Pulmonary embolism presenting as adult respiratory distress syndrome—support for a hypothesis

Williams, Adrian J.; Yauch, David C.; Finberg, Stephen N.; Santiago, Silverio; Fisher, H. Kenneth

doi:10.1136/pgmj.58.679.290

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…However, in pre-damaged lungs with a probable increase in capillary permeability, the redistributed flow led to manifest edema while the non-perfused lobes suffered much less severe damage, as reported in one case of ARDS and pulmonary embolism [ 19 ]. Marini and colleagues showed a similar increase of edema in ex vivo experiments when blood flow was increased during high tidal volume ventilation [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of regional perfusion block in healthy and injured lungs

Cambiaghi

Vasques

Mörer

et al. 2017

ICMx

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BackgroundSevere hypoperfusion can cause lung damage. We studied the effects of regional perfusion block in normal lungs and in the lungs that had been conditioned by lavage with 500 ml saline and high V T (20 ml kg−1) ventilation.MethodsNineteen pigs (61.2 ± 2.5 kg) were randomized to five groups: controls (n = 3), the right lower lobe block alone (n = 3), lavage and high V T (n = 4), lung lavage, and high V T plus perfusion block of the right (n = 5) or left (n = 4) lower lobe. Gas exchange, respiratory mechanics, and hemodynamics were measured hourly. After an 8-h observation period, CT scans were obtained at 0 and 15 cmH2O airway pressure.ResultsPerfusion block did not damage healthy lungs. In conditioned lungs, the left perfusion block caused more edema in the contralateral lung (777 ± 62 g right lung vs 484 ± 204 g left; p < 0.05) than the right perfusion block did (581 ± 103 g right lung vs 484 ± 204 g left; p n.s.). The gas/tissue ratio, however, was similar (0.5 ± 0.3 and 0.8 ± 0.5; p n.s.). The lobes with perfusion block were not affected (gas/tissue ratio right 1.6 ± 0.9; left 1.7 ± 0.5, respectively). Pulmonary artery pressure, PaO2/FiO2, dead space, and lung mechanics were more markedly affected in animals with left perfusion block, while the gas/tissue ratios were similar in the non-occluded lobes.ConclusionsThe right and left perfusion blocks caused the same “intensity” of edema in conditioned lungs. The total amount of edema in the two lungs differed because of differences in lung size. If capillary permeability is altered, increased blood flow may induce or increase edema.Electronic supplementary materialThe online version of this article (10.1186/s40635-017-0161-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Effects of regional perfusion block in healthy and injured lungs

Cambiaghi

Vasques

Mörer

et al. 2017

ICMx

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“…Bilateral, non-cardiogenic pulmonary oedema has been documented as a manifestation of PE in patients aged 61 [40] and 72, respectively [41]. Unilateral pulmonary oedema was reported in a 54 year old man in whom chest radiography also showed increased lucency in one region of the lung ields (Westermark's sign) and prominence of one of the pulmonary arteries (Palla's sign) [42].…”

Section: Pulmonary Oedema As a Manifestation Of Pulmonary Embolismmentioning

confidence: 99%

“…Atypical features include lobar consolidation mimicking pneumonia [44]. Other atypical features include cavitation [45], pneumothorax [45], hydropneumothorax [46], pyopneumothorax [47], pneumomediastinum [48], and pulmonary oedema [40][41][42].…”

Section: Atypical Radiographic Signs Of Pementioning

confidence: 99%

Atypical manifestations of pulmonary embolism

Jolobe¹

2020

Arch Vas Med

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Pulmonary embolism (PE) is an age-related disorder which is potentially fatal, but frequently misdiagnosed. However, the true prevalence of pulmonary embolism is unknown. Inaccurate estimates of PE prevalence might, in part, be attributable to underrecognition of atypical presentations of this disorder. If true prevalence is unknown, the positive predictive values of both typical and atypical symptoms and signs of PE will be unreliable. The negative predictive value of those parameters will, likewise, be unreliable. The aim of this review is to make clinicians more aware of atypical manifestations of PE, thereby increasing the likelihood of correct diagnosis and, hence, ascertainment of the true prevalence of PE. The range of atypical manifestations was explored by a literature search, using MEDLINE from using the search terms atypical, uncommon, unusual, pulmonary embolism, lung embolism, pulmonary thromboembolism.This search revealed atypical presenting features such as non pleuritic retrosternal pain, abdominal pain, atypical breathing patterns, pulmonary oedema, Dressler's syndrome, atypical radiographic manifestations, atypical electrocardiographic features, manifestations associated with oxygen saturation of 95% or more, coexistence of acute myocardial infarction and pulmonary embolism, coexistence of thoracic aortic dissection and pulmonary embolism, neurological manifestations other than stroke, paradoxical embolism, acute venous thrombosis of atypical location, and pulmonary embolism with normal D-dimer levels.Atypical manifestations of pulmonary embolism https://www.heighpubs.org/hjvsm 009 https://dx.

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“…Although patients with SCI are predisposed to deep vein thrombosis and subsequent pulmonary embolus, a direct etiological relationship between PE and ARDS/ALI is rarely seen. 21,22 Although limited by the administrative nature of the NIS database, an interesting avenue of further study could be to Figure 3 Mortality rates based on characteristic of injury, illustrating that patients with SCI and closed fracture had highest rates of mortality. Fx, fracture.…”

Section: Betweenmentioning

confidence: 99%

Acute respiratory distress syndrome and acute lung injury in patients with vertebral column fracture(s) and spinal cord injury: a nationwide inpatient sample study

et al. 2013

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Study design: Retrospective Nationwide Inpatient Sample (NIS) study. Objectives: To determine national trends in prevalence, risk factors and mortality for vertebral column fracture (VCF) and spinal cord injury (SCI) patients with and without acute respiratory distress syndrome/acute lung injury (ARDS/ALI). Setting: United States of America, 1988 to 2008. Methods: The NIS was utilized to select 284 612 admissions for VCF with and without acute SCI from 1988 to 2008 based on ICD-9-CM. The data were stratified for in-hospital complications of ARDS/ALI. Results: Patients with SCI were more likely to develop ARDS/ALI compared with those without (odds ratio (OR): 4.9, 95% confidence interval (CI) 4.7-5.2, Po0.001). Compared with patients with lumbar fractures, those with cervical, thoracic and sacral fractures were more likely to develop ARDS/ALI (Po0.001). ARDS/ALI was statistically more prevalent (Po0.01) in VCF/SCI patients with epilepsy, sepsis, cardiac arrest, congestive heart failure (CHF), hypertension, chronic obstructive pulmonary disease and metabolic disorders. Patients with female gender, surgery at rural practice setting, and coronary artery disease and diabetes were less likely to develop ARDS/ALI (Po0.001). VCF/SCI patients who developed ARDS/ALI were more likely to die in-hospital than those without ARDS/ALI (OR 6.5, 95% CI 6.0-7.1, Po0.001). Predictors of in-hospital mortality after VCF/SCI include: older age, male sex, epilepsy, sepsis, hypertension, CHF, chronic obstructive pulmonary disease and liver disease. Patients who developed ARDS/ALI stayed a mean of 25 hospital days (30-440 days) while patients without ARDS/ALI stayed a mean of 6 days (7-868 days, Po0.001). Conclusion: Our analysis demonstrates that SCI patients are more at risk for ARDS/ALI, which carries a significantly higher risk of mortality.

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Pulmonary embolism presenting as adult respiratory distress syndrome—support for a hypothesis

Cited by 5 publications

References 10 publications

Effects of regional perfusion block in healthy and injured lungs

Effects of regional perfusion block in healthy and injured lungs

Atypical manifestations of pulmonary embolism

Acute respiratory distress syndrome and acute lung injury in patients with vertebral column fracture(s) and spinal cord injury: a nationwide inpatient sample study

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