Search Results (308)

Background: Following acute pulmonary embolism (PE), disease outcomes vary among patients. Complete recovery occurs in some cases, while others may experience persistent long-term symptoms, disease recurrence, or progression to chronic thromboembolic pulmonary hypertension (CTEPH). The exact reasons behind incomplete recovery and different outcomes are still not well established. This review aims to present the existing data regarding the clinical significance of residual thrombi after acute PE, particularly in the context of disease recurrence, the development of CTEPH, or persistent symptoms and functional limitations. Methods: Original articles, systematic reviews, and meta-analyses relevant to the topic are reviewed. Results: Incomplete thrombus resolution after acute PE is quite common, with studies showing that it affects one-fourth to one-third of PE patients, despite receiving optimal anticoagulant treatment. It has been shown that residual thrombi after acute PE play a role in the risk of PE recurrence. However, there is still no standardized method to differentiate disease recurrence from residual thrombi in pulmonary imaging studies, particularly in cases where no follow-up scans and different imaging techniques are used for thrombi detection. Residual vascular obstruction is necessary for the development of CTEPH. Evidence suggests that the extent of residual thrombi contributes to a higher risk of CTEPH. Still, there is a need to standardize both the timing of residual thrombi assessment and the evaluation of their distribution, in relation to the development of CTEPH. The significance of residual thrombi for persistent symptoms and functional limitation remains debatable. Research indicates that nearly half of patients experience long-term symptoms after acute PE. Still, it is believed that these symptoms are not necessarily caused only by residual thrombi, but rather by the worsening of other comorbid conditions. Conclusions: Studies show that residual thrombi after acute PE are significant for PE outcomes. It may be beneficial to consider evaluating residual pulmonary vascular obstruction when treating patients after acute PE to optimize the duration of anticoagulant therapy and improve patient outcomes. Full article

Coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines have been associated with numerous side effects since their widespread release to the public. Cardiovascular complications include myocarditis and pericarditis, Takotsubo cardiomyopathy, postural orthostatic tachycardia syndrome (POTS), arrhythmias, sudden cardiac death, and cardiac tamponade. Pulmonary complications are pulmonary embolism (PE), interstitial lung disease (ILD), idiopathic pulmonary fibrosis (IPF), pneumonia, eosinophilic granulomatosis with polyangiitis, pneumonitis, and pulmonary hypertension. Despite these complications, the risk–benefit analysis still strongly favors vaccination, as these events occur more frequently with natural infection and confer a significantly worse prognosis. This study outlines the evidence surrounding each attributed effect, the clinical course including diagnosis and management, and the proposed pathophysiology. To our knowledge, this is the most comprehensive review of the cardiopulmonary effects of COVID-19 vaccination to date. Full article

Background: A popliteal vein aneurysm (PVA) is a rare vascular abnormality that can lead to the formation of venous thrombi, resulting in potentially life-threatening pulmonary embolism (PE). Methods: We present the case of a 30-year-old female who presented with recurrent pulmonary embolism complicated by cardiorespiratory arrest. Emergency thrombolysis was initiated, which successfully stabilized the patient. Further diagnostic evaluation, including imaging studies, revealed the presence of a giant popliteal vein aneurysm (60/70 mm) as the underlying cause of recurrent embolism. Results: The patient underwent surgical repair of the popliteal vein aneurysm to prevent further thromboembolic events. The procedure was performed successfully, and the patient recovered favorably. Conclusions: This case underscores the importance of recognizing PVA as a potential cause of recurrent PE, particularly in young patients without typical risk factors. Full article

Background: Popliteal venous aneurysms (PVA) are an uncommon but potentially severe condition due to their association with increased risk of recurrent pulmonary embolisms. Because of their rarity, their aetiology, natural history, and optimal treatment strategies have been poorly defined. The aim of this paper is to report a comprehensive systematic review on the treatment strategies and outcomes in PVA, summarizing current evidence. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science, covering studies published from database inception through February 2025 (protocol registered on PROSPERO CRD420251008927). The primary endpoint was the analysis of outcomes and complications associated with surgical and conservative management. Results: Nine studies, including 173 adult patients with popliteal venous aneurysms, were included. The mean age was 56 years (range 18–86 years, mean aneurysm diameter 25.4 mm). Most of the patients were female (73, 42.2%). Overall, 85 (49.1%) aneurysms were saccular and 74 (42.8%) fusiform, although morphology was not consistently reported across all studies. Intraluminal thrombus was reported in 26 cases (15.0%), and pulmonary embolism upon presentation in 21 (12.1%). Surgical treatment was performed in 119 patients (68.8%), while 54 (31.2%) were managed conservatively. Fifteen patients (13.0%) experienced postoperative complications, including wound infections (4, 3.5%), hematomas (7, 6.0%), and nerve injury (4, 3.5%), but no cases of postoperative pulmonary embolisms were observed. Following surgery, anticoagulation was indicated in most cases for 3–6 months or a long life. During follow-up (mean 35 months, range 1–262), thrombosis of the surgical reconstruction was observed in 1 patient (0.8%). Death occurred in 3 cases (5.5%), all in the non-surgical group: 2 (3.7%) due to malignancy and 1 (1.9%) from myocardial infarction. Conclusions: PVA is a rarely described condition potentially associated with the risk of PE. In their management, surgical strategies in association with oral anticoagulation represent the most commonly described approach, allowing for satisfactory results and a low rate of complications. Full article

Background/Objectives: Deep inferior epigastric perforator (DIEP) flap reconstruction is considered the gold standard for autologous breast reconstruction due to its favorable aesthetic results and low donor site morbidity. Nevertheless, it remains associated with potentially life-threatening complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE). This report aims to describe a complex clinical case in which severe thromboembolic and ischemic complications occurred despite adherence to standard prophylactic protocols. Methods: We present the case of a 65-year-old female with multiple thromboembolic risk factors—including obesity, a history of heavy smoking, hormone therapy, and prior COVID-19 infection—who underwent immediate bilateral breast reconstruction with DIEP flaps following mastectomy. Results: Within the first 24 h postoperatively, the patient developed a massive pulmonary embolism requiring intensive care management. Despite appropriate anticoagulation and supportive measures, she subsequently experienced full-thickness necrosis of the central portion of the abdominal flap. Thrombophilia screening and diagnostic imaging did not reveal peripheral venous thrombosis, raising the hypothesis of a hypercoagulable state potentially related to prior SARS-CoV-2 infection. Conclusions: This case underscores the importance of individualized risk stratification and suggests that current prophylaxis protocols may be insufficient for patients with overlapping thrombotic risk factors. The findings advocate for further investigation into the long-term vascular effects of COVID-19 and support reconsidering extended or intensified prophylaxis in high-risk populations undergoing complex microsurgical procedures. Full article

Pulmonary embolism (PE) remains a major cardiovascular emergency associated with significant morbidity and mortality. Despite advances in risk stratification models, accurately predicting which intermediate-high-risk patients will deteriorate remains challenging. Systemic thrombolysis, while effective in high-risk PE, is not a viable option for a significant proportion of patients due to contraindications, and its efficacy in the intermediate-high-risk group remains inconclusive. Drawing parallels from acute myocardial infarction and stroke, where percutaneous interventions have revolutionized treatment, interventional therapies are emerging as a promising alternative for PE management. However, challenges persist regarding optimal patient selection, procedural timing, and balancing efficacy with safety. The establishment of pulmonary embolism response teams (PERTs) has played a crucial role in streamlining decision-making and facilitating access to advanced therapies. As novel catheter-based techniques continue to evolve, the field of PE management is undergoing a paradigm shift, mirroring the transformation seen in acute coronary and cerebrovascular care, positioning interventional approaches at the forefront of therapy. Full article

Background/Objectives: The incidence, timing, and predictors of hemodynamic and respiratory deterioration in patients with high-risk or intermediate-high-risk pulmonary embolism (PE) undergoing pulmonary mechanical thrombectomy (PMT) remain poorly understood. This hemodynamic and respiratory instability can lead to modifications in the anesthetic management. This study investigates these key factors and quantifies the 30-day mortality following thrombectomy. Methods: A retrospective study was conducted on 98 patients aged ≥18 years who underwent PMT. Patients were categorized based on the occurrence of cardiac arrest (CA). Results: Of the 98 patients, 34 had high-risk PE, 62 intermediate/high-risk, and 2 low risk. There were 27 cases of CA, 17 pre- and 10 intra-PMT. An SBP < 90 mmHg increases the risk of CA by 33 (p < 0.001); men have an 8-fold higher risk than women (p = 0.004); SpO₂ <90% by 6 (p = 0.012); and pre-existing respiratory conditions increase the risk by 4 (p = 0.047)). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were 8206 ± 11660.86 and 2388.50 ± 5683.71 pg/mL (p = 0.035) in patients with and without CA, respectively. During PMT, 14% of patients required increased vasoactive drug use, and 38.77% were intubated, including 12 who required ECMO support. Sedation was administered in 64.3% of patients, while general anesthesia was used in 38.8%, with a preemptive indication in 23.5%. The survival rate of patients without CA before and/or during PMT was 96%. Conclusions: While PMT was successfully performed in all patients, hemodynamic and respiratory instability remained a significant concern. More than 10% of patients experienced severe hemodynamic instability, primarily during thrombus extraction, requiring conversion from sedation to general anesthesia. Male sex, pre-existing respiratory disease, SpO₂ < 90%, and SBP < 90 mmHg were associated with an increased risk of CA. Additionally, elevated NT-proBNP levels were linked to a higher incidence of CA. Full article

Objectives: The pulmonary artery pulsatility index (PAPI) is a novel hemodynamic parameter that reflects right ventricular (RV) function. PAPI was shown to be useful in predicting outcomes following left ventricular assist device (LVAD) implantation, acute RV infarction, and in patients with chronic RV failure. The standard method to estimate PAPI is during right heart catheterization (RHC); however, echocardiography-based PAPI was also shown to be accurate. In the current study, we evaluated the ability of echocardiography-based PAPI to predict outcomes of patients with acute pulmonary embolism (PE). Methods: A total of 177 patients (mean age 67 ± 15, 54.1% male) with acute PE were included in the study. PAPI was calculated based on measurements from standard transthoracic echocardiography. Results: 27% of patients needed oxygen support, 5.6% were on mechanical ventilation, and 7.3% were on inotropic support. The 30-day mortality rate in the whole cohort was 8.3%. Lower PAPI measurements were associated with increased 30-day mortality (p < 0.05), a higher rate of RV failure (p < 0.001), and the need for inotropic support (p < 0.05). There was no association between PAPI and the need for oxygen support (p = 0.59), mechanical ventilation (0.06), or length of stay (LOS) (p = 0.414). PAPI was superior to tricuspid annular plane systolic excursion (TAPSE) in predicting mortality and RV failure. Conclusions: Echocardiography-derived PAPI is feasible and superior over TAPSE in predicting RV failure and mortality among patients with acute PE. Full article

Background: Lymphomas account for approximately 10% of cancers diagnosed during pregnancy, with Hodgkin’s lymphoma being the most common. However, non-Hodgkin lymphomas, including primary mediastinal large B-cell lymphoma (PMBCL), also represent a significant proportion. Both mediastinal lymphomas and pregnancy develop a hypercoagulable state, increasing the risk of venous thromboembolism and massive pulmonary embolism (PE), requiring extracorporeal membrane oxygenation (ECMO). Methods: Clinical data, blood test and imagings have been collected by the medical records of the patient. Results: We present a 25-year-old woman, at 32 weeks of gestation, who presented to the emergency department with progressive dyspnea and asthenia. Echocardiography revealed a hemodynamically significant pericardial effusion and severe right ventricular dysfunction. Given the severity of her condition, she underwent an emergency caesarean section and subsequently a pericardial drainage. A chest computed tomography scan revealed an incidental mediastinal mass along with a massive PE. Despite pericardial drainage, she remained hemodynamically unstable. Since thrombolysis was contraindicated for the recent cesarean section, venoarterial ECMO was initiated. Systemic anticoagulation was guaranteed by heparin, which shifted to argatroban for heparin resistance. The mediastinal mass was also biopsied, and the diagnosis of PMBCL carried out. Cytoreductive chemotherapy was initiated with the COMP-R regimen (i.e., cyclophosphamide, vincristine, methotrexate, prednisone, and rituximab), and the patient progressively improved up to ICU and hospital discharge. Conclusions: This case highlights the challenges in managing a complicated patient requiring early multidisciplinary intervention, which was crucial for stabilizing the patient and optimizing fetal and maternal prognosis. Full article

Pulmonary embolism (PE) remains a critical condition with significant mortality and morbidity, necessitating timely detection and intervention to improve patient outcomes. This review examines the evolving role of artificial intelligence (AI) in PE management. Two primary AI-driven models that are currently being explored are deep convolutional neural networks (DCNNs) for enhanced image-based detection and natural language processing (NLP) for improved risk stratification using electronic health records. A major advancement in this field was the FDA approval of the Aidoc© AI model, which has demonstrated high specificity and negative predictive value in PE diagnosis from imaging scans. Additionally, AI is being explored for optimizing anticoagulation strategies and predicting PE recurrence risk. While further large-scale studies are needed to fully establish AI’s role in clinical practice, its integration holds significant potential to enhance diagnostic accuracy and overall patient management. Full article

Background: Pulmonary embolism (PE) is a major cause of morbidity and mortality accounting for 100,000 deaths per year in the United States and 5–10% of in-hospital deaths. There is sparse comparative data on readmission patterns in patients who undergo early versus late catheter directed thrombolysis (CDT) for acute PE. Research Question: Is the procedure day for acute PE associated with a difference in 30-day readmission rates? Study Design and Method: This study was performed by using the Nationwide Readmissions Database between 2016 and 2019. Patients with acute PE who underwent CDT were identified using codes from the International Classification of Diseases, 10th Edition (ICD 10). Results: The 30-day readmission rates were higher for patients who underwent CDT on Day 2 or afterwards compared to Day 1 and Day 0 (7.1% vs. 5.7% vs. 5.2%). Patients who had CDT on Day 2 or later had a higher rate of 30-day readmission mortality compared to those who had CDT on Day 1 or 0 (0.6% vs. 0.3% vs. 0.2%. The 30-day readmission rates for heart failure were higher among patients who had CDT on Day 2 compared to those who had CDT on Day 0 of admission (2% vs. 1.0% vs. 0.9%). Interpretation: Delayed CDT for acute PE was associated with increased rates of 30-day readmission, readmission mortality, and readmission for heart failure. These findings emphasize the need for earlier CDT for the treatment of acute PE. Full article

Background: As urbanization progresses, the resulting air pollution has become an increasingly severe public health issue, known to exacerbate respiratory and cardiovascular diseases. Recent studies suggest that it may also affect blood coagulation mechanisms. In this study, Mendelian randomization (MR) analysis was used to explore the causal relationship between air pollution and pulmonary embolism (PE). Methods: This study employs MR techniques, using genetic variants associated with air pollution exposure to assess their impact on VTE. Data from large-scale genomic studies, including the UK Biobank and OpenGWAS, were analyzed to explore the relationship between genetic susceptibility to air pollution and the risk of pulmonary embolism. The study also conducted multivariable MR analysis, adjusting for potential confounders such as smoking and BMI. Results: The study finds that long-term exposure to PM2.5 and PM10 significantly increases the risk of pulmonary embolism, with the association for PM2.5 being the most significant. The study also indicates that pollutants like PM2.5–10, NO₂, and NO_x have a smaller but still notable impact on PE risk. Multivariable MR analysis confirmed the robustness of these results, further highlighting the role of air pollution in thrombosis. Conclusions: In conclusion, this study emphasizes the significant causal relationship between air pollution and PE, providing evidence that pollutants like PM2.5, PM10, and NO_x contribute to thrombotic events. Full article

Venous thromboembolism (VTE) is a relatively common condition that is the leading cause of preventable deaths in developed nations. VTE encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE) and affects both hospitalized and non-hospitalized patients. When left untreated, VTE is associated with substantial morbidity and mortality; accurate risk assessment and appropriate prophylaxis programs are therefore vital, as overlooked risk factors of these processes can potentially result in misdiagnosis and inappropriate treatment of the condition, with associated complications. In this study, we aimed to assess the impact of active monitoring on VTE management practices among healthcare providers to improve patient outcomes at Imam Abdulrahman Al Faisal Hospital (IAFH) in Riyadh, Saudi Arabia, from April 2018 to July 2023. In this study, a longitudinal retrospective study design was utilized and data from 33,237 admitted patients were analyzed using a Statistical Process Control (SPC) chart to evaluate the relationship between VTE risk assessment, active monitoring, and patient outcomes. In total, 11 cases of hospital-acquired VTE were identified, with patients aged 18–40 years representing most cases (7 out of 11 cases) and a male predominance of 54.5%. The overall VTE incidence rate during the study period was 0.31%, or one case per 11,000 admissions, including four cases of PE and seven cases of DVT. The results of this study indicate that active monitoring through continuous education and regular patient rounds significantly improves adherence to VTE risk assessment and prophylaxis at IAFH. The researchers attributed the increased identification and timely reporting of VTE cases to vigilance by healthcare providers and not to a decline in the quality of care. A comprehensive multidisciplinary strategy for VTE management and continuous quality improvement can aid in reducing VTE-related morbidity and improve patient outcomes. Lastly, we recommend addressing the risk factors associated with the occurrence of hospital-acquired VTE and performing post-discharge follow-ups of patients. Full article

Background: Pulmonary embolism (PE) remains a major concern in emergency patients presenting with respiratory symptoms, with an increase in the demand for CT pulmonary angiography (CTPA) and low yields of this ever more sensitive test. We wanted to investigate factors associated with pulmonary embolism on CTPA, aiming to reduce unnecessary requests. Methods: In a single-center, retrospective study, we analyzed all CTPA reports for emergency patients during the year 2023. Various patients’ variables were evaluated for associations with the presence/absence of PE, including the presence or absence of pulmonary pathology identified prior to the CTPA order. Results: A total of 1555 CTPA reports were analyzed, of which 278 (17.9%) were positive for PE. The highest ORs (40.9) for PE were found for patients diagnosed with DVT prior to CTPA. The lowest odds ratios of having PE were found for patients with acute congestive heart failure (OR = 0.141), especially in the absence of cancer (OR = 0.089) and for patients with hypercapnia in COPD exacerbation (OR = 0.062). Tachycardia and hypoxemia were the physiological variables positively associated with PE, while hypercapnia was negatively associated with PE. For patients with heart failure, COPD exacerbation, and pneumonia, higher D-dimer cut-off values (3.87 mg/L, 1.25 mg/L, and 1.34 mg/L, respectively) were found to retain 100% sensitivity for PE. Conclusions: Stricter criteria for CTPA orders in the presence of other pulmonary pathologies may reduce unnecessary scanning. Higher D-dimer cut-off values in such cases may lead to higher specificity without sacrificing sensitivity. Full article

Background: Right ventricular thrombosis (RVT) is rarely detected in clinical practice. Depending on its aetiology, RVT may originate from a deep venous thrombosis (type A) or in situ (type B). Type A is characterized by increased mobility and frequent pulmonary embolization, whereas type B is nonmobile and is associated with significant right ventricular (RV) dilatation and dysfunction. Methods: A type B RVT complicated by subsegmental pulmonary embolism (PE) was diagnosed in a 46-year-old man with acute-on-chronic respiratory failure secondary to acute exacerbation of interstitial lung disease. He underwent a multimodality imaging assessment of the RV mass that comprehensively incorporated TTE, TEE, contrast-enhanced chest CT, and LGE-CMR. Results: During the clinical course, a serial echocardiographic assessment of the RV mass allowed for a dynamic evaluation of its features and cardiac haemodynamics. Conventional TTE was implemented with colour tissue Doppler imaging (TDI) and pulsed wave (PW) TDI to improve the visualization of the RV mass and to objectively measure its mobility. The increased RVT mass peak antegrade velocity (>10 cm/s) was predictive of subsequent RVT fragmentation and PE. Conclusions: Colour TDI and PW-TDI may aid in the differential diagnosis of RV masses and may improve the prognostic risk stratification of patients with right-sided intracardiac masses. Full article