TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS最新文献

Right Heart Thrombi Complicating Acute Pulmonary Embolism 右心血栓合并急性肺栓塞

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 2021-05-01 DOI: 10.1164/AJRCCM-CONFERENCE.2021.203.1_MEETINGABSTRACTS.A2994

D. Nelson, L. Leys, S. Donaldson, A. Mehari

引用次数: 0

COVID-19 Associated Acute Respiratory Distress Syndrome, Treated with Tissue Plasminogen Activator, as a Compassionate Salvage Therapy 组织纤溶酶原激活剂治疗COVID-19相关急性呼吸窘迫综合征，作为一种体恤救助疗法

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3509

G. Sidhu, A. Basit, F. Popilevsky

{"title":"COVID-19 Associated Acute Respiratory Distress Syndrome, Treated with Tissue Plasminogen Activator, as a Compassionate Salvage Therapy","authors":"G. Sidhu, A. Basit, F. Popilevsky","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3509","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3509","url":null,"abstract":"Introduction: The association of diffuse pulmonary micro and macro thrombi is well established in acute respiratory distress syndrome (ARDS). Similar pathological findings are observed in COVID-19 related pulmonary injury. Herein, we present a COVID-19 induced respiratory failure case, treated with unconventional tissue plasminogen activator (tPA) infusion therapy, which led to remarkable hypoxemia improvement. Case description: 53-year-old male, a former smoker, presented with fever, cough, and shortness of breath. He tested positive for COVID-19 and was found to have bilateral lower lobe consolidation on Chest CT and elevated inflammatory markers. The patient was started on therapeutic anticoagulation with enoxaparin. The patient was hypoxic, requiring 6 liters oxygen supplementation via nasal cannula initially, but on day 9, he developed worsening hypoxic respiratory failure requiring 100 % High-flow nasal cannula (HFNC) oxygen supplementation without significant change in radiological findings compared to prior imaging. A spike in D dimer levels was appreciated as well, from 2600 to 10,000 ng/mL. The decision was made to administer tPA 25 mg over 2 hours, followed by a 25 mg tPA infusion administered over the next 22 hours. Therapeutic enoxaparin was restarted afterwards. His oxygenation status improved after the bolus dose and required 50 % HFNC. On day 2 of administration, the patient's hypoxemia dramatically improved, and the patient was saturating 96% with 3 liters of oxygen supplementation. Discussion: Our patient developed refractory hypoxemia which couldn't be explained by radiographic findings and combined with a spike in D dimer, suggested a high thrombotic burden in the pulmonary circulation which prompted us to consider low dose tPA as a salvage therapy. Dramatic improvement of hypoxemia post tPA administration confirmed our suspicion. Multiple case series in mechanically ventilated and non-mechanically ventilated patients with COVID-19 associated ARDS, have shown mortality benefit after tPA infusion. However not commonly used in view of the potential adverse effect of life-threatening bleed. Our case highlights the fact that, in spite of absence of randomized evidence, tPA may be used as a compassionate salvage therapy, if no contraindications exist.","PeriodicalId":244282,"journal":{"name":"TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132859751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Non-ST Elevation Myocardial Infarction in the Setting of Coronary Artery Aneurysm with a Subtherapeutic INR 非st段抬高型心肌梗死与亚治疗性INR冠状动脉瘤的关系

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3518

F. Shaikh, D. Kumar, S. Haider, P. Patel

引用次数: 0

Paving the Way to a New Valve 为新阀门铺平道路

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3526

C. Sherrod, C. Duazo

引用次数: 0

Phantom Pulmonary Embolism or True Phenomenon 虚幻性肺栓塞或真实现象

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3498

Q. Zhang, M. Lake, J. Madara, A. Raza, K. Shan, J. Fields

引用次数: 0

Severe Thrombocytopenia Following Initiation of Heparin for Pulmonary Embolism That Was Treated with Folic Acid 叶酸治疗肺栓塞后肝素治疗后严重血小板减少

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3491

O. Ajibola, S. Ramineni, A. Ajibola, R. Mazurkiewicz

引用次数: 0

Post COVID-19 Complication: A Near Miss Case of Pulmonary Embolism COVID-19后并发症:一例险些漏诊的肺栓塞病例

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3508

A. Jamil, A. Syeda, V. Shyam

{"title":"Post COVID-19 Complication: A Near Miss Case of Pulmonary Embolism","authors":"A. Jamil, A. Syeda, V. Shyam","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3508","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3508","url":null,"abstract":"Introduction:It is now well established that COVID-19 infection is associated with hypercoagulability especially in those with severe respiratory disease and higher degree of inflammation. We present an unusual case of pulmonary embolism (PE) with atypical symptoms in a COVID-19 survivor.Case Report:A 47-year-old African-American, non-smoker female with a history of hypertension and morbid obesity presented with sudden onset of dizziness associated with nausea and vomiting. The patient was in her usual state of health prior to the onset of symptoms. She described her dizziness as a sensation of room spinning. Review of systems was otherwise normal. She was in no acute distress, vital signs were within normal limits and oxygen saturation was 98% on room air. Physical examination including the Dix-Hallpike maneuver was unremarkable. Laboratory investigations and EKG were normal. A CT angiography of the head and neck did not reveal any cerebral ischemia, however, it disclosed findings concerning PE. A CT angiography of the chest demonstrated bilateral emboli with filling defects confirming PE. Echocardiogram was normal. The patient did not have any risk factors for PE like recent immobilization, travel, surgery, use of oral contraceptives or hormonal therapy, malignancy and personal or family history of thromboembolic disorders. Of note, six months ago she was tested positive for COVID-19 with mild symptoms which did not require hospitalization. COVID-19 test during this admission was negative, but D-dimer was not obtained. In the absence of any other plausible etiology of dizziness, her symptoms were attributed to atypical presentation of PE. She was treated with heparin and discharged on oral anticoagulation therapy with apixaban for one year. Discussion:Although there are several proposed hypotheses, the exact pathogenesis of hypercoagulability in COVID-19 infection is unclear. Thus far, the reported cases of PE as a complication of COVID-19 infection presented within six weeks of disease onset. Our patient developed bilateral PE six months post infection, which was not severe enough to require hospitalization, in the absence of any other risk factors for PE. More recent studies suggest that patients with a BMI greater than 30 kg per meter square, like our patient, have a greater propensity to develop PE but in the setting of severe disease. Physicians should be cognizant of this clinical entity and have a high index of suspicion for PE in patients with prior COVID-19 infection irrespective of the timeline and disease severity especially in those with atypical presentation like our patient.","PeriodicalId":244282,"journal":{"name":"TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116523518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Reinke's Edema Secondary to Fluid Overload from Acute Right Heart Failure: First Reported Case 急性右心衰继发于液体超载的Reinke水肿:首例报道

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3516

J. Zweig, A. Gohar

引用次数: 0

A Case of Saddle Pulmonary Embolism in the Recovery Phase of COVID-19 Infection COVID-19感染恢复期鞍状肺栓塞1例

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3501

J. C. Valencia-Manrique, K. Ghosh, M.R. Velasquez Espiritu, A. Poor

{"title":"A Case of Saddle Pulmonary Embolism in the Recovery Phase of COVID-19 Infection","authors":"J. C. Valencia-Manrique, K. Ghosh, M.R. Velasquez Espiritu, A. Poor","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3501","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3501","url":null,"abstract":"Introduction: COVID-19 is an infection caused by severe-acute-respiratory syndrome coronavirus-2 (SARS-CoV-2).1 Many recent reports have shown an increased risk of venous thromboembolism (VTE)4-5. Despite therapeutic anticoagulation with elevated D-dimer is widely described7, data on post-discharge prophylactic anticoagulation is limited.Case report: A 52-year-old female presented with 1-day mid-sternal chest pain and difficulty breathing. Her medical history included type-2-Diabetes Mellitus, obesity, and a hospital admission 4 weeks prior for COVID-19. She received Ceftriaxone, Azithromycin, Hydroxychloroquine, and prophylactic anticoagulation. She remained stable, with no fever or oxygen requirements and was discharged home to selfquarantine. She returned to the hospital, describing pain as sharp, constant, mild, radiating to left chest and back, aggravating on lying down and alleviating on leaning forward. Physical exam was normal, with no tachycardia, tachypnea, or hypoxemia. D-dimer was elevated (6834ng/dL), with normal troponin-T and pro Btype natriuretic peptide. In light of the findings, a contrasted Chest-CT was performed, showing a saddle pulmonary embolus (PE) in left pulmonary artery and non-obstructing thrombus in right main pulmonary artery. Electrocardiogram showed sinus rhythm and right-bundle-branch block, but no “S1Q3T3 pattern”.Patient was admitted to ICU and received enoxaparin. COVID-19 was negative. She remained hemodynamically stable. Lower extremities venous duplex scan was negative for DVT, echocardiogram reported normal ventricular function and dilation of inferior vena cava, consistent with elevated right atrial pressure. Patient was discharged on apixaban.Discussion: Several COVID-19 case-studies have highlighted the association with VTE4-5. During SARSCoV-1 epidemic the reported incidence of DVT and PE was 20% and 11% respectively10. The underlying pathophysiology is probably related to excessive inflammatory response “cytokine storm” and microvascular thrombosis. It is known that infections, either viral, bacterial or fungal can activate immune-thrombotic pathways as initial inflammatory response. However, in COVID-19, such response is disproportioned. McGonagle6 described that the tropism for angiotensin-converting enzyme 2 expressed on type-II pneumocytes and the proximity of these cells to vasculature, combined with the aforementioned inflammation may play the main role. Is COVID-19 a risk factor for PE at the recovery phase of the disease? When are the patients at the highest risk for VTE? Should COVID-19 PE be treated as provoked? Can D-dimer be relied upon as indicator for anticoagulation initiation in these settings? and if so, at what levels? Should COVID-19 patients be discharged on prophylactic anticoagulation? As more patients are being treated, COVID-19's role as risk factor for VTE in the recovery is still unclear.","PeriodicalId":244282,"journal":{"name":"TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS","volume":"151 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127517500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Withholding Anticoagulation from Subsegmental Pulmonary Embolism on Emergency Department Discharge: Determining Eligibility and Facilitating Continuity of Care 在急诊科出院的亚节段性肺栓塞中保留抗凝:确定资格并促进护理的连续性

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3500

D. J. Isaacs, M. Balasubramanian, E. Taye, D. Vinson

引用次数: 0