Thursday, 28 November 2013

Pulmonary vascular disease – Pulmonary embolism – The Causes

Pulmonary vascular disease is defined as a condition of blood flow to the lung’s artery is blocked suddenly due to a blood clot somewhere in the body, including pulmonary embolism, chronic thromboembolic disease, pulmonary arterial hypertension, pulmonary veno-occlusive disease, pulmonary arteriovenous malformations, pulmonary edema, etc.
I. Pulmonary embolism
Pulmonary embolism (PE) is defined as a condition of blockage of blood flow due to a blood clot of either in main artery of the lung or somewhere else in the body. In most cases, it is in the deep veins of the legs or pelvic. The disease is a common and affect as many as 500,000 persons annually in the United States
B.1. Causes
1. Popliteal venous aneurysm
There is a report of a case of surgical treatment of a 44 years old man, for a popliteal venous aneurysm that was complicated by pulmonary thromboembolism(6).
2. Total hip/knee arthroplasty
Total hip/knee arthroplasty Total hip/knee arthroplasty may cause venous thromboembolism (VTE) as a postoperative complication. There is a report of a patient who developed pulmonary embolism (PE) 6 days after arthroscopic rotator cuff repair but recovered without sequelae. In this case, the possibility of DVT of the lower limbs was denied by contrast-enhanced CT. Most possibly, the source of PE was deep vein thrombosis (DVT) of the upper limb under Desault fixation which showed arthroscopic surgery-related swelling postoperatively(7).
3. Vertebral compression fractures (VCFs)
i n osteoporotic VCFs, pulmonary cement embolism was detected in 23% of PVP sessions, developed in the distal to third-order pulmonary arteries, and was related to leakage into the inferior vena cava, according to the study by Seoul National University Bundang Hospital(8).
4. Medication
Medication such as Heparin , bivalirudin (0.1 mg/kg bolus and 1.75 mg/kg per h infusion) plus warfarin in certain patient can be a potential cause of pulmonary embolism.
A 68-year-old man was referred to the emergency department 6 h after onset of sudden acute dyspnoea. Immediate ECG showed sinus tachycardia with the typical S1-Q3-T3 pattern and incomplete right bundle branch block. The echocardiogram showed the presence of mobile thrombus in the right atrium, a distended right ventricle with free wall hypokinesia and displacement of the interventricular septum towards the left ventricle. Lung spiral computed tomography (CT) showed bilateral pulmonary involvement and confirmed the picture of a thrombotic system in the right atrium and caval vein. Thrombolytic treatment with recombinant tissue plasminogen activator (rt-PA) and heparin (alteplase 10 mg bolus, then 90 mg over 2 h) was administered. Six hours after thrombolysis bleeding gums and significant reduction in platelet count (around 50,000) were observed(9).
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