Syncope is not an uncommonly presenting manifestation of acute PE. Patients with acute PE and syncope have similar characteristics to those without syncope. Syncope does not seem to determine a poor prognosis.
We retrospectively reviewed the medical records of 154 consecutive patients with acute pulmonary embolism (PE) admitted to an Internal Medicine Service. At presentation, fever (temperature > 37 degrees C) without other identified causes was present in 28 patients (18.2%): 27 patients had low-grade fever (temperature 37-39 degrees C) and one patient had high-grade fever (temperature > 39 degrees C). Epidemiological and clinical characteristics, electrocardiographic and chest radiograph abnormalities and mortality rate were similar in patients with and without fever. Fever, including high-grade fever, is a possible presenting feature in patients with acute PE. Patients with acute PE and fever have similar characteristics compared with those without fever.
Churg-Strauss syndrome (CSS) is a systemic small-vessel vasculitis characterised by the presence of asthma and eosinophilia. Central nervous system involvement (cerebral infarctions or intracerebral haemorrhage) is rare in CSS. Spontaneous subarachnoid hemorrhage (SAH) has been described in other systemic vasculitides. SAH is exceptional in CSS. We present a 47-year-old woman with CSS presenting as a spontaneous SAH with cerebral angiography findings consistent with vasculitis of the basilar artery and without aneurysms or arteriovenous malformations. She received treatment with prednisone and cyclophosphamide, and 2 months later the basilar artery was normal on magnetic resonance angiography.
The possibility of an intermediate V/Q lung scan is higher in elderly patients and in patients with previous cardiopulmonary disease (especially with chronic obstructive pulmonary disease). Emphysema is the only chest radiograph abnormality associated with a greater possibility of an intermediate V/Q lung scan.
Wheezing in acute pulmonary embolism may be more frequent in patients with previous cardiopulmonary disease. However, wheezing also occurs in patients with acute pulmonary embolism without previous cardiopulmonary disease. Wheezing may be a sign of severity in acute pulmonary embolism.
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