunction. In this case report, we aimed to give information about perioperative anesthesia and surgical management of pulmonary endarterectomy which was successfully managed without Cardiopulmonary Bypass.


Subject(s)
Humans , Male , Middle Aged , Pulmonary Embolism/surgery , Endarterectomy , Anesthesia/methods , Pulmonary Embolism/physiopathology , Pulmonary Embolism/diagnostic imaging , Tomography, X-Ray Computed
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