| Autor: |
van Langevelde K; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands., Srámek A, Vincken PW, van Rooden JK, Rosendaal FR, Cannegieter SC |
| Jazyk: |
angličtina |
| Zdroj: |
Haematologica [Haematologica] 2013 Feb; Vol. 98 (2), pp. 309-15. Date of Electronic Publication: 2012 Jul 16. |
| DOI: |
10.3324/haematol.2012.069195 |
| Abstrakt: |
Pulmonary embolism is considered to originate from embolization of a deep-vein thrombosis, resulting in two manifestations of one disease: venous thrombosis. However, in up to 50% of patients with pulmonary embolism no deep-vein thrombosis is found with ultrasonography. An explanation for this low proportion is currently lacking. Other imaging modalities may increase the yield of detection of deep-vein thrombosis in the calf or in the abdominal region. Alternatively, not all pulmonary emboli may originate from deep-vein thromboses in the extremities. We searched for the origin of pulmonary emboli, by performing total-body magnetic resonance imaging-scans to visualize thrombi. Ninety-nine patients with a first pulmonary embolism confirmed by computed tomography underwent a magnetic resonance direct thrombus imaging-scan, a validated technique using endogenous contrast. Additionally, acquired and genetic risk factors were assessed. No thrombus was found in 55 patients, whereas a thrombus was identified in 44 patients. The commonest thrombus location was the lower leg; 12 patients had isolated calf vein thrombosis and five had isolated superficial vein thrombosis. A peripheral thrombus was found by magnetic resonance imaging in less than half of patients with pulmonary embolism. We propose several hypotheses to explain the absence of thrombi, such as a cardiac thrombus origin or embolization of the whole deep-vein thrombus. The possibility that pulmonary embolism arises de novo in the lungs, due to local inflammation-driven coagulation, needs to be considered. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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