Pulmonary Embolism. II. Diagnosis and Treatment

Janata-Schwatczek, Karin; Weiß, Konrad; Riezinger, Irmgard; Bankier, Alexander A.; Domanovits, Hans; Seidler, Dan

doi:10.1055/s-2007-998990

Cited by 19 publications

(6 citation statements)

References 119 publications

(182 reference statements)

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“…Deep vein thrombosis is known to be an important risk factor for PE, but clinical signs of deep vein thrombosis are rare and nonspecific. 19 While leg pain or swelling were reported before cardiac arrest in only a few cases, we have detected deep vein thrombosis in 85% of our patients at autopsy. This suggests that lack of signs of deep vein thrombosis is not as helpful in acute decision making as previously believed.…”

Section: Commentmentioning

confidence: 48%

Pulmonary Embolism as Cause of Cardiac Arrest

Kürkciyan

Meron²,

Sterz³

et al. 2000

Arch Intern Med

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306

186

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Section: Commentmentioning

confidence: 48%

Pulmonary Embolism as Cause of Cardiac Arrest

Kürkciyan

Meron²,

Sterz³

et al. 2000

Arch Intern Med

Self Cite

306

186

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“…In addition, it seems that spiral CT will play an increasingly important role. At this point, spiral CT has already been incorporated into the clinical routine in many institutions [41]. Spiral CT is already used as a primary screening test for PE where radionuclide lung imaging is unavailable, and in this context, spiral CT can be regarded as sensitive and specific enough to diagnose or rule out relevant PE.…”

Section: Limitations Of Spiral Computed Tomography Angiographymentioning

confidence: 99%

Spiral computed tomography of pulmonary embolism

Herold¹

2002

European Respiratory Journal

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Spiral computed tomography of pulmonary embolism. C.J. Herold. #ERS Journals Ltd 2002. ABSTRACT: Within the last several years, spiral computed tomography angiography (SCTA) of the pulmonary arteries has emerged as a noninvasive angiographic modality for the evaluation of patients with suspected pulmonary embolism (PE). SCTA is based on continuous computed tomography (CT) data acquisition during patient transport through the rotating X-ray tube and detector system, where scanning is performed in the time period in which the injected contrast material passes through the pulmonary arteries. Single detector spiral CT has a sensitivity of y85-90% and a specificity between 88-95%. Sensitivity and specificity are very likely to increase with the use of multidetector spiral CT scanners that allow scanning of large lung volumes with a scan collimation as narrow as 1 mm.Currently, SCTA is most commonly used as a primary imaging method in patients with suspected PE, and as a second-line method in cases with inconclusive ventilation/ perfusion scintigraphy results. SCTA has proven to be cost-effective, especially in combination with ultrasound of the lower extremities.Limitations of the method include a decreased sensitivity for the detection of small isolated clots in the peripheral pulmonary arterial bed, and a potentially reduced image quality in patients with coexistent cardiopulmonary disorders.Despite these limitations, several studies have now documented that, in patients with suspected pulmonary embolism, it is safe to withhold anticoagulation therapy if a spiral computed tomography exam of the pulmonary arteries is negative and no lower extremity venous thrombosis is present. In the future, multislice computed tomography scanning of the pulmonary arteries with multiplanar reformation and one-stop shopping, i.e. scanning of the pulmonary arteries and the lower extremity veins in a single session, will further enhance the role of computed tomography angiography in the examination of patients with suspected pulmonary embolism. Pulmonary embolism (PE) is often encountered both in the hospital setting and in private clinical practice. Because untreated PE is associated with a greatly increased mortality risk, accurate diagnosis of PE is of critical importance [1,2]. However, because clinical findings, laboratory tests, and signs and symptoms at physical examination are often nonspecific, imaging methods are a significant part of the diagnostic evaluation of patients with suspected PE.Since PE is not an isolated disorder but, rather, a symptom of the entire venous thromboembolism complex, imaging studies of the lower extremities and the pelvis, the most common source of pulmonary emboli, are a fundamental requirement for the diagnostic work-up of patients with suspected PE. Various imaging modalities have been attempted in this evaluation process within the last few decades. For many years, ventilation/perfusion (V/Q) scintigraphy has served as the noninvasive procedure of choice for the assessment of patients with susp...

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“…Haematology x haemoglobin 12.4 g/dl (12)(13)(14)(15)(16) x white cell count 10.9 × 10 9 /l (4.5-11.0) x eosinophils 0.7 × 10 9 /l (0.0-0.4) x platelets 308 × Learning points…”

Section: Results Of Initial Investigationsmentioning

confidence: 99%

Visceral leishmaniasis masquerading as tuberculosis in a patient with AIDS

Yaduvanshi

Jain

et al. 1999

Postgraduate Medical Journal

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SummaryThe clinical features of viral encephalitis consist of headache, fever, seizures and encephalopathy. We report three patients with high-grade gliomas presenting with encephalitic illnesses. The diagnosis of brain tumour should always be borne in mind if definite evidence for a viral infection is not obtained.Keywords: glioma; viral encephalitis; encephalopathy Viral encephalitis is characterised by headache, confusion, altered consciousness with or without seizures, and fever. The most commonly identified cause of sporadic communityacquired encephalitis is herpes simplex virus (HSV) type I, which may be diagnosed on viral culture of cerebrospinal fluid (CSF), polymerase chain reaction (PCR) analysis looking for HSV DNA, serological testing for IgM antibodies, or brain biopsy. Characteristically the virus attacks the medial temporal lobes and insular cortex giving rise to a focal encephalitis which carries a significant mortality rate. 1 Rarely, the patient presents with symptoms and signs of raised intracranial pressure, giving rise to the possibility of a temporal lobe abscess. The converse situation, whereby a high-grade tumour presents as an acute encephalitic illness, has only rarely been reported. The following three cases illustrate that this diagnosis should always be borne in mind if definite evidence for a viral infection causing the encephalopathy is not obtained, especially if the PCR test is negative for the presence of viral DNA. Case reportsCase 1 A 41-year-old woman presented with tonicclonic seizures, fever, drowsiness and confusion. Magnetic resonance imaging (MRI) showed extensive high signal abnormality in the left temporal lobe and posterior parietal region (figure 1). CSF was normal. A presumptive diagnosis of herpes simplex encephalitis (HSE) was made and she improved after intravenous acyclovir. However, her seizures persisted and 2 years later her MRI scan showed an increase in the size of the temporal lesion (figure 1). Approximately one month later, she was found unconscious at home. A CT scan now showed a large lesion with considerable midline shift. Emergency decompression was unsuccessful and she died without regaining consciousness. The histology of the lesion was glioblastoma multiforme. Case 2A 49-year-old man became acutely confused and then had serial tonic-clonic seizures. On admission he was pyrexial, tachycardic and unconscious. MRI showed extensive high T2 signal change aVecting the right temporal and frontal lobes with some mass eVect (figure 2). CSF examination including PCR for HSV DNA was negative. He was started on acyclovir and gradually improved. He had persistent simple partial seizures and a repeat MRI 3 weeks later showed no change. A stereotactic brain biopsy was carried out and revealed an anaplastic astrocytoma. He was treated with external beam radiotherapy followed by combination chemotherapy. Case 3A 72-year-old woman presented with a 2-week history of episodes of vagueness and confusion. MRI revealed a lesion involving the grey and white matter of the...

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Pulmonary Embolism. II. Diagnosis and Treatment

Cited by 19 publications

References 119 publications

Pulmonary Embolism as Cause of Cardiac Arrest

Pulmonary Embolism as Cause of Cardiac Arrest

Spiral computed tomography of pulmonary embolism

Visceral leishmaniasis masquerading as tuberculosis in a patient with AIDS

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