MyMedR

Fulltext Concomitant fat embolism syndrome and pulmonary embolism in a patient with patent foramen ovale

Dk Yeak R, Liew SK

Acta Orthop Traumatol Turc, 2020 Jul;54(4):465-468.

PMID: 32812879 DOI: 10.5152/j.aott.2020.20035

We present a rare case of a patient with concurrent fat embolism and pulmonary embolism, in a closed femur fracture with patent foramen ovale (PFO). A 24-year-old man was involved in a motor vehicle accident with a closed left midshaft femur fracture. He developed fat embolism syndrome (FES) on day 3 of admission, and plating was performed. The D-dimer concentration was also high, which raised the suspicion of pulmonary artery embolism. Computed tomography pulmonary angiography (CTPA) revealed right inferior lobar pulmonary artery embolism and FES. A transthoracic echocardiogram (TEE) was performed, which showed a PFO. The presence of a PFO in patients with pulmonary embolism increases the risk of systemic embolism. Therefore, we recommend the routine echocardiogram for patients with pulmonary embolism to exclude any cardiac defect in causing right-to-left shunts, which predisposes the patient to paradoxical embolism.

Matched MeSH terms: Embolism, Paradoxical/prevention & control*

Prevalence and risk factors of retinal arteriolar emboli: the Singapore Malay Eye Study

Cheung N, Lim L, Wang JJ, Islam FM, Mitchell P, Saw SM, et al.

Am J Ophthalmol, 2008 Oct;146(4):620-4.

PMID: 18639861 DOI: 10.1016/j.ajo.2008.05.033

To examine the prevalence and risk factors of retinal arteriolar emboli, a risk predictor of stroke, in an Asian population.

Matched MeSH terms: Embolism/ethnology*

Fulltext Haemangioma: Surgery or Embolization?

Ghazali Mat Nor, Nasruddin Jaafar

Ann Dent, 1995;2(1):-.

MyJurnal

The mangement of vascular lesions such as haemangiomas frequently present difficult choices between various treatment modalities. Circumstances may limit the,number of options available for the surgeon. This article describes the circumstances, investigations, difficult choices, and eventual treatment of a case of a mandibular haemangioma. It is concluded that for a medium sized haemangioma such as in this case,in the absence of facilities to embolize it, surgical excision may be safely carned out provided that proper investigations and precautions have been conducted. An angiogram is of utmost important in determining the feeding vessels and is very important before any surgical procedure is attempted.

Matched MeSH terms: Embolism

Life-saving percutaneous intervention in young patient with massive pulmonary embolism

Yaakob ZH, Undok AW, Abidin IZ, Wan Ahmad WA

Ann Saudi Med, 2012 6 19;32(4):433-6.

PMID: 22705620

Massive pulmonary embolism (PE) is not an uncommon condition, and it usually carries a high risk of mortality. It is one of the fatal conditions that commonly affect young patients. A definitive treatment for patients with massive PE is still lacking, and surgical intervention carries a substantial mortality risk. Thus, percutaneous intervention (clot fragmentation and/or aspiration) remains an option in some patients, specifically in those with a risk of bleeding, contraindicating the use of thrombolysis. There have been no randomized trials to validate percutaneous intervention in massive PE. A sufficient level of evidence is still lacking, and its use depends upon the expert committee's opinion and study of previous case reports. We present a 23-year-old man with first onset massive PE secondary to protein C deficiency, who was treated successfully with the combination of systemic thrombolysis and percutaneous interventions.

Matched MeSH terms: Pulmonary Embolism/etiology; Pulmonary Embolism/physiopathology; Pulmonary Embolism/therapy*

Contribution of VKORC1 and CYP2C9 polymorphisms in the interethnic variability of warfarin dose in Malaysian populations

Gan GG, Phipps ME, Lee MM, Lu LS, Subramaniam RY, Bee PC, et al.

Ann Hematol, 2011 Jun;90(6):635-41.

PMID: 21110192 DOI: 10.1007/s00277-010-1119-6

Within the Asian populations, Indian patients had been reported to require higher warfarin dose compared with the Chinese and Malay patients, and this could not entirely be explained by cytochrome P450 (CYP)2C9 gene variants. Genetic variants of vitamin K epoxide oxidase reductase complex subunit 1 (VKORC1) has been well established as one of key determinants in the different responses of warfarin amongst patients. Adult patients who attended an anticoagulation clinic with stable INR were recruited. VKORC1 and CYP2C9 genotype were sequenced, and clinical characteristics were assessed. A total of 91 Malays, 96 Chinese, and 46 Indian patients were recruited. The mean age was 55 years and 51.5% were males. The mean dose of warfarin for all patients was 3.7 mg, and the mean daily dose of warfarin was significantly higher in Indians compared with the Chinese and Malay patients, 4.9 versus 3.5 and 3.3 mg, respectively (p

Matched MeSH terms: Pulmonary Embolism/drug therapy; Pulmonary Embolism/ethnology; Pulmonary Embolism/genetics

Fulltext Pinch-off syndrome from a chemoport catheter successfully managed with endovascular retrieval

Chuah JS, Wong WL, Bakin S, Lim RZM, Lee EP, Tan JH

Ann Med Surg (Lond), 2021 May;65:102294.

PMID: 33948169 DOI: 10.1016/j.amsu.2021.102294

Introduction and importance: A totally implantable venous access device (TIVAD), also referred to as 'chemoport', is frequently used for oncology patients. Chemoport insertion via the subclavian vein access may compress the catheter between the first rib and the clavicle, resulting in pinch-off syndrome (POS). The sequela includes catheter transection and subsequent embolization. It is a rare complication with incidence reported to be 1.1-5.0% and can lead to a devastating outcomes.

Case presentation: 50-year-old male had his chemoport inserted for adjuvant chemotherapy 3 years ago. During the removal, remaining half of the distal catheter was not found. There was no difficulties during the removal. Chest xray revealed that the fractured catheter had embolized to the right ventricle. Further history taking, he did experienced occasional palpitation and chest discomfort for the past six months. Electrocardiogram and cardiac enzymes were normal. Urgent removal of the fractured catheter via the percutaneous endovascular approach, under fluoroscopic guidance by an experience interventional radiologist was done. The procedure was successful without any complication. Patient made an uneventful recovery. He was discharged the following day, and was well during his 3rd month follow up.

Conclusion: Early detection and preventive measures can be done to prevent pinch-off syndrome. Unrecognized POS can result in fatal complications such as cardiac arrhythmia and septic embolization. Retrieval via the percutaneous endovascular approach provide excellent outcome in the case of embolized fractured catheter.

Matched MeSH terms: Embolism

The acute presentation of pulmonary thromboembolism: a retrospective viewpoint

Tan WP, Goh SH, Cham GW, Chng SM

Ann Acad Med Singap, 2002 May;31(3):375-81.

PMID: 12061300

INTRODUCTION: Acute pulmonary thromboembolism (PE) has been considered rare among Asians. We aim to describe the frequency and clinical features of this condition in a hospital in Singapore. Among patients admitted by the Emergency Department (ED), comparisons were made between those primarily diagnosed in the ED and those who were not.

MATERIALS AND METHODS: Retrospective review of all cases of radiologically proven acute PE over a 20-month period.

RESULTS: Sixty-two patients were identified. The mean age was 61.5 +/- 18.0 years with a female to male ratio of 1.8:1. There were more Malays compared to other races. There were also more Caucasians, given the proximity of the hospital to the airport and the inclusion of tourists. The commonest symptoms were dyspnoea and chest pain, while the commonest signs were tachycardia and tachypnoea. Prolonged immobilisation was the commonest risk factor. Electrocardiographic S1Q3T3 pattern was seen in more patients compared to Western studies. Cardiomegaly was the commonest chest X-ray finding. Thirty-two patients were identified to have a source of embolisation. Overall mortality rate was 21%. The ED diagnosed 36% of the cases. Alternative admitting diagnoses were predominantly ischaemic heart disease and pneumonia. The group diagnosed in the ED were notably female (P = 0.044), Caucasian (P = 0.002) and had prolonged immobilisation (P = 0.025) prior to the onset of PE.

CONCLUSION: Acute PE is not as rare here as previously thought. Clinical features reveal more similarities than differences compared to other studies in the literature. We advocate a high index of suspicion for earlier diagnosis in the ED.

Matched MeSH terms: Pulmonary Embolism/diagnosis*; Pulmonary Embolism/etiology; Pulmonary Embolism/epidemiology*

Public Prosecutor v. Dr. Nadason Kanagalingam, 9 June 1984

Malaysia. High Court

Annu Rev Popul Law, 1987;14:39.

PMID: 12346715

The defendant, an obstetrician and gynaecologist, was accused of voluntarily causing a woman to miscarry, such miscarriage having been performed without good faith and an intention to save the woman's life. The Court upheld the conviction of the defendant, rejecting his argument, supported by an expert witness, that he had performed the abortion in order to avoid the possibility of pulmonary embolism, which might result because the woman had enlarged varicose veins. It held that the argument was not reasonable under the current law and that procuring an abortion was a serious matter to be done only as a last resort to save the life of a woman or to save her from becoming a mental "wreck."

Matched MeSH terms: Embolism; Pulmonary Embolism*

Postoperative venous thromboembolism in Asia: a critical appraisal of its incidence

Liew NC, Moissinac K, Gul Y

Asian J Surg, 2003 Jul;26(3):154-8.

PMID: 12925290

Venous thromboembolism (VTE) has historically been perceived to be a rare disorder in Asia. However, new evidence has emerged recently that contradicts this perception. The question of routine VTE prophylaxis has been hotly debated in Asia due to disagreement on its incidence. We reviewed and analysed studies on postoperative VTE in Asian patients to determine if the condition was indeed rare and if the routine prophylactic measures as recommended by internationally accepted guidelines should be adopted in Asia.

Matched MeSH terms: Pulmonary Embolism/diagnosis; Pulmonary Embolism/epidemiology*

A thrombosed saccular posterior cerebral artery aneurysm in an infant

Cheung H, Lee FC

Australas Radiol, 1993 Feb;37(1):90-2.

PMID: 8323524

A case of recurrent hemiplegia due to saccular aneurysm of the left posterior cerebral artery in a female infant is described. The diagnosis was made at angiography, prompted by CT detection of a hyperdense, intra-aneurysmal thrombus, and was confirmed at subsequent surgery.

Matched MeSH terms: Intracranial Embolism and Thrombosis/complications

Cerebral venous thrombosis associated with antithrombin III deficiency

Lee MK, Ng SC

Aust N Z J Med, 1991 Oct;21(5):772-3.

PMID: 1759929

Matched MeSH terms: Intracranial Embolism and Thrombosis/blood*; Intracranial Embolism and Thrombosis/etiology

Cerebral arterial gas embolism in air force ground maintenance crew--a report of two cases

Lee CT

Aviat Space Environ Med, 1999 Jul;70(7):698-700.

PMID: 10417007

Two cases of cerebral arterial gas embolism (CAGE) occurred after a decompression incident involving five maintenance crew during a cabin leakage system test of a Hercules C-130 aircraft. During the incident, the cabin pressure increased to 8 in Hg (203.2 mm Hg, 27 kPa) above atmospheric pressure causing intense pain in the ears of all the crew inside. The system was rapidly depressurized to ground level. After the incident, one of the crew reported chest discomfort and fatigue. The next morning, he developed a sensation of numbness in the left hand, with persistence of the earlier symptoms. A second crewmember, who only experienced earache and heaviness in the head after the incident, developed retrosternal chest discomfort, restlessness, fatigue and numbness in his left hand the next morning. Both were subsequently referred to a recompression facility 4 d after the incident. Examination by the Diving Medical Officer on duty recorded left-sided hemianesthesia and Grade II middle ear barotrauma as the only abnormalities in both cases. Chest X-rays did not reveal any extra-alveolar gas. Diagnoses of Static Neurological Decompression Illness were made and both patients recompressed on a RN 62 table. The first case recovered fully after two treatments, and the second case after one treatment. Magnetic resonance imaging (MRI) of the brain and bubble contrast echocardiography performed on the first case 6 mo after the incident were reported to be normal. The second case was lost to follow-up. Decompression illness (DCI) generally occurs in occupational groups such as compressed air workers, divers, aviators, and astronauts. This is believed to be the first report of DCI occurring among aircraft's ground maintenance crew.

Matched MeSH terms: Intracranial Embolism and Thrombosis/diagnosis; Intracranial Embolism and Thrombosis/etiology*; Intracranial Embolism and Thrombosis/therapy; Embolism, Air/diagnosis; Embolism, Air/etiology*; Embolism, Air/therapy

Fulltext Rare and lethal complication of barium enema intravasation

Loo GH, Marzuki F, Henry F

BJR Case Rep, 2018 Dec;4(4):20180017.

PMID: 30931138 DOI: 10.1259/bjrcr.20180017

Barium enema investigation is regarded as a safe investigative procedure. Rarely, it may cause complications such as colonic perforation and barium intravasation. Barium intravasation may be caused by the inadvertent introduction of the catheter into the vagina, thereby into the vaginal venous plexus. It may also occur through mechanical colonic perforation with the catheter, or via diseased bowel conditions. This may lead to complications such as liver microabscesses, massive pulmonary embolism, hypovolemic shock, disseminated intravascular coagulopathy and even sudden death. With that in mind, we would like to report an interesting case of barium intravasation into the portal venous system via the vagina venous plexus. The patient experienced abdominal discomfort with mild per vaginal bleed and went into disseminated intravascular coagulopathy. She received supportive management and she made a full recovery.

Matched MeSH terms: Pulmonary Embolism

Fulltext Two variants of fat embolism syndrome evolving in a young patient with multiple fractures

Bajuri MY, Johan RR, Shukur H

BMJ Case Rep, 2013;2013.

PMID: 23576653 DOI: 10.1136/bcr-2013-008631

Fat embolism syndrome (FES) is a continuum of fat emboli. Variants of FES: acute fulminant form and classic FES are postulated to represent two different pathomechanisms. Acute fulminant FES occurs during the first 24 h. It is attributed to massive mechanical blockage pulmonary vasculature by the fat emboli. The classic FES typically has a latency period of 24-36 h manifestation of respiratory failure and other signs of fat embolism. Progression of asymptomatic fat embolism with FES frequently represents inadequate treatment of hypovolaemic shock. We present a rare case of two variants of FES evolving in a patient with multiple fractures to emphasis the importance of adequate and appropriate treatment of shock in preventing the development of FES. Since supportive therapy which is a ventilatory support remains as the treatment of FES, it is appropriate to treat FES in the intensive care unit setting.

Matched MeSH terms: Embolism, Fat/etiology*; Embolism, Fat/radiography*; Embolism, Fat/therapy; Pulmonary Embolism/etiology*; Pulmonary Embolism/radiography*; Pulmonary Embolism/therapy

Multiple asymptomatic vascular air embolisms following contrast-enhanced CT scan

Zulkifle AM, Faisal M

BMJ Case Rep, 2019 Aug 28;12(8).

PMID: 31466969 DOI: 10.1136/bcr-2018-229169

Vascular air embolism (VAE) is a known complication of contrast-enhanced CT (CECT) scan occurring in venous or arterial circulation with a wide spectrum of presentations. We report a case of a 44-year-old woman with endometrial adenocarcinoma stage IVB complicated with liver abscess and pulmonary embolism who developed VAE following a routine CECT scan after the sixth cycle of chemotherapy. This was an incidental finding and the patient remained asymptomatic throughout. As such, she was treated conservatively and gradually recovered. This case report serves as a reminder that VAE should be considered in patients presenting with unexplained symptoms following this procedure.

Matched MeSH terms: Embolism, Air/etiology*

Fulltext Imaging features of toxic megacolon

Ong SCL, Mohaidin N

BMJ Case Rep, 2018 Sep 30;2018.

PMID: 30275028 DOI: 10.1136/bcr-2018-227121

Matched MeSH terms: Pulmonary Embolism/etiology*

Fulltext Characteristic imaging findings in pulmonary fat embolism syndrome (FES)

Ong SCL, Balasingam V

BMJ Case Rep, 2017 Nov 23;2017.

PMID: 29170189 DOI: 10.1136/bcr-2017-223007

Matched MeSH terms: Embolism, Fat/therapy; Pulmonary Embolism/therapy

Immediate postpartum cardiorespiratory collapse: a management quandary

Azarisman SM, Liza RA, Radhiana H, Sujana SS, Maskon O, Rosli MA, et al.

Blood Coagul Fibrinolysis, 2010 Sep;21(6):601-4.

PMID: 20581659 DOI: 10.1097/MBC.0b013e32833c2b9f

A 35-year-old multiparous woman was found unresponsive, tachypnoeic, hypoxic and in shock 4 h postpartum. The ECG revealed S1 Q3 T3, a right bundle branch block pattern and right-axis deviation. The computed tomography of her pulmonary arteries revealed bilateral pulmonary artery thrombosis with dilated right ventricle. She was fibrinolyzed with intravenous Tenecteplase 30 mg bolus. Her saturation and tachypnoea improved and her ECG reverted to sinus rhythm subsequently. We discuss our use of off-label Tenecteplase in postpartum pulmonary embolism and review the literature.

Matched MeSH terms: Pulmonary Embolism/drug therapy*; Pulmonary Embolism/physiopathology; Pulmonary Embolism/radiography

Fulltext A Single Centre Annual Audit on Computed Tomography Pulmonary Angiogram: Demographic, Clinical Scoring System, Patients’ Outcome

Low Qin Jian, Teo Kuo Zhau, Mohd Nadzri Misni, Cheo Seng Wee

Borneo Journal of Medical Sciences, 2020;14(2):11-18.

MyJurnal

Computed tomography pulmonary angiogram (CTPA) is widely used in the investigation of suspected pulmonary embolism. CTPA is not without adverse effects as it involves intravenous contrast injection and radiation exposure. The annual incidence of pulmonary embolism is 60 – 70 per 100,000 populations and CTPA remains the commonest imaging modality1. This study aims to audit all CTPA performed at Hospital Sultanah Nora Ismail, Batu Pahat, Johor for the entire year of 2018 to illustrate the demographic data, symptoms, risk factors, clinical scoring system applied and patients’ outcome. A retrospective study was conducted to audit all CTPA performed between 1st January to 31st December 2018 via the radiology department electronic records and patients’ records. There were a total of 60 CTPA performed in the entire year of 2018 with 16 positive and 44 negative scans. Among the 16 positive scans, 7 (44%) had a Wells score above 6, 6 (38%) had a Wells score between 2 – 6 and 3 (18%) had a Wells score less than 2. Out of the 16 positive scans, 4 (25%) were known malignancy and 1 was a known case of anti-phospholipid syndrome. All 60 patients had electrographs and arterial blood gases performed prior to CTPA. D dimer was performed in 15 cases (5%). Among the 16 positive scan patients, 4 (25%) passed away during the same admission directly or indirectly related to pulmonary embolism. This annual computed tomography audit report will assist clinicians in making better diagnostic decision when dealing with patients with suspected pulmonary embolism.

Matched MeSH terms: Pulmonary Embolism

Fulltext Fat embolism syndrome treated with methylprednisolone: a different perception or a misconception?

Mohd Shaffid Md Shariff, Hanizah Ngadiron, Firdaus Hayati, Affirul Chairil Ariffin

Borneo Journal of Medical Sciences, 2017;11(3):45-48.

MyJurnal

Fat embolism syndrome is manifested by the fat globule presence in the pulmonary and systemic circulation. A 34-year-old man was involved in a motor vehicle accident with a fracture of the left femur and avulsion fracture of the left posterior cruciate ligaments. He developed signs and symptoms that suggested an early diagnosis of fat embolism syndrome. Intravenous methylprednisolone administration was administered as part of the treatment. The role of methylprednisolone in a patient with fat embolism syndrome is controversial due to unproven effectiveness. In this case, fat embolism syndrome after a femur fracture was treated successfully with methylprednisolone.

Matched MeSH terms: Embolism, Fat

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