The development of thrombus on the tricuspid valve is very rare. This report describes a case of acute pulmonary embolism (PE) with a mass on the tricuspid valve in a normal heart, detected by bedside transthoracic echocardiography (TTE). After successful surgical management, the histopathological examination revealed the mass from the tricuspid valve to be mixed thrombus. The early use of bedside TTE can facilitate the prompt diagnosis and aggressive therapy when PE is suspected.
Female ; Humans ; Middle Aged ; Pulmonary Embolism ; diagnosis ; Thrombosis ; diagnosis ; Tricuspid Valve ; pathology

Optical coherence tomography (OCT) is a new imaging technique capable of obtaining high-resolution intravascular images and has been used in interventional cardiology. However, an application of OCT in pulmonary arteries had seldom been documented. In this case, OCT imaging is performed in peripheral pulmonary arteries and shows mural red thrombi. Subsequently, the red thrombi are aspirated and confirmed by a histological examination. These findings suggest that OCT may be a useful tool to depict peripheral pulmonary artery thrombi.
Adult ; Angiography ; Humans ; Male ; Pulmonary Artery/*pathology/radiography ; Pulmonary Embolism/*diagnosis ; Tomography, Optical Coherence/*methods ; Tomography, X-Ray Computed

PURPOSE: To evaluate the low attenuation of mosaic pattern in pulmonary embolism, as observed on HRCT, and to correlate the findings with the pathologic features of resected lung. MATERIALS AND METHODS: Using permanent embolic materials, pulmonary embolism was induced in eight Yorkshire pigs. Pre-and post-embolic pulmonary angiography was performed and after 6 weeks, the incidence and pattern of parenchymal change in low attenuation (mosaic pattern), as seen on HRCT, was evaluated. The animals were then sacrified and contact radiography of the lung was performed. Thirty-eight segments of pathology were taken from the area in which the presence of embolism had been suggested. Pathologic and HRCT findings were then correlated. RESULTS: On HRCT, low attenuation was seen in 23 of 36 segments (64%) and showed variable patterns : crescent peripheral hyperlucency (61%, n=14), heterogeneous mottled hyperlucency (17%, n=4), lobular hyperlucency (13%, n=3), and homogeneous segmental hyperlucency (9%, n=2). Parenchymal low attenuation was seen on HRCT in 10 of 11 segments (91%) in which large segmental arterial occlusion occurred, and in 3 of 16 segments (19%) in which there was small segmental arterial occlusion. Abnormal pathologic findings were pulmonary congestion, dilatation of pulmonary arteries, interlobular septal thickening, and thrombus formation. Among the 38 pathologic segmental specimens, 29 were from the area in which HRCT findings were positive, and in which pulmonary embolism subsequently occurred. In only four of nine segments (44%) in the area in which HRCT fingings were negative was pulmonary embolism subsequently. CONCLUSION: HRCT findings of pulmonary embolism at six weeks after embolization showed variable patterns of low attenuation, diminished diameter of pulmonary arteries, and normal diameter of bronchi. In cases with large segmental arterial occlusion, the finding of low attenuation was more common ; this may be due to reduced blood flow to the embolic area, in combination with bronchiolar spasm. For the early diagnosis of pulmonary embolism, these findings may be useful.
Angiography ; Animals ; Bronchi ; Dilatation ; Early Diagnosis ; Embolism ; Estrogens, Conjugated (USP) ; Incidence ; Lung ; Pathology ; Pulmonary Artery ; Pulmonary Embolism* ; Radiography ; Spasm ; Swine ; Thrombosis

Pulmonary embolism (PE) is a common disease with a high mortality rate due to right ventricular dysfunction and underfilling of the left ventricle. We present a case of a 33-year-old man with hemodynamically compromised massive PE. His left atrium was collapsed with marked dilatation of the right atrium and ventricle on multi-detector-row CT scans. The patient was treated with an intracatheter injection of a mutant tissue-type plasminogen activator and subsequently showed clinical and radiological improvements. The small left atrial size in combination with a right ventricular pressure overload was considered to be an adjunctive sign of hemodynamically compromised massive PE.
Tomography, X-Ray Computed ; Pulmonary Embolism/diagnosis/*pathology ; Male ; Humans ; Heart Atria/*pathology ; Echocardiography ; Dilatation, Pathologic ; Adult

Inflammatory bowel disease often involves extra-intestinal organs. Cerebral thrombosis, portal vein thrombosis and pulmonary thrombosis have been reported. Deep vein thrombosis and pulmonary thromboembolism are significant causes of mortality in patients with inflammatory bowel disease. A 48-year-old woman was diagnosed as inflammatory bowel disease on colonoscopy and histology. We used hydrocortisone and mesalazine for the treatment of disease. Nineteen days later, she complained of abrupt dyspnea. Pulmonary CT angiography revealed a thromboembolism in right pulmonary arteries. After the treatment of heparin therapy, follow-up pulmonary CT angiography showed significant improvement of previously thrombosed pulmonary arteries.
Acute Disease ; Colitis, Ulcerative/complications/*diagnosis ; Colonoscopy ; Female ; Humans ; Middle Aged ; Pulmonary Embolism/*diagnosis/etiology/pathology ; Tomography, X-Ray Computed

Actins ; metabolism ; Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Kidney Neoplasms ; pathology ; Middle Aged ; Pulmonary Artery ; Pulmonary Embolism ; pathology ; Radiography ; Sarcoma ; diagnostic imaging ; metabolism ; pathology ; surgery ; Vascular Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Vimentin ; metabolism

To report a non-fatal case of reperfusion pulmonary edema (RPE) after the removal of a hepatocellular carcinoma embolus, which had caused an acute obstruction of the tricuspid valve and pulmonary vasculature during a hepatic lobectomy. Pulmonary embolism caused by hepatocellular carcinoma embolus is extremely rare, and, in the present case, it was associated with unusual clinical features. A 69-year-old ASA II woman with hepatocellular carcinoma was presented for an elective left hepatic lobectomy. During the surgery, the tumor embolus was dislodged from the interior of the lumen of the inferior vena cava (IVC), which then drifted into the tricuspid valve area and pulmonary vasculature. The patient showed the specific signs of acute pulmonary embolism, such as a reduction in end-tidal carbon dioxide, an increase in central venous pressure, and a decrease in arterial pressure. The patient exhibited the symptoms for about 10 minutes. After this period, however, cardiovascular variables became relatively stable, even during a mechanical obstruction due to cross-clamping the pulmonary artery for embolectomy. After several hours of pulmonary embolectomy, the patient experienced an episode of RPE. The ventilatory supports for the treatment of RPE were successful, and the patient recovered without any complications. The patient's case in the present study demonstrates that pulmonary embolism may occur as a result of a hepatocellular carcinoma extending into the IVC during operative management. The anesthesiologist should be careful of the possibilities of RPE after removal of the tumor embolus.
Vena Cava, Inferior ; Tomography, X-Ray Computed ; Time Factors ; Reperfusion ; Radiography, Thoracic ; Pulmonary Embolism/diagnosis/radiography ; Pulmonary Edema ; Liver Neoplasms/*pathology ; Liver/pathology ; Humans ; Female ; Edema ; Cardiovascular System ; Carcinoma, Hepatocellular/*pathology ; Aged

OBJECTIVETo identify the risk factors associated with the severity of pulmonary embolism among patients with deep venous thrombosis of lower extremities.

METHODSThis prospective study enrolled 208 patients with acute deep venous thrombosis to screen for pulmonary embolism between July 2010 and July 2012 in Beijing Shijitan Hospital. There were 101 male and 107 female patients, with a mean age of (59 ± 16) years. Gender, age, extension, side of lower extremities of deep venous thrombosis was analyzed by χ² test. Ordinal Logistic regression was used to determine risk factors associated with severity of pulmonary embolism.

RESULTSThere were 83 patients with iliofemoral deep venous thrombosis, 102 patients with femoropopliteal and 23 patients with calf deep venous thrombosis. Pulmonary embolism was detected in 70 patients with the incidence of 33.7%. Pulmonary embolism was significantly correlated with extension (χ² = 17.286, P = 0.004) and sides (χ² = 15.602, P = 0.008) of deep venous thrombosis, not with age (χ² = 7.099, P = 0.260), gender (χ² = 7.014, P = 0.067), thrombotic risk factors (χ² = 3.335, P = 0.345) in univariate analysis. Results of multivariate ordinal logistic regression showed that iliofemoral vein thrombosis (OR = 6.172, 95% CI: 1.590 to 23.975, P = 0.009) and bilateral venous thrombosis (OR = 7.140, 95% CI: 2.406 to 24.730, P = 0.001) are associated with more serious pulmonary embolism.

CONCLUSIONSIncidence of pulmonary embolism is still high in patients with deep venous thrombosis. Extensive iliofemoral and bilateral vein thrombosis may increase risk of severity of pulmonary embolism. Clinicians should pay more attention to these high-risk patients.

Acute Disease ; Adult ; Aged ; Female ; Humans ; Incidence ; Logistic Models ; Lower Extremity ; pathology ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Embolism ; diagnosis ; pathology ; Risk Factors ; Veins ; pathology ; Venous Thrombosis ; diagnosis ; pathology

The authors analyzed 175 cases of spinal cord tumor who had been operated upon at the Department of Neurosurgery of the Seoul National University Hospital from 1973 to 1986. The tumor was most common in the 5th decade of age(47 cases, 26.9%) and 24 cases(13.7%) were children. And the ratio of male to female was 1.2:1. The pathologic diagnosis was neurogenic tumor in 73 cases(41.7%), metastatic tumor in 29 cases(16.6%), glial tumor in 24 cases(13.7%), and meningeal tumor in 23 cases(13.1%) in the order of frequency, and the tumors of dysembryogenesis were only 2 cases(1.1%). The tumors were located most frequently in the thoracic area(79 cases, 45.1%) and I the intradural extramedullary space(79 cases, 45.1%). The most common initial presentation was pain(86 cases, 49.1%) and the mean duration of presentation was 20.6 months. On admission 70 cases(40.0%) were in the 'paraparesis stage'. The mean value of the CSF protein was 741mg%. The rate of positivity of the plain spinal radiologic study was 55.7% and the most common positive findings was the increased interpedicular distance(46 cases, 29.1%). the total or gross total removal was possible in 105 cases (60.0%). The surgical result within the postoperative one month was recovery in 52 cases(29.7%), improvement in 76 cases(43.4%), stationary state in 36 cases (20.6%), progression in 11 cases(6.3%). After 20.1 months of the mean follow-up duration in 109 cases(62.3%), the result was recovery in 69 cases(63.3%), improvement in 16 cases(14.7%), stationary state in 8 cases(7.3%), progression in 16 cases(14.7%). As a major complication, there was a spinal deformity in 6 cases(3.4%), pulmonary embolism in 2 cases(1.1%), postoperative hematoma and meningitis in 1 case(0.6%) each. Ten cases(5.7%) were followed up to their deaths. And the authors discussed the clinical features of the spinal cord tumors reported in the literatures and the results of the present study with a more detailed consideration on each of major pathologies, neurogenic tumors, meningeal tumors, glial tumors, and metastatic tumors.
Child ; Congenital Abnormalities ; Diagnosis ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Male ; Meningeal Neoplasms ; Meningitis ; Neurosurgery ; Pathology ; Pulmonary Embolism ; Seoul ; Spinal Cord Neoplasms* ; Spinal Cord*

Alveolar soft part sarcoma (ASPS) is a rare malignant soft-tissue neoplasm of unknown histogenesis. The two main sites of occurrence are the lower extremities in adults and the head and neck in children. We report the first case of pleural ASPS occurring in a 58-yr-old man who presented with progressive dyspnea. A computed tomographic scan of the thorax revealed a large enhancing pleural mass with pleural effusion in the left hemithorax. Wide excision of the pleural mass was performed. Histologically, the tumor consisted of organoid nests of large polygonal cells, the cytoplasm of which had eosinophilic and D-PAS positive granules. Immunohistochemical staining showed that the tumor cell nuclei were positive for transcription factor 3 (TFE3). The pleural ASPS with multiple bone metastases recurred 1 yr after surgery and the patient died of acute pulmonary embolism 1.5 yr after diagnosis.
Bone Neoplasms/diagnosis/secondary ; Dyspnea/etiology ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Pleura/physiopathology ; Positron-Emission Tomography and Computed Tomography ; Pulmonary Embolism/diagnosis ; Sarcoma, Alveolar Soft Part/*diagnosis/pathology/radiography ; Soft Tissue Neoplasms/*diagnosis/pathology/radiography ; Transcription Factor 3/metabolism