The remaining lung infarction is a rare but life-threatening complication after a thoracic operation and trauma. We report a case of this rare complication after the left upper lobectomy due to pulmonary aspergilloma. The infarction of the remaining left lower lobe occurred due to kinking of the pulmonary vessels after the left upper lobectomy and the completion pneumonectomy was performed in the post-operative second day. Therefore, prompt diagnosis and treatment may be necessary to prevent morbidity and mortality associated with pulmonary infarction from torsion of pulmonary artery and vein.
Diagnosis ; Infarction ; Lung ; Mortality ; Pneumonectomy ; Pulmonary Artery ; Pulmonary Infarction* ; Veins

In this report, we describe a case of previous undiagnosed masses of the pulmonary valve mimicking infective endocarditis that were incidentally found during the work-up of a 62-year-old woman, who was presented with abdominal discomfort and dyspepsia. The pathologic findings were characteristics of a papillary fibroelastoma. Although benign, papillary fibroelastomas have the potential to cause lethal embolic events such as stroke, myocardial infarction, and pulmonary embolism are reported in some cases. Tumor identification and surgical excision are important to prevent such complications.
Dyspepsia ; Endocarditis ; Female ; Humans ; Middle Aged ; Myocardial Infarction ; Pulmonary Embolism ; Pulmonary Valve ; Stroke

A retrospective clinical observation was done in 90 cases of acute myocadial infarction admitted to Hanyang University Hospital from July 1972 to Dec. 1980. The following results were obtained. 1) The ratio of male to female was 2.3:1. Most patients(63.2%) were in the age groups between the 6th and 7th decades. 2) The main symptoms of acute myocardial infarction were chest pain(76.6%), dyspnea (64.4%), radiating pain(27.7%), epigastric pain(18.8%) and palpitation(15.5%). The painless infarction accounted for 11.1% of all cases. 3) The most common preceding disease was hypertension(38.5%) and other associated diseases were diabetes mellitus(13.2%), C.V.A.(8.8%), angina pectoris(8.8%), previous myocardial infarction(6.6%) and drug intoxication(3.3%). No preceding diseases were found in 12.0% of cases. 4) The anterior wall infarction was 45.5% of 90 cases, inferior wall infarction 22.2%, antero-inferior wall infarction 11.2%, subendocardial infarction 7.7%, posterolateral infarction 2% on ECG. 5) The mortality rate of patients according to the Killip class was 4.2% in class I, 14.3% in class II, 50% in class III and 76.9% in class IV. Group of high Killip class was associated with high mortality. 6) In long term prognosis according to Norris' coronary prognostic index, the highest value was 11.72 with average value of 7.02+/-2.65 in survival group, whereas in death group, the lowest value was 5.08, the highest 16.88 and average value was 10.4+/-3.86. 7) High risk subgroup who complicated within the first 4 admission days, occupied 21.1% and low risk subgroup without complication occupied 46.7%. After the 5th admission days, 2.2% of high risk subgroup was expired, whereas there was no death cases in low risk subgroup. 8) Average duration of hospitalization was 22.4+/-9.5 days in high risk subgroup and 17.3+/-6.8 days in low risk subgroup. In low risk subgroup, 10 cases were discharged within the 7th day of admission and 30 cases after the 8th day of admission. 9) 89.5% of total death occured within the 4th hospitalized day, and 66.7% of cases under systolic BP of 84mmHg were expired. Definite cardiomegaly on chest X-ray and past history of myocardial infarction were associated with high mortality. Half of cases with pulmonary edema were died.
Cardiomegaly ; Dyspnea ; Electrocardiography ; Female ; Hospitalization ; Humans ; Infarction ; Male ; Mortality ; Myocardial Infarction* ; Prognosis ; Pulmonary Edema ; Retrospective Studies ; Thorax

Primary pulmonary hypertension is a rare and progressive disease with poor prognosis. Despite much previous studies, there is neither clear explanation in the etiology and the pathogenesis nor confirmative treatment modalities. Its main cause of death is due to the right ventricular failure but the left ventricular function is relatively well preserved. The chest pain mimickig the angina pectoris is common and it is mostly due to the right ventricular ischemia or distension of pulmonary artery, but left ventricular ischemia or infarction is very rarely seen. We experienced a case of primary pulmonary hyperetension with left ventricular hypertrophy that complicated to acute myocardial infarction in 14-year-old male.
Adolescent* ; Angina Pectoris ; Cause of Death ; Chest Pain ; Humans ; Hypertension, Pulmonary* ; Hypertrophy, Left Ventricular* ; Infarction ; Ischemia ; Male* ; Myocardial Infarction* ; Prognosis ; Pulmonary Artery ; Ventricular Function, Left

BACKGROUND: Pulmonary thromboembolism(PTE) is a life threatening disease that needs early diagnosis. Spiral CT angiography depict thromboemboli in the central pulmonary vessels with greater than 90% sensitivity and specificity, which approaches the results of pulmonary angiography in the Prospective Investigation of Pulmonary value(clinical utility) of the spiral CT angiography with 2D image (multiplanar reformation) and 3D images(Shaded surface display, Minimal intensity projection) in the pulmonary thromboembolism. METHODS: We retrospectively analysed spiral CT angiography and prlmonary angiography, lung scan and clinical recordings of 20 patients who had PTE diagnosed by spiral CT angiography(n=19 cases) or pulmonary angiography(n=1 case) from September 1997 to August 1998. Among 20 patients who had underwent spiral CT angiography, 14 patients could be performed lung perfusion scan at the same time. We analyzed the vascular and parenchymal change in spiral CT angiogram. RESULTS: Anatomical distribution of PTE was as follows : 1) left lung(n=103) < right lung(n=129), 2) upper and middle(or lingular) lobe(n=101) < lower lobe(n=116), 3) proximal < distal but 5th order in lower lobe was decreased in distribution. Spiral CT angiography could allow accurate demonstration of 19/20 cases(95%) PTE in our study. Spiral CT angiography could demonstrate acute PTE in 16 patients and chronic PTE in 3 patients. Spiral CT angiography could also showed the combined lung parenchymal lesions(Infarction(n=9 cases), atelectasis(n=4 cases), pleural effusion(n=6 cases)). CONCLUSIONS: Spiral CT angiography with 2D image (multiplanar reformation) and 3D images(shaded surface display, minimal intensity projection) is a noninvasive diagnostic tool in the pulmonary thromboembolism. This method had several advantages; 1) It was showed the distribution of pulmonary embolism in total lung field. 2) It had high sensitivity in diagnosis of pulmonary embolism. 3) It discriminated between acute and chronic PTE. 4) It was showed the associated disease such as lung infarction, atelectasis, pleural effusion. 5) It was correlated with scintigraphic findings.
Angiography* ; Diagnosis* ; Early Diagnosis ; Humans ; Infarction ; Lung ; Perfusion ; Pleural Effusion ; Pulmonary Atelectasis ; Pulmonary Embolism* ; Retrospective Studies ; Tomography, Spiral Computed*

Pulmonary thrombo-embolism in operating room is one of the important cause of morbidity and mortality in patients undergoing femur neck fracture surgery. However, the diagnosis of pulmonary thromboembolism may not be easy because sudden shock can have many different causes (e.g. myocardial infarction, hypovolemia, pneumothorax, non-cardiogenic pulmonary edema, pulmonary thrombo- embolism) and specialized diagnostic tools are not readily available in the operating room. Rapid and accurate diagnosis of pulmonary thromboembolism is very important in outcome of patients. We report a case in which pulmonary thromboembolism under spinal anesthesia occured just before the beginning of operation.
Anesthesia, Spinal* ; Diagnosis ; Femoral Neck Fractures ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction ; Operating Rooms ; Pneumothorax ; Pulmonary Edema ; Pulmonary Embolism* ; Shock

PURPOSE: To analyze the cineangiographic appearance and determine the clinical importance of coronary-to-bronchial artery communication. MATERIALS AND METHODS: The coronary cineangiograms of 4,620 patients were reviewed, and 12 cases of coronary-to-bronchial artery communications were observed in 10 patients (M:F=6:4; mean age, 48.4 years). The cineangiographic findings were analyzed and correlated with these of other imaging studies [perfusion scan (n=5), computed tomographic angiography (CTA) (n=4), conventional chest computed tomography (CT) (n=1), and conventional angiography (n=6)]. RESULT: Cineangiography revealed that hypertrophied branches of the coronary artery communicated with bronchial arteries in which adjacent hypervascular staining, was observed, and which were accompanied by pulmonary shunts (n=9). The underlying diseases identified among the ten patients were Takayasu arteritis (n=5), chronic inflammatory pulmonary disease (n=3), pulmonary thromboembolism (n=1), and or newly diagnosed pulmonary tuberculosis (n=1). The lung fields supplied by coronary-to-bronchial communication showed close correlation with the territories of perfusion defects, decreased pulmonary vascularity, or inflammatory lesions revealed by other imaging studies. CONCLUSION: Coronary-to-bronchial artery communication can present as a secondary result of occlusive disease of the pulmonary arteries or chronic pulmonary inflammation, and in patients with hemoptysis involving, for example, incomplete embolization or myocardiac infarction, it may be problematic.
Angiography ; Arteries ; Bronchial Arteries* ; Cineangiography ; Coronary Vessels ; Hemoptysis ; Humans ; Infarction ; Lung ; Lung Diseases ; Perfusion ; Pneumonia ; Pulmonary Artery ; Pulmonary Embolism ; Takayasu Arteritis ; Thorax ; Tuberculosis, Pulmonary

Behcet's disease is a complex multisystem disease that features recurrent aphthous stomatitis, recurrent genital ulcerations, and eye lesions(uveitis or chorioretinitis). Among the systemic manifestat ions, pulmonary involvement is known to be rare and only a few cases have been documented. The most important features of pulmonary lesions in Behcet's disease are recurrent hemoptysis, which is often massive, and fatal pleuritic chest pain and recurrent high fever and fleeting nature of the pulmonary infiltrates. We report a case of Behcet's disease manifestated as high fever and pleural effusions which was complicated by pulmonary infarction ans a result of pulmonary arteritis.
Arteritis ; Chest Pain ; Fever ; Hemoptysis ; Ions ; Pleural Effusion* ; Pulmonary Infarction ; Stomatitis, Aphthous ; Ulcer

Bacterial endocarditis is a disease with protean manifestations whose presentation has recently changed greatly. Right-sided endocarditis associated with congenital heart lesions is now relatively less common. Patients with ventricular septal defect are at risk for right-sided endocarditis, but its incidence is low in children and adolescents. The organism is frequently a staphylococcus and the clinical course is dominated by septic pulmonary infarction and septicemia. We reported two cases of pulmonic vegetation and pulmonary infarction associated VSD with brief review of literature.
Adolescent ; Child ; Endocarditis ; Endocarditis, Bacterial ; Heart ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Pulmonary Infarction* ; Sepsis ; Staphylococcus

Carbon monoxide (CO) is a well-known chemical asphyxiant, which causes tissue hypoxia with prominent neurological and cardiovascular injury. After exposure to CO, several cardiac manifestations have been reported, including arrhythmias, acute myocardial infarction, and pulmonary edema. However, an ST elevation myocardial infarction (STEMI) due to CO poisoning is a very rare presentation, and the treatment for STEMI due to CO poisoning is not well established. Here, we report a rare case of STEMI complicated by increased thrombogenicity secondary to acute CO poisoning and complete revascularization after antithrombotic treatment.
Anoxia ; Arrhythmias, Cardiac ; Carbon ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Myocardial Infarction ; Pulmonary Edema