Pregnancy-adapted YEARS algorithm: can YEARS do more for pregnant women?

Pregnancy-adapted YEARS algorithm provides high certainty in ruling out pulmonary embolism and high efficiency in reducing the need for CTPA http://bit.ly/2GgH4sv.

Ocular findings in patient with primary familial pulmonary hypertension.

Exudative retinal detachment as subretinal fluid accumulation occurs due to chorioretinal eye disease (inflammation, infection, tumor, vascular abnormalities) and in systemic diseases too. The aim of this case report was to emphasize connection between the ophthalmological pathology and other systemic conditions. This is a case report of a 45-year old woman who suffered from pulmonary hypertension caused by many recurrent thromboembolic events. During one of eight previous hospitalizations she complained of blurred vision. Bilateral exudative detachment is diagnosed by an ophthalmologist. Parenteral steroids and acetazolamide provided quick recovery.

[Pulmonary thromboembolism and deep venous thrombosis in the antiphospholipid syndrome--case report]. / Plucna tromboembolija i duboka venska tromboza u antifosfolipidnom sindromu--prikaz slucaja.

INTRODUCTION: Systemic lupus erythematosus is a multisystemic disease of unknown etiology with diverse clinical symptoms depending on the organ affected. Plasma of affected patients contains a specific anticoagulant called lupus anticoagulant. It is an antibody which belongs to the class of antiphospholipid antibodies which bind to phospolipid-binding proteins, molecules of natural coagulation inhibitors, thus increasing the risk of thrombosis. Systemic lupus erythematosus commonly affects the skin, joints, serosa, hematopoietic tissue, kidneys and the nervous system. Pulmonary symptoms may manifest as pleurisy, pneumonia, chronic interstitial pulmonary disease, but pulmonary thromboembolism is the most common pulmonary manifestation. CASE REPORT: This is a case report of a young female patient who has been suffering from systemic lupus erythematosus for twenty years. She was treated for superficial thrombophlebitis for several times. She was admitted to our hospital a year before, when she developed pulmonary thromboembolism following deep venous thrombosis of the right leg, although at that time she was treated by oral anticoagulants. She was discharged from hospital with vena cava filter placement and further anticoagulant treatment. In a one year period she was hospitalized again due to relapse pulmonary of thromboembolism. DISCUSSION: Thrombotic complications in systemic lupus are more frequent in patients with antiphospholipid antibodies. Prevention of thrombotic complications by anticoagulant agents in patients who already developed thrombotic manifestations is considered necessary. CONCLUSION: Anticoagulant treatment should be, for preventive reasons, introduced in all patients with a systemic disease and with anticoagulant factor, even if they haven't developed a thrombotic attack and they should undergo prothrombin time measurements and INR: 3-4.

[Radiologic manifestations of pulmonary embolisms as round shadows]. / Plucne tromboembolije radioloski manifestovane kao okrugle senke.

INTRODUCTION: A radiologic finding takes a prominent place in establishing the diagnosis of pulmonary thromboembolism. It may rather vary in appearance, depending on the size of the obturated blood vessel. Changes in the pulmonary parenchyma develop within 24 hours after pulmonary thromboembolism attack occurs. In microembolism, the radiologic finding appears normal. Triangle-shaped shadows characteristic for pulmonary thromboembolism may appear as either round or oval on computerized CT scan. In standard chest X-ray finding, these lesions look like tumorous ones. RESULTS: Over the period from 1995 to 1997, there were 421 patients treated for pulmonary thromboembolism at the Institute of Pulmonary Diseases in Sremska Kamenica (Yougoslavia), whereas 3.09% of them presented with an oval shadow in a standard chest X-ray or CT finding. The analysis performed in 1981 revealed that majority of patients with pulmonary thromboembolism (11.4%) had round-shaped shadows. DISCUSSION: Any round-shaped shadow discovered by both standard chest X-ray and CT findings should be carefully investigated because differential diagnostics includes a variety of diseases. CONCLUSION: A round-shaped or oval lung shadow seen in standard chest X-ray or CT finding should be suspected for lung cancer. Patients are therefore submitted to aggressive diagnostic procedures. Pulmonary thromboembolism should also be thought of in order to initiate proper treatment in time.

[Pulmonary thromboembolism and acute renal insufficiency caused by renal artery thrombosis]. / Plucna tromboembolija udruzena sa akutnom renalnom insuficijencijom, nastalom zbog tromboze renalnih arterija.

INTRODUCTION: Pulmonary thromboembolism is a clinical and pathophysiological condition caused by occlusion of pulmonary arteries by thrombotic embolus. Deep venous thrombosis needn't necessarily be evident. Acute renal insufficiency is a syndrome manifested by rapid decrease or even complete urinary retention, which may be due to obturation of renal arteries by a thrombus. The condition is clinically manifested by hematuria, oliguria, anuria and death due to uremia. CASE REPORT: The patient had a history of disease and a chest X-ray finding both irrelevant for establishing the working diagnosis. Blood gas analysis presented prominent hypoxemia with hyperventilation and ECG finding exhibited right heart overload, pointing to pulmonary thromboembolism. On the third day of treatment with heparin, the patient developed hematuria, oliguria and excessive elevation of nitrogen in blood as a sign of acute renal insufficiency, leading to fatal outcome. Autopsy revealed deep venous thrombosis of the left femoral vein, with massive pulmonary thromboembolism and thrombosis of both femoral arteries, inducing acute renal failure. DISCUSSION: Although the patient had a typical radiologic presentation of pulmonary thromboembolism, treatment with heparin was initiated on the basis of his blood gas analysis and ECG findings. Deep venous thrombosis was not clinically evident and acute renal failure could not be explained during patient's lifetime. CONCLUSION: This is a rare case of acute renal failure due to a rare occurrence of bilateral acute thrombosis of renal arteries.

[Treatment of pulmonary embolism and prevention of recurrence by placement of a vena cava filter in deep venous thrombosis: case report]. / Lecenje plucne embolije i sprecavanje recidiva ugradnjom kava filtra kod duboke venske tromboze: prikaz slucaja.

INTRODUCTION: In patients with pulmonary thromboembolism it is crucial to suspect the disease, establish the diagnosis and initiate anticoagulation treatment as early as possible in order to prevent relapses, which may be fatal. Deep venous thrombosis of lower extremities is the most common site of origin, which initially may remain obscure. CASE REPORT: Two weeks prior to admission the patient had right-sided chest pain accompanied with dyspnea, interpreted and treated as pleuropneumonia. Pulmonary thromboembolism was suspected due to clinical symptoms, chest X-ray, elevated enzyme levels findings, blood gas analysis with hypoxemia and ECG with right heart overload. The diagnosis of pulmonary thromboembolism confirmed by lung scintigraphy presented with perfusion defects. After twenty days of heparin therapy, the patient developed left leg edema. Ultrasound screening confirmed bilateral iliacfemoral popliteal vein thrombosis of iliacofemoropopliteal veins bilaterally. Phlebography performed via jugular vein disclosed thrombotic material in the right common iliac vein, as well as in the vena cava inferior. In the course of the procedure vena cava filter has been placed. DISCUSSION: Although the patient was receiving anticoagulation heparin therapy, he developed pulmonary thromboembolism relapse and deep venous thrombosis. In our patient, vena cava filter placement was aimed at preventing pulmonary thromboembolism relapse. Since a deficit of S protein was also established, the patient is unfortunately likely to develop thrombosis at other sites as well. CONCLUSION: In our patient pulmonary thromboembolism was a consequence of deep venous thrombosis, and the diagnosis was established by ultrasound screening of the lower extremities and confirmed by phlebography. During phlebography vena cava filter was placed in order to prevent pulmonary thromboembolism.