Pulmonary aneurysm

Pulmonary embolism or infarction Aortic aneurysm Pulmonary aneurysm Bronchovascular fistula AV-malformation... 

Efthimiou and colleagues reported five patients with BD who presented with hemoptysis and reviewed 25 other cases in the literature (12). They found that the presence of any pulmonary manifestation was associated with active BD at other sites. Patients with hemoptysis were more likely to be male and have evidence of deep venous thrombosis and thrombophlebitis as compared with patients who did not have hemoptysis. Pulmonary arteriography revealed occlusions of proximal vessels similar to that seen with pulmonary emboh. Thrombosis of large proximal or multiple peripheral arteries may lead to pulmonary hypertension, and single or multiple pulmonary aneurysms may be present. Pulmonary artery aneurysms have a poor prognosis, with more than one-half of patients dying of pulmonary hemorrhage within three years (5). 

Magnetic resonance imaging (MRI) has been suggested as an alternative noninvasive method for the diagnosis of pulmonary aneurysms however it may not be as sensitive as the helical CT for small-sized aneurysms (28). 

BD is a chronic systemic vascuhtis that can be associated with pulmonary manifestations in up to 10% of patients. Pulmonary aneurysms are the most common form of pulmonary involvement and carry a poor prognosis. Further investigation is needed to better undaatand the pathogenesis of disease and to explore novel treatment options through the conduct of rigorous standardized trials. 

Vascular phenomena, major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway s lesions... 

Suggested Alternatives for Differential Diagnosis Abdominal aneurysm, aortic dissection, pleural effusion, subarachnoid hemorrhage, superior vena cava syndrome, hantavirus pulmonary syndrome, mediastinitis, fulminate mediastinal tumors pneumonia, gastroenteritis, meningitis, ecthyma, rat bite fever, spider bite, leprosy, plague, tularemia, coccidioidomycosis, diphtheria, glanders, histoplasmosis, psittacosis, typhoid fever, and rickettsial pox. 

Cocaine abuse is a risk factor for myocardial ischemia, infarction, and dysrhythmias, as well as pulmonary edema, ruptured aortic aneurysm, infectious endocarditis, vascular thrombosis, myocarditis, and dilated cardiomyopathy (35). 

Telangiectasias are collections of dilated capillaries that are usually of no clinical significance (Milandre et al. 1987). They may be associated with hereditary hemorrhagic telangiectasia (the Osler-Weber-Rendu syndrome), but this is more likely to be associated with neurological complications from a pulmonary arteriovenous malformation with right-to-left shunting, such as cerebral hypoxia, brain abscess, paradoxical and septic embolism, or from an associated intracranial arteriovenous malformation or aneurysm (McDonald et al. 1998). 

Multiple sclerosis Preganglionic Spinal birth injury Tuberculosis Pancoast tumor Aortic aneurysm Enlarged mediastinal glands Enlargement of thyroid Lymphadenopathy Thoracic neuroblastoma Pulmonary mucormycosis Trauma... 

Cocaine abuse is a risk factor for myocardial ischemia, infarction, and dysrhythmias, as well as pulmonary edema, ruptured aortic aneurysm, infectious endocarditis, vascular thrombosis, myocarditis, and dilated cardiomyopathy (32). Acutely, cocaine suppresses myocardial contractility, reduces coronary caliber and coronary blood flow, induces electrical abnormalities in the heart, and increases heart rate and blood pressure. These effects can lead to myocardial ischemia (33,34). However, intranasal cocaine in doses used medicinally or recreationally does not have a deleterious effect on intracardiac pressures or left ventricular performance (35). 

A 48-year-old man with an inflammatory aneurysm of the ascending aorta and severe heart failure due to massive aortic regurgitation was given a continuous intravenous infusion of milrinone O.Smicrograms/kg/ minute (1). His pulmonary arterial pressure fell and his symptoms improved over 7 weeks while he was taking corticosteroids. The diseased tissue was successfully replaced at operation and the milrinone was tapered uneventfully. 

X-ray examination still plays some role especially in the acute phase (heart enlargement and pulmonary oedema) and in the detection of aneurysms and calcifications, visualisation of heart valves, pacemakers, etc. 

Figure 4.54) and dissecting aortic aneurysm (Figure 7.4). An example of ST-segment elevation in massive pulmonary embolism is shown in Figure 4.54, which coincides with the development of... 

Among the non-ischaemic cardiovascular causes of thoracic pain that should be ruled out, some present a benign prognosis as pericarditis, while others, in turn, point to a much serious prognosis, such as an acute aortic syndrome (dissecting aneurysm or other aortic pathologies) and a pulmonary embolism. On the whole, these account for 5-10% of all cases of thoracic pain. 

Not for patients with angina pectoris, myocardial infarction, dissecting aneurysm or pulmonary edema can increase blood sugar will arrest active labor Preferred by many for emergency treatment of aortic dissection 80 to 90% response rate can be followed by same drug taken orally May precipitate angina, myocardial infarction not used for aortic dissection main use is in pregnancy... 

Trimethaphan (500 mg/10 ml by IV infusion) is indicated for the production of controlled hypotension during surgery, for the short-term acute control of blood pressure in hypertensive emergencies, and in the emergency treatment of pulmonary edema in patients with pulmonary hypertension associated with systemic hypertension. In addition, trimethaphan has been used in patients with dissecting aortic aneurysm or in ischemic heart disease when other agents could not be used. 

Chronic infection with C burnetii is usually manifested by infective endocarditis, which is also the most severe complication of Q fever. In addition, a report73 from France of 92 cases published in 1993 also listed hepatitis, infected vascular prostheses and aneurysms, osteomyelitis, pulmonary infection, cutaneous infection, and an asymptomatic form. In addition, 7 of the 92 patients described in this report experienced fever only. Also noted was the observation that although 81% of patients had an identifiable risk factor, only 31% lived in a rural area. In addition, some form of immunodeficiency was observed in 20% of the patients, raising the possibility that chronic Q fever occurs as a result of reactivation of latent infection.73 Inflammatory pseudotumor of the lung as a chronic complication of Q fever has also been reported.74,75... 

With the current advances in technology allowing more accurate and controlled deployment of embolic agents, embolotherapy has now become the procedure of choice for the management of visceral and solid organ aneurysms [40-42]. In addition, embolotherapy has now arguably become the primary facet in the management of vascular malformations of all varieties, in the central nervous system and head and neck [43, 44], pulmonary circulation [45-48], viscera, trunk and extremities [49-54]. 

DeLima LG, Wynands JE, Bourke ME, Walley VM (1994) Catheter-induced pulmonary artery false aneurysm and rupture case report and review. J Cardiothorac Vase Anesth 8 70-75... 

Tal MG, Saluja S, Henderson KJ, White RI Jr (2002) Vein of Galen technique for occluding the aneurysmal sac of pulmonary arteriovenous malformations. J Vase Interv Radiol 13 1261-1264... 

Fragments of the thrombi may become detached, be released in the general circulation, and finally get caught in vessels distant from the thrombotic vessel. As we have seen, these ectopic vascular plugs are called emboli. Venous emboli originate from thrombi that developed in the peripheral veins. Emboli that plug the major pulmonary arteries are often responsible for sudden death. When emboli are found in the peripheral arteries, they usually originate from thrombi in the heart or in an aneurysmal sac. The steps involved with formation of blood clots or thrombi are summarized in Fig. 7-8. 

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