scholarly journals Saddle pulmonary emboli: an unusual presentation

CJEM ◽  
2009 ◽  
Vol 11 (06) ◽  
pp. 558-559
Author(s):  
Truptesh H. Kothari ◽  
Shivangi Kothari ◽  
Mahima Pandey ◽  
Harshit Khara ◽  
Nishant Dhungel
Keyword(s):  
Pulmonary Artery ◽  
Troponin I ◽  
Femoral Vein ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Factor V Leiden ◽  
Superficial Femoral Vein ◽  
Presenting Symptoms ◽  
Coronary Syndrome ◽  
The Right

A 38-year-old man with a history of polyposis syndrome diagnosed 3 years previously, with poor compliance for follow-up, presented to the emergency department with symptoms of retrosternal chest pain associated with dizziness and shortness of breath. His blood pressure was 94/43 mm Hg, his pulse was 123 beats/min and he had an oxygen saturation of 84% on room air. The patient’s initial laboratory results showed a hemoglobin of 80 g/L and blood gas with a pH of 7.23. He had a normal chest radiograph and electrocardiogram, but had an elevated troponin I at 0.12 μg/L. He was given acetylsalicylic acid for suspicion of acute coronary syndrome. On physical examination, the patient was found to have right calf tenderness. With this finding and the presenting symptoms, he underwent computed tomography angiography (CTA) of the chest. The chest CTA showed a massive saddle embolus with a filling defect completely occluding the right pulmonary artery and extending through the main pulmonary artery segment to involve the left pulmonary artery. There were also diffuse filling defects involving bilateral pulmonary segmental arteries (Fig. 1 and Fig. 2). The patient received alteplase and underwent a workup for a hypercoagulable state. His workup revealed positive anticardiolipin antibodies and factor V Leiden. The Doppler ultrasound of his lower extremities showed an extensive thrombus measuring more than 6 cm extending in the right superficial femoral vein. The patient was then referred for placement of an inferior vena cava filter.

scholarly journals Pulmonary Embolism Saddle

2021 ◽  
Vol 8 (6) ◽  
Author(s):  
Behyamet O ◽  
◽  
Daoud MA ◽  
Boris AA ◽  
Rachida L ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Assessment And Evaluation ◽  
Adenocarcinoma Of The Prostate ◽  
The Right ◽  
Preventive Methods

Pulmonary embolism remains a fatal and frequent complication of thromboembolic disease despite the development of preventive methods. Cancer patients are at higher risk of thromboembolism than those in the general population [1]. The thoracic CT angiography is the standard examination; it makes the diagnosis with certainty by showing the endoluminal thrombus. Saddle pulmonary embolism is a radiological term; it is defined by the presence of a thrombus overlapping the bifurcation of the main pulmonary artery extending to both right and left. It represents 2 to 5% of pulmonary embolisms [2]. We present the image of a hemodynamically stable 69-year-old patient followed for adenocarcinoma of the prostate who was referred in our training to a thoraco-abdomino-pelvic scanner for assessment and evaluation of his pathology. The chest CT revealed a hypo dense endoluminal thrombus of the pulmonary artery trunk extended to its right and left dividing branches (Figure 1). Abdominal sections showed an endoluminal thrombus of the right common iliac vein extending to the inferior vena cava (Figure 2).

Selective denervation of the heart

1983 ◽  
Vol 244 (4) ◽  
pp. H607-H613 ◽  
Author(s):  
W. C. Randall ◽  
J. X. Thomas ◽  
M. J. Barber ◽  
L. E. Rinkema
Keyword(s):  
Pulmonary Artery ◽  
Left Atrium ◽  
Superior Vena ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Canine Heart ◽  
The Right

Total denervation of the canine heart consisted of intrapericardial neural dissection of the left atrium, left superior pulmonary vein, and main pulmonary artery and cutting of the ventrolateral cardiac nerve (stage I). The fat pad and all nerves were removed from between the pulmonary artery and aorta (stage II). Dissection proceeded from the pericardial reflection along the superior vena cava to the azygos vein, which was cleared, double tied, and cut. The right pulmonary artery was cleaned, and the superior right atrium was dissected to its intersection with the left atrium (stage III). Denervation was tested by electrical stimulation of both vagi and stellate ganglia, while recording inotropic, chronotropic, and dromotropic events, before and after each stage. Stage I deleted most left autonomic input to the heart without interrupting right sympathetics. Stage II completed left autonomic denervation but preserved much of the right sympathetic input. Large nerves along the dorsal surface of the pulmonary artery carried inputs from both left and right sympathetics. Stage III completed the denervation of atrioventricular and sinoatrial nodal structures and removed all remaining ventricular inotropic influences. Selective denervation of atrioventricular and sinoatrial nodal regions appears feasible for preparation of chronic canine models.

Inferior vena cava reconstruction with a superficial femoral vein graft after resection of a venous leiomyosarcoma

2020 ◽  
pp. 1-8
Author(s):  
Ovidiu Tirnavean ◽  
Christophe Van Bellinghen ◽  
Luc Monfort ◽  
Bruno Coulier ◽  
Michel Buche ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Vein Graft ◽  
Inferior Vena ◽  
Femoral Vein ◽  
Vena Cava ◽  
Superficial Femoral Vein

Comprehensive transthoracic cardiac imaging in mice using ultrasound biomicroscopy with anatomical confirmation by magnetic resonance imaging

2004 ◽  
Vol 18 (2) ◽  
pp. 232-244 ◽  
Author(s):  
Yu-Qing Zhou ◽  
F. Stuart Foster ◽  
Brian J. Nieman ◽  
Lorinda Davidson ◽  
X. Josette Chen ◽  
...  
Keyword(s):  
Cardiac Imaging ◽  
Superior Vena ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
High Frequency Ultrasound ◽  
The Right

High-frequency ultrasound biomicroscopy (UBM) has recently emerged as a high-resolution means of phenotyping genetically altered mice and has great potential to evaluate the cardiac morphology and hemodynamics of mouse mutants. However, there is no standard procedure of in vivo transthoracic cardiac imaging using UBM to comprehensively phenotype the adult mice. In this paper, the characteristic mouse thoracic anatomy is elucidated using magnetic resonance (MR) imaging on fixed mice. Besides the left parasternal and apical windows commonly used for transthoracic ultrasound cardiac imaging, a very useful right parasternal window is found. We present strategies for optimal visualization using UBM of key cardiac structures including: 1) the right atrial inflow channels such as the right superior vena cava; 2) the right ventricular inflow tract via the tricuspid orifice; 3) the right ventricular outflow tract to the main pulmonary artery; 4) the left atrial inflow channel, e.g., pulmonary vein; 5) the left ventricular inflow tract via the mitral orifice; 6) the left ventricular outflow tract to the ascending aorta; 7) the left coronary artery; and 8) the aortic arch and associated branches. Two-dimensional ultrasound images of these cardiac regions are correlated to similar sections in the three-dimensional MR data set to verify anatomical details of the in vivo UBM imaging. Dimensions of the left ventricle and ascending aorta are measured by M-mode. Flow velocities are recorded using Doppler at six representative intracardiac locations: right superior vena cava, tricuspid orifice, main pulmonary artery, pulmonary vein, mitral orifice, and ascending aorta. The methodologies and baseline measurements of inbred mice provide a useful guide for investigators applying the high-frequency ultrasound imaging to mouse cardiac phenotyping.

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