Use of computed tomography – Digital subtraction angiography in differentiating pulmonary thrombosis and pulmonary artery dissection in a large pulmonary artery aneurysm

Publication date: Available online 28 March 2016 Source:Respiratory Medicine Case Reports Author(s): Hashrul Rashid, Andy K. Lim, Kenneth K. Lau 70 year-old female with chronic obstructive pulmonary disease (COPD) presented with typical symptoms of an exacerbation of COPD. Management of COPD resolved her wheezing, but ongoing hypoxia and retrospective history of atypical chest pain prompted exclusion of a pulmonary embolus. A CT Pulmonary Angiogram (CTPA) with standard 64-slice CT revealed an extensive non-occlusive defect in a grossly dilated right pulmonary artery. Presence of circumferential cuff of soft tissue within sub-segmental pulmonary artery branch raised the possibility of pulmonary artery dissection (PAD). Exclusion of PAD was important as it precluded full anticoagulation. A dynamic CT-digital subtraction angiography (CT-DSA) with the 320-slice multidetector CT (Aquillon-one Vision, Toshiba) did not reveal any intimal flap or contrast extension into the pulmonary arterial wall, suggesting it is unlikely to be PAD. The patient was started on full anticoagulation and reported improvement of symptoms with reduction in pulmonary thrombus burden on repeat CTPA at 4 weeks. To our knowledge, this is the first reported use of dynamic CT-DSA in ruling out PAD.
Source: Respiratory Medicine Case Reports - Category: Respiratory Medicine Source Type: research

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Source: Expert Review of Hematology - Category: Hematology Tags: Expert Rev Hematol Source Type: research
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Source: Specified Life - Category: Information Technology Tags: index jules berman jules j berman precision medicine Source Type: blogs
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A man in his 60s presented with dull, right-sided shoulder pain of 12 hours ’ duration relieved by nitroglycerin. He reported escalating exertional chest discomfort with dyspnea over the preceding weeks. Medical history included a provoked deep vein thrombosis and chronic obstructive pulmonary disease. He took no new medications or supplements, and had not travelled signi ficantly. Examination revealed an S4 heart sound at the apex and bilateral lower extremity edema. His high-sensitivity troponin-T level was 1365 ng/L at presentation and 1310 ng/L at 6 hours (normal range, 0-14 ng/L). Laboratory investigations were ...
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research
Publication date: 2016 Source:Respiratory Medicine Case Reports, Volume 18 Author(s): Hashrul N.Z. Rashid, Andy K. Lim, Kenneth K. Lau 70 year-old female with chronic obstructive pulmonary disease (COPD) presented with typical symptoms of an exacerbation of COPD. Management of COPD resolved her wheezing, but ongoing hypoxia and retrospective history of atypical chest pain prompted exclusion of a pulmonary embolus. A CT Pulmonary Angiogram (CTPA) with standard 64-slice CT revealed an extensive non-occlusive defect in a grossly dilated right pulmonary artery. Presence of circumferential cuff of soft tissue within sub-se...
Source: Respiratory Medicine Case Reports - Category: Respiratory Medicine Source Type: research
Abstract D-dimer levels are increased in patients with acute pulmonary embolism (PE). However, D-dimer levels are also increased in patients with community-acquired pneumonia (CAP). The aim of this prospective cohort study was to examine the incidence and clinical features of patients preliminarily diagnosed with CAP and with increased D-dimer levels, and who finally were diagnosed with PE. Patients diagnosed with CAP and hospitalized in the Respiratory Department of the Tenth People’s Hospital Affiliated to Tongji University between May 2011 and May 2013 were enrolled. D-dimer levels were measured routinel...
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Source: Policy and Medicine - Category: American Health Authors: Source Type: blogs
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