ABSTRACT
Indications regarding surgical pulmonary embolectomy for treatment of submassive/massive acute pulmonary embolism remain controversial. An institutional experience with pulmonary embolectomy for acute pulmonary embolism (APE) was reviewed. A retrospective analysis of all patients undergoing pulmonary embolectomy for APE from September 2004 to January 2007 was conducted. Demographic data, clinical presentation and outcomes were analyzed. Fifteen patients underwent surgery for APE over a period of 27 months [average age 59.6 (range 35-89) years, (seven male, eight female)]. Six (40%) patients were admitted with known APE and nine patients exhibited post admission APE (seven - after surgical procedures, two - after cerebrovascular accident). Clinical presentation included dyspnea (86.67%), hemodynamic instability requiring continuous vasopressor support (40%), echocardiographic evidence of right ventricular dilatation (80%). Ten patients undergoing early/expedient embolectomy all survived while delayed surgery in the other five patients (>24 h) was associated with 60% mortality. Expanding indications for early surgical pulmonary embolectomy has stemmed from reliable echocardiographic identification of right ventricular compromise and recognition of these findings as harbingers of subsequent hemodynamic embarrassment. Our series underscores the benefit of early consideration and performance of pulmonary embolectomy in these critically ill patients.
Subject(s)
Embolectomy , Pulmonary Artery/surgery , Pulmonary Embolism/surgery , Acute Disease , Adult , Aged , Aged, 80 and over , Dilatation, Pathologic , Dyspnea/etiology , Dyspnea/surgery , Echocardiography, Transesophageal , Female , Hemodynamics , Humans , Male , Middle Aged , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/physiopathology , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/mortality , Retrospective Studies , Time Factors , Treatment Outcome , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/surgeryABSTRACT
We present a case report of a 50-year-old male who sustained a gunshot wound to the right chest. The initial thoracotomy demonstrated a nonbleeding gunshot wound in the middle lobe and was otherwise unremarkable. Later that day, after continued resuscitation, his chest tube output dramatically increased and he was taken back for redo thoracotomy. An injury to the lateral branch of the middle lobe pulmonary artery was encountered and suture ligated. The patient presented several weeks later with hemoptysis. Computed tomography of the chest demonstrated pooling of contrast in the middle lobe. Angiography confirmed the diagnosis of a pulmonary artery pseudoaneurysm and was coil embolized without difficulty. This report represents a case of coil embolization of traumatic pulmonary artery pseudoaneurysm.
