Electrical impedance tomography (EIT) is a new non-invasive functional imaging technology, which has the advantages of non-invasion, non-radiation, low cost, fast response, portability and visualization. In recent years, more and more studies have shown that EIT has great potential in the detection of lung diseases and has been applied to early diagnosis and treatment of some diseases. This paper introduced the basic principle of EIT, discussed the research and clinical application of EIT in the detection of acute respiratory distress syndrome, chronic obstructive pulmonary disease, pneumothorax and pulmonary embolism, and focused on the summary and introduction of indicators and functional images of EIT related to the detection of lung diseases. This review will help medical workers understand and use EIT, and promote the further development of EIT in lung diseases as well as other fields.
Humans ; Electric Impedance ; Tomography/methods* ; Lung Diseases/diagnosis* ; Pulmonary Disease, Chronic Obstructive/diagnosis* ; Pulmonary Embolism/diagnosis* ; Respiratory Distress Syndrome/diagnosis*

Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) associated vasculitis is an autoimmune disease usually with severe multiple dysfunction syndrome, especially prominent acute renal failure. A 65-year-old woman was admitted with progressive dyspnoea for six months and fever, sputum with blood, pain of the lower extremities and intermittent claudication for two days, indicating multiple organ involvement (respiratory system, blood vessels). The renal involvement was relatively mild, presenting with microscopic haematuria. The chest computed tomography demonstrated multiple pulmonary embolisms. Ultrasound and computed tomography angiography for the lower extremity vessels showed venous and arterial thrombosis. Exclusion of other diseases that can cause multiple organ damage and thrombosis, the positive perinuclear ANCA and MPO-ANCA strongly support the diagnosis of MPO-ANAC-associated vasculitis. The patient's physical condition has been greatly improved by treatment with corticosteroids and anticoagulation.
Aged ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis* ; Female ; Humans ; Lower Extremity/diagnostic imaging* ; Peroxidase ; Pulmonary Embolism/diagnostic imaging* ; Thrombosis

Anticoagulants ; Humans ; Pulmonary Embolism/diagnosis* ; Recurrence ; Risk Factors ; Venous Thromboembolism

No abstract available.
Diagnosis ; Ductus Arteriosus, Patent ; Endarteritis ; Pulmonary Embolism

OBJECTIVE: To evaluate the radiation dose for pregnant women and fetuses undergoing commonly used computed tomography of the pulmonary arteries (CTPA) scan protocols and subsequently evaluate the simulated effect of an optimized scan length. MATERIALS AND METHODS: A total of 120 CTPA datasets were acquired using four distinctive scan protocols, with 30 patients per protocol. These datasets were mapped to Cristy phantoms in order to simulate pregnancy and to assess the effect of an effective radiation dose (in mSv) in the first, second, or third trimester of pregnancy, including a simulation of fetal dose in second and third trimesters. The investigated scan protocols involved a 64-slice helical scan at 120 kVp, a high-pitch dual source acquisition at 100 kVp, a dual-energy acquisition at 80/140 kVp, and an automated-kV-selection, high pitch helical scan at a reference kV of 100 kVref. The effective dose for women and fetuses was simulated before and after scan length adaptation. The original images were interpreted before and after scan length adaptations to evaluate potentially missed diagnoses. RESULTS: Large inter-scanner and inter-protocol variations were found; application of the latest technology decreased the dose for non-pregnant women by 69% (7.0–2.2 mSv). Individual scan length optimization proved safe and effective, decreasing the fetal dose by 76–83%. Nineteen (16%) cases of pulmonary embolism were diagnosed and, after scan length optimization, none were missed. CONCLUSION: Careful CTPA scan protocol selection and additional optimization of scan length may result in significant radiation dose reduction for a pregnant patient and her fetus, whilst maintaining diagnostic confidence.
Angiography ; Dataset ; Diagnosis ; Female ; Fetus ; Humans ; Pregnancy Trimester, Third ; Pregnancy ; Pregnant Women ; Pulmonary Artery ; Pulmonary Embolism

OBJECTIVE: To evaluate the value of conventional and age-adjusted D-dimer cut-off value combined with 2-level Wells score for diagnosis of suspected pulmonary embolism. METHODS: In the study, 335 patients with suspected pulmonary embolism who visited Peking University People's Hospital were enrolled retrospectively, then 274 patients with age over fifty years were chosen. The 2-level Wells score was applied to evaluate the clinical probability of pulmonary embolism, the diagnostic value of traditional D-dimer cut-off value (500 μg/L) and age adjusted D-dimer cut-off value (age×10 μg/L above 50 years) combined with Wells score no greater than 4 were compared. Computed tomography pulmonary arteriography (CTPA) was considered as the gold standard for diagnosis of pulmonary embolism. RESULTS: (1) The area under a receiver operating characteristic (ROC) curve (AUC) in analysis of the combination of Wells score no greater than 4 and traditional D-dimer cut-off value was 0.764 (95%CI: 0.703-0.818). On the other hand, the AUC in a ROC analysis of the combination of Wells Score no greater than 4 and age-adjusted D-dimer cut-off value was 0.814 (95%CI:0.756-0.863). These two results did not differ statistically (Z=0.05, P=0.121). (2) The sensitivity, specificity, positive predictive value, negative predictive value and Youden index of the diagnosis of pulmonary embolism of the combination of traditional D-dimer cut-off value and 2-level Wells Score were 100%, 48.9%, 28.8%, 100%, and 0.49, respectively. Meanwhile, the sensitivity, specificity, positive predictive value, negative predictive value and Youden index of the diagnosis of pulmonary embolism of the combination of age-adjusted D-dimer cut-off value and 2-level Wells Score were 97.4%, 62.3%, 35.5%, 99.1%, and 0.60, respectively. Compared with using traditional D-dimer cut-off value, using age-adjusted D-dimer cut-off value could improve the diagnosis specificity (traditional D-dimer cut-off value group: 48.9%, age-adjusted D-dimer cut-off value group: 62.3%) of pulmonary embolism without reducing the sensitivity (traditional D-dimer cut-off value group: 100%, age-adjusted D-dimer cut-off value group: 99.1%). (3) Among the 222 patients with Wells Score no greater than 4, 90 patients were with D-dimer less than traditional cut-off value (500 μg/L), and 25 patients (account for 11.3% of all 222 patients) were with D-dimer between traditional cut-off value and age-adjusted cut-off value. CONCLUSION The application of age-adjusted D-dimer cut-off value can improve the diagnostic specificity of pulmonary embolism in patients over 50 years, without reducing the sensitivity. It can be used for ruling out suspected pulmonary embolism safely.
Fibrin Fibrinogen Degradation Products/analysis* ; Humans ; Predictive Value of Tests ; Pulmonary Embolism/diagnosis* ; Retrospective Studies ; Sensitivity and Specificity

“Thrombus-in-transit” in pulmonary embolism is associated with high mortality and refers to a free-floating clot in the right atrium or right ventricle, indicating that deep vein thrombosis is present en route to the pulmonary artery. Thrombus entrapped in a patent foramen ovale (PFO) is a rare condition and is associated with paradoxical systemic embolism. Here, we report a case of acute pulmonary embolism with thrombus-in-transit through a PFO in a 68-year-old woman with a diagnosis of metastatic pancreatic cancer undergoing palliative chemotherapy. She presented with syncope after acute onset of exertional dyspnea and was diagnosed with cardiogenic shock due to massive pulmonary embolism with thrombus-in-transit on admission to the emergency room. We treated her with systemic thrombolysis and anticoagulation therapy instead of surgical thrombectomy. We show that hemodynamically unstable pulmonary embolism with thrombus-in-transit entrapped by a PFO may be successfully treated with systemic thrombolysis without paradoxical embolism.
Aged ; Diagnosis ; Drug Therapy ; Dyspnea ; Embolism ; Embolism, Paradoxical ; Emergency Service, Hospital ; Female ; Foramen Ovale ; Foramen Ovale, Patent ; Heart Atria ; Heart Ventricles ; Humans ; Mortality ; Pancreatic Neoplasms ; Pulmonary Artery ; Pulmonary Embolism ; Shock, Cardiogenic ; Syncope ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis ; Venous Thrombosis

Mesenteric venous thrombosis has a low prevalence and nonspecific clinical symptoms, and it may cause bowel infarction and death. Early diagnosis and prompt surgical intervention with anticoagulants are important to patients. We examined a 27-year-old woman complaining of diffuse abdominal pain and hematochezia, and diagnosed extensive mesenteric venous thrombosis with intestinal infarction and pulmonary thromboembolism. In light of the patient's symptoms, an operation seemed necessary. However, because of the high risk of mortality, we decided to look for another option. The patient was successfully treated with intensive medical care and a radiological procedure in spite of intestinal infarction.
Abdominal Pain ; Adult ; Anticoagulants ; Early Diagnosis ; Female ; Gastrointestinal Hemorrhage ; Humans ; Infarction ; Mesenteric Ischemia ; Mesenteric Vascular Occlusion ; Mortality ; Prevalence ; Pulmonary Embolism ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator

BACKGROUND: To summarize the clinical features of patients with pulmonary embolism after lobectomy and to explore the methods of diagnosis and treatment of pulmonary embolism after lobectomy. METHODS: The clinical data of 6 patients with pulmonary embolism after lobectomy between July 2007 and July 2017 were retrospectively analyzed. RESULTS: Of the 6 patients, 3 died within 24 h of onset and 3 patients were cured and discharged. CONCLUSIONS Pulmonary embolism after lobectomy is a rare postoperative complication in thoracic surgery. It is difficult to diagnose and has a high mortality rate. Preoperative thromboembolic risk assessment and postoperative prevention are important.
Aged ; Female ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Pneumonectomy ; adverse effects ; Postoperative Complications ; diagnosis ; etiology ; therapy ; Pulmonary Embolism ; diagnosis ; etiology ; therapy ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; adverse effects

BACKGROUND: Pulmonary embolism (PE) is one of the most severe complications after thoracic surgeries. Thus it is of great importance to learn the characteristics of acute PE after thoracic surgeries. This study summarized the clinical characteristics and experience on the diagnosis and treatment of 37 patients with postoperative acute pulmonary embolism, in order to improve its prophylaxis and management level. METHODS: We retrospectively reviewed 37 patients with postoperative acute pulmonary embolism following thoracic surgeries. Age, gender, body mass index (BMI), diagnosis, surgical procedure, onset time, clinical presentation, diagnosis and management were comprehensively analyzed. RESULTS: There were 16 males (43.2%) and 21 females (56.8%). The average age was (65.64±6.29) years (range from 53 years to 82 years) and 32 patients were over 60 years. BMI ranged from 17.1 kg/m² to 30.8 kg/m² with median of 26.3 kg/m². And 27 patients' BMI (73.0%) were over 25.0 kg/m². Thirty-four patients (91.9%) were with malignancies. Median presentation time was the 4th day postoperatively, while 11 patients were presented on the 3rd day postoperatively which accounted for the most. Patients with acute pulmonary embolism accounted for 77.8% from 9 am to 9 pm. D-dimer (D-D) ranged from 1.0 μg/mL-20.0 μg/mL (FEU) with median of (7.09±4.45) μg/mL (FEU) and 32 (86.5%) patients' D-D were over 3.00 μg/mL (FEU). CONCLUSIONS The survival rate of postoperative acute pulmonary embolism can be increased by fully understanding its clinical characteristics, early diagnosis and multiple disciplinary treatment.
Acute Disease ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Postoperative Complications ; diagnosis ; etiology ; therapy ; Pulmonary Embolism ; diagnosis ; etiology ; therapy ; Retrospective Studies ; Survival Rate ; Thoracic Surgical Procedures ; adverse effects