[The role of spiral computer tomography in diagnostic algorithms in patients with suspected pulmonary embolism]. / Rola spiralnej tomografii komputerowej w algorytmach diagnostycznych u chorych z podejrzeniem zatorowosci plucnej.

The recognizing of the EP is still not satisfied because specifity and sensitivity of clinical symptoms is relatively low. SCT is an important examination in the diagnostic of pulmonary embolism and is the alternative to often nonconclusive scintigraphy and conclusive but invasive pulmonary angiography. The authors describe the role of SCT in the diagnostic algorithm of the suspected pulmonary embolism of the high and not high risk, discuss the interpretation of result of SCT due to the sort of SCT (SDCT or MDCT) and to clinical probability of PE and they discuss the problem of subsegmental PE.

[Chronic thromboembolic pulmonary embolism not preceded by clinical thromboembolic event - clinical, echocardiographic and haemodynamic course]. / Przebieg przewleklego zakrzepowo−zatorowego nadcisnienia plucnego niepoprzedzonego incydentem zatorowym ­ ocena kliniczna, echokardiograficzna i hemodynamiczna.

Chronic thromboembolic pulmonary embolism not preceded by clinical thromboembolic event(s) in a 50 year-old male with a history of three-year dyspnea on exertion was detected. Proximal chronic pulmonary embolism, mean pulmonary artery pressure 32 mm Hg, and pulmonary vascular resistance of 444 dyn x s(-1) x cm(-5) were found. We describe a 11-year clinical course of anticoagulated patient with monitoring of functional status and echocardiography and with control of pulmonary haemodynamics at the end of follow-up.

Pulmonary thromboembolism in 102 consecutive patients with chronic atrial fibrillation. Diagnostic value of echocardiography.

BACKGROUND: Little is known about the incidence and diagnosis of pulmonary thromboembolism (PE) in patients with chronic permanent atrial fibrillation (CAF). Also it has not been established if echocardiography, a diagnostic tool useful in clinical evaluation of both diseases, is of value in diagnosis of PE in CAF patients. AIM: To establish the prevalence of PE among patients suffering from CAF without or with poorly controlled anticoagulation as well as to evaluate the possibility to detect PE and to assess the diagnostic role of echocardiography. METHODS: Prevalence of PE in a population of 102 patients (52 males and 50 females at the mean age of 68 years, range 32-88 years) admitted to hospital between January and December 2004 with diagnosis of CAF was studied retrospectively. Echocardiography-based original algorithm of PE diagnosis in such patients was analysed. RESULTS: Among 102 patients with CAF, 20 (19%) cases of PE were diagnosed, including 12 with acute PE (APE) and 8 suffering from chronic thromboembolic pulmonary hypertension (CTEPH). Patients with CAF and APE as well as with CAF and CTEPH had increased right ventricular dimension (p=0.0002 and p=0.001, respectively), higher tricuspid pressure gradient (p=0.005 and p=0.001, respectively) and shorter pulmonary artery acceleration time (p=0.00006 and p=0.0004, respectively) estimated in echocardiography as compared to patients with CAF but without PE. Subjects with CAF and PE had also significantly decreased left ventricular dimension and better left ventricular performance. CONCLUSIONS: A relatively high incidence of PE among patients with CAF not treated with anticoagulants or with poorly controlled anticoagulation therapy was noted. The important value of a diagnostic algorithm employing echocardiography in a diagnosis of clinically significant APE and CTEPH in this group of patients was also shown.

[Characteristics of acute, hemodynamically stable pulmonary embolism presenting as a syncope]. / Charakterystyka ostrej, hemodynamicznie stabilnej zatorowosci plucnej ujawniajacej sie omdleniem.

Syncope (S) occurs in approximately 10% patients with acute pulmonary embolism (APE) and is commonly ascribed to the massive, hemodynamically instable APE. The aim of the study was to assess the occurrence and significance of S revealing hemodynamically stable APE. We found syncope in 6 of 21 (29%) consecutive patients (16 females, 5 males; age from 46-87 years, mean age of 71 years) who were diagnosed with APE and in whom other reasons for S were excluded. All patients were treated with anticoagulation. They all survived hospitalization and no APE recurrences were found during in-hospital period. Patients with APE-S compared to patients with APE and without S had smaller baseline RVED (21.2 +/- 2 vs. 27.3 +/- 5.6, p = 0.01), however both groups did not differ statistically in baseline vital signs, angiographic, hemodynamic, other echocardiographic parameters as well as in the results of laboratory findings. It is concluded, that S signals hemodynamically stable APE more frequently than is quoted. APE-S patients could not be clearly discriminate from APE patients without S on the basis of the parameters studied and S did not impact the course of APE during in- hospital period.

[Acute myocardial infarction treated with primary PCI complicated by pulmonary embolism--a case report]. / Pierwotna interwencja wiencowa w swiezym zawale serca powiklana zatorowoscia plucna.

A case of 53-year-old male who was admitted to the hospital due to a chest pain, is presented. ECG showed ST elevation in precordial leads. The patient was successfully treated with primary angioplasty. On the third day of hospitalization, he collapsed with hypotension. Routine echocardiographic examination revealed signs of pulmonary embolism. An adequate pharmacotherapy was implemented and the patient improved. After 10 days of treatment and rehabilitation he was discharged home. The present case report points out on pulmonary embolism as a rare but potentially life-threatening complication of coronary angioplasty.