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Diagnosis and Treatment of Massive Pulmonary Thromboembolism in a Patient with Metastatic Colon Adenocarcinoma

Yıl 2013, Cilt: 5 Sayı: 2, 22 - 28, 01.12.2013

Öz

Aim: Massive pulmonary thromboembolism (PTE) is one of the cause of unexpected deaths in
hospitalized patients. Our aim is to present diagnosis and treatment of massive pulmonary
thromboembolism in a patient with pneumonia and cancer.
Case: A 52 years old male with a metastatic colon adenocarcinoma, admitted to the emergency
department with shortness of breath, one month after the right hemicolectomy and chemotherapy.
The physical examination of the patient: general condition was bad and he had tachypnea,
tachycardia, and rals in the left lung bases and leukocyte: 21.000 K/ml, CRP: 28mg/dl, Ph:7.46,
PaO2:56.6, PaCO2:23.2, SO2:%82, HCO3:19.8. Tachypnea, tachycardia, hypoxia, hypocapnia,
and respiratory alkalosis was observed, PTE was considered and diagnosed by CT pulmonary
angiography. 50 mg Alteplase was applied to the patient. After administration of alteplase, general
condition was improved (pH:7.37, PaO2:85.1, PaCO2: 38.9,SO2:98.5%, HCO3:20.3).
Conclusion:Pneumonia, may mask the diagnosis of PTE and should be considered in patients with
dyspnea, hypocapnia, hypoxia, and hypotension

Kaynakça

  • Davidson BL (2000). Risk assessment and prophylaxis of venous thromboembolism in acutely and/or critically ill patients. Haemostasis, 30 (2): 77-81.
  • Goldhaber SZ, Visani L, De Rosa M (1999). Acute pulmonary embolism: Clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet, 353 (9162): 1386-1389.
  • Kasper W, Konstantinides S, Geibel A, Tiede N,Krause T, Just H (1997). Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pul-monary embolism. Heart, 77(4): 346-349.
  • Alpert JS, Smith R, Carlson J, Ockene IS, Dexter L,Dalen JE (1976). Mortality in patients treated for pulmonary embolism. JAMA, 236(13): 1477-1480.
  • Sandler DA, Martin JF (1989). Autopsy proven pulmonary embolism in hospital patients: Are we detecting enough deep vein thrombosis? J R Soc Med, 82(4): 203-205.
  • Neuhaus A, Bentz RR, Weg JG (1978). Pulmonary embolism in respiratory failure. Chest, 73(4): 460-465.
  • Khorana AA, Francis CW, Culakova E, Kuderer NM, LymanGH (2007). Frequency, risk factors and trends for venous thromboembolism among hospitalized cancer patients. Cancer, 110(10): 2339-2346.
  • Blom JW, Doggen CJ, Osanto S, Rosentaal FR (2005). Malignancies, protrombotic mutations, and the risk of venous thrombosis. JAMA, 293(6): 715-722.
  • Geerts W, Pineo G, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al (2004). Prevention of venous thrombo embolism, the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest, 126(3): 338 - 400.
  • Şimşek A, Türkkan Ö, Melek K, Eyüboğlu FÖ (2010). Assessment of Patients with Pulmonary Thromboembolism (PTE) Diagnosed in Our Clinic: 5 Years Experience. Tur Toraks Der, 11: 149-154.
  • Casiato DA (2004). Hematologic complications. In: Casiato DA,Territo MA (eds). Manual of Clinical Oncology. 5th ed.Philadelphia: Lippincott Williams & Wilkins, 651-653.
  • Torbichi A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al (2008). ESC Committee for Practice Guidelines (CPG). Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on Pulmonary Embolism, European Society of Cardiology. Eur Heart J, 29(18): 2276 -2315.
  • PIOPED Investigators (1990). Value of the ventilation-perfusion lung scan in acute pulmonary embolism. JAMA, 263(20): 2753-2759.
  • Hasan Yiğit, Elif Ergün (2012). Pulmonary CT Angiography. Turkiye Klinikleri J Radiol-Special Topics, 5(3): 53- 63.
  • Cushman M, Tsai A, Heckbert SR (2001).Incidence rates, case fatality, and recurrence rates of deep vein thrombosis and pulmonary embolus: the Longitudinal Investigation of Thromboembolism Etiology (LITE). Thromb Haemost, 86: 2349.
  • Meyer G, Sors H, Charbonnier B, Kasper W, Bassand JP, Kerr IH et al (1992). Effects of intravenous urokinase versus alteplase on total pulmonary resistance in acutemassive pulmonary embolism: a European multicenter double-blind trial. The European Cooperative Study Group for Pulmonary Embolism. J Am Coll Cardiol, 19(2): 239–245.
  • Goldhaber SZ, Kessler CM, Heit J, Markis J, Sharma GV, Dawley D et al (1988). Randomised controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet, 2(8606): 293–298.
  • Meneveau N, Schiele F, Metz D, Valette B, Attali P, Vuillemenot A et al (1998). Comparative efficacy of a two- hour regimen of streptokinase versus alteplase in acute massive pulmonary embolism: immediate clinical and hemodynamic outcome andone-year follow-up. J Am Coll Cardiol, 31(5): 1057–1063.
  • Meneveau N, Schiele F, Vuillemenot A, Valette B, Grollier G, Bernard Y et al (1997). Streptokinase vs alteplase in massive pulmonary embolism. A randomized trial assessing right heart haemodynamics and pulmonary vascular obstruction. Eur Heart J, 18(7): 1141–1148.
Yıl 2013, Cilt: 5 Sayı: 2, 22 - 28, 01.12.2013

Öz

Kaynakça

  • Davidson BL (2000). Risk assessment and prophylaxis of venous thromboembolism in acutely and/or critically ill patients. Haemostasis, 30 (2): 77-81.
  • Goldhaber SZ, Visani L, De Rosa M (1999). Acute pulmonary embolism: Clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet, 353 (9162): 1386-1389.
  • Kasper W, Konstantinides S, Geibel A, Tiede N,Krause T, Just H (1997). Prognostic significance of right ventricular afterload stress detected by echocardiography in patients with clinically suspected pul-monary embolism. Heart, 77(4): 346-349.
  • Alpert JS, Smith R, Carlson J, Ockene IS, Dexter L,Dalen JE (1976). Mortality in patients treated for pulmonary embolism. JAMA, 236(13): 1477-1480.
  • Sandler DA, Martin JF (1989). Autopsy proven pulmonary embolism in hospital patients: Are we detecting enough deep vein thrombosis? J R Soc Med, 82(4): 203-205.
  • Neuhaus A, Bentz RR, Weg JG (1978). Pulmonary embolism in respiratory failure. Chest, 73(4): 460-465.
  • Khorana AA, Francis CW, Culakova E, Kuderer NM, LymanGH (2007). Frequency, risk factors and trends for venous thromboembolism among hospitalized cancer patients. Cancer, 110(10): 2339-2346.
  • Blom JW, Doggen CJ, Osanto S, Rosentaal FR (2005). Malignancies, protrombotic mutations, and the risk of venous thrombosis. JAMA, 293(6): 715-722.
  • Geerts W, Pineo G, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al (2004). Prevention of venous thrombo embolism, the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest, 126(3): 338 - 400.
  • Şimşek A, Türkkan Ö, Melek K, Eyüboğlu FÖ (2010). Assessment of Patients with Pulmonary Thromboembolism (PTE) Diagnosed in Our Clinic: 5 Years Experience. Tur Toraks Der, 11: 149-154.
  • Casiato DA (2004). Hematologic complications. In: Casiato DA,Territo MA (eds). Manual of Clinical Oncology. 5th ed.Philadelphia: Lippincott Williams & Wilkins, 651-653.
  • Torbichi A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, et al (2008). ESC Committee for Practice Guidelines (CPG). Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on Pulmonary Embolism, European Society of Cardiology. Eur Heart J, 29(18): 2276 -2315.
  • PIOPED Investigators (1990). Value of the ventilation-perfusion lung scan in acute pulmonary embolism. JAMA, 263(20): 2753-2759.
  • Hasan Yiğit, Elif Ergün (2012). Pulmonary CT Angiography. Turkiye Klinikleri J Radiol-Special Topics, 5(3): 53- 63.
  • Cushman M, Tsai A, Heckbert SR (2001).Incidence rates, case fatality, and recurrence rates of deep vein thrombosis and pulmonary embolus: the Longitudinal Investigation of Thromboembolism Etiology (LITE). Thromb Haemost, 86: 2349.
  • Meyer G, Sors H, Charbonnier B, Kasper W, Bassand JP, Kerr IH et al (1992). Effects of intravenous urokinase versus alteplase on total pulmonary resistance in acutemassive pulmonary embolism: a European multicenter double-blind trial. The European Cooperative Study Group for Pulmonary Embolism. J Am Coll Cardiol, 19(2): 239–245.
  • Goldhaber SZ, Kessler CM, Heit J, Markis J, Sharma GV, Dawley D et al (1988). Randomised controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet, 2(8606): 293–298.
  • Meneveau N, Schiele F, Metz D, Valette B, Attali P, Vuillemenot A et al (1998). Comparative efficacy of a two- hour regimen of streptokinase versus alteplase in acute massive pulmonary embolism: immediate clinical and hemodynamic outcome andone-year follow-up. J Am Coll Cardiol, 31(5): 1057–1063.
  • Meneveau N, Schiele F, Vuillemenot A, Valette B, Grollier G, Bernard Y et al (1997). Streptokinase vs alteplase in massive pulmonary embolism. A randomized trial assessing right heart haemodynamics and pulmonary vascular obstruction. Eur Heart J, 18(7): 1141–1148.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Diğer ID JA34ZF95JN
Bölüm Case Report
Yazarlar

Süreyya Yılmaz Bu kişi benim

Yaşar Yıldırım Bu kişi benim

Zülfükar Yılmaz Bu kişi benim

Emre Aydın Bu kişi benim

Recai Akdoğan Bu kişi benim

Barış Çil Bu kişi benim

Ali Kemal Kadiroğlu Bu kişi benim

Füsun Topçu Bu kişi benim

M. Emin Yılmaz Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2013
Yayımlandığı Sayı Yıl 2013 Cilt: 5 Sayı: 2

Kaynak Göster

APA Yılmaz, S., Yıldırım, Y., Yılmaz, Z., Aydın, E., vd. (2013). Diagnosis and Treatment of Massive Pulmonary Thromboembolism in a Patient with Metastatic Colon Adenocarcinoma. International Archives of Medical Research, 5(2), 22-28.
AMA Yılmaz S, Yıldırım Y, Yılmaz Z, Aydın E, Akdoğan R, Çil B, Kadiroğlu AK, Topçu F, Yılmaz ME. Diagnosis and Treatment of Massive Pulmonary Thromboembolism in a Patient with Metastatic Colon Adenocarcinoma. IAMR. Aralık 2013;5(2):22-28.
Chicago Yılmaz, Süreyya, Yaşar Yıldırım, Zülfükar Yılmaz, Emre Aydın, Recai Akdoğan, Barış Çil, Ali Kemal Kadiroğlu, Füsun Topçu, ve M. Emin Yılmaz. “Diagnosis and Treatment of Massive Pulmonary Thromboembolism in a Patient With Metastatic Colon Adenocarcinoma”. International Archives of Medical Research 5, sy. 2 (Aralık 2013): 22-28.
EndNote Yılmaz S, Yıldırım Y, Yılmaz Z, Aydın E, Akdoğan R, Çil B, Kadiroğlu AK, Topçu F, Yılmaz ME (01 Aralık 2013) Diagnosis and Treatment of Massive Pulmonary Thromboembolism in a Patient with Metastatic Colon Adenocarcinoma. International Archives of Medical Research 5 2 22–28.
IEEE S. Yılmaz, Y. Yıldırım, Z. Yılmaz, E. Aydın, R. Akdoğan, B. Çil, A. K. Kadiroğlu, F. Topçu, ve M. E. Yılmaz, “Diagnosis and Treatment of Massive Pulmonary Thromboembolism in a Patient with Metastatic Colon Adenocarcinoma”, IAMR, c. 5, sy. 2, ss. 22–28, 2013.
ISNAD Yılmaz, Süreyya vd. “Diagnosis and Treatment of Massive Pulmonary Thromboembolism in a Patient With Metastatic Colon Adenocarcinoma”. International Archives of Medical Research 5/2 (Aralık 2013), 22-28.
JAMA Yılmaz S, Yıldırım Y, Yılmaz Z, Aydın E, Akdoğan R, Çil B, Kadiroğlu AK, Topçu F, Yılmaz ME. Diagnosis and Treatment of Massive Pulmonary Thromboembolism in a Patient with Metastatic Colon Adenocarcinoma. IAMR. 2013;5:22–28.
MLA Yılmaz, Süreyya vd. “Diagnosis and Treatment of Massive Pulmonary Thromboembolism in a Patient With Metastatic Colon Adenocarcinoma”. International Archives of Medical Research, c. 5, sy. 2, 2013, ss. 22-28.
Vancouver Yılmaz S, Yıldırım Y, Yılmaz Z, Aydın E, Akdoğan R, Çil B, Kadiroğlu AK, Topçu F, Yılmaz ME. Diagnosis and Treatment of Massive Pulmonary Thromboembolism in a Patient with Metastatic Colon Adenocarcinoma. IAMR. 2013;5(2):22-8.

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