An Unusually Rare but Interesting Co-Occurrence of Idiopathic Pulmonary Artery and Pulmonary Vein Thrombosis: A Case Report.
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ABSTRACT:
SUBMITTER: Sharifkazemi M
PROVIDER: S-EPMC7026553 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Introduction and importance Pulmonary artery aneurysms are rare anomalies of the pulmonary vasculature. They are often asymptomatic and frequently an incidental finding on imaging or autopsy. It is imperative to closely monitor pulmonary artery aneurysms as they can result in sudden dissection, rupture, and death. Due to the rarity of this disease, the number of studies on pulmonary artery aneurysm management are limited and debated in the literature. Case presentation We report a case of an initially symptomatic patient with dyspnea on exertion with an incidental finding of a large 5.0 × 6.4 cm pulmonary artery aneurysm that responded well to conservative management. Her dyspnea self-resolved and the decision was made to closely monitor the patient every three months with serial computed tomography angiography imaging. Clinical discussion Idiopathic aneurysms of the main pulmonary artery are rare with a poorly understood pathogenesis primarily due to the limited number of cases. There are no clear guidelines for management, but the least invasive approach should be used due to the risk of serious adverse events. Pharmacologic treatment of underlying comorbidities and serial computed tomography angiography imaging should be considered as conservative management. Conclusion Six months later, she remains hemodynamically stable and the aneurysm has decreased in size by 15%. This case highlights that conservative management should be considered first line therapy in asymptomatic, hemodynamically stable patients regardless of aneurysm size. Highlights • Management of pulmonary artery aneurysms is debated in the literature regarding conservative vs. surgical management.• Conservative management can lead to shrinkage of the pulmonary artery aneurysm.• Patients without risk factors can be successfully managed by serial CTA imaging.
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Project description:Pulmonary embolism is a life-threatening condition, which can result in respiratory insufficiency and death. Blood clots occluding branches of the pulmonary artery (PA) are traditionally considered to originate from thrombi in deep veins (usually in legs). However, growing evidence suggests that occlusion of the vessels in the lungs can develop without preceding deep vein thrombosis (DVT). In this work, we used an inferior vena cava (IVC) complete ligation model of DVT in Wistar rats to explore the possibility and mechanisms of PA thrombosis under the conditions where all routes of thrombotic mass migration from peripheral veins are blocked. We demonstrate that rats both with normal and reduced neutrophil counts developed thrombi in the IVC, although, neutropenia caused a substantial decrease in thrombus size and a shift from fresh fibrin toward mature fibrin and connective tissue inside the thrombus. Massive fibrin deposition was found in the PA branches in the majority of DVT rats with normal neutrophil counts, but in none of the neutropenic animals. Neutrophil ablation also abolished macroscopic signs of lung damage. Altogether, the results demonstrate that thrombi in the lung vasculature can form in situ by mechanisms that require local neutrophil recruitment taking place in the DVT setting.
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Project description:BACKGROUND:The prognostic significance of coexisting deep vein thrombosis (DVT) in acute pulmonary embolism (PE) is controversial. This study aimed to provide routine patient care data on the impact of this association on PE severity and 3-month outcomes in a population presenting with symptomatic venous thromboembolism (VTE) from the REMOTEV registry. METHODS AND RESULTS:REMOTEV is a prospective, non-interventional study of patients with acute symptomatic VTE, treated with direct oral anticoagulants (DOACs) or standard anticoagulation (vitamin K antagonists (VKA) or parenteral heparin/fondaparinux alone) for at least 3 months. From 1 November 2013 to 28 February 2018, among 1241 consecutive patients included, 1192 had a follow-up of at least 3 months and, among them, 1037 had PE with (727) or without DVT (310). The median age was 69 (55-80, 25th-75th percentiles). Patients with PE-associated DVT had more severe forms of PE (p < 0.0001) and, when DVT was present, proximal location was significantly correlated to PE severity (p < 0.01). However, no difference in all-cause mortality rate (hazard ratio (HR) 1.36 (CI 95% 0.69-2.92)), nor in the composite criterion of all-cause mortality and recurrence rate (HR 1.56 (CI 95% 0.83-3.10)) was noted at 3 months of follow-up. CONCLUSION:In REMOTEV, coexisting DVT was associated with a higher severity of PE, with no impact on short-term prognosis.
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