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Seltene Ursachen akuter, chirurgisch-interventionsbedürftiger Lungenembolien

Unusual causes of acute pulmonary embolisms requiring surgery

  • Übersicht
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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Akute Lungenembolien, deren Ursache nicht in einer Thrombose gründen, sind selten. Ihr klinischer Verlauf ist in vielen Fällen fatal. Die Auslöser dieser nichtthrombotischen pulmonalen Embolien (NTPE) sind mannigfaltig: Körperzellen (Adipozyten, Amnionzellen, Trophoblasten, Tumorzellen), Bakterien, Pilze, Parasiten, Gase und Fremdkörper. Aufgrund retrospektiver Studien muss man davon ausgehen, dass viele pulmonale Embolien nicht korrekt und zeitnah diagnostiziert werden. Diese Arbeit gibt vor dem Hintergrund einer umfassenden Literaturzusammenstellung eine Übersicht über die möglichen Ursachen einer NTPE. Die zeitnahe, richtige Diagnose Lungenembolie kann lebensrettend sein. Die Ursache der Lungenembolie zu finden, ist entscheidend sowohl für die initiale Therapie als auch die Prophylaxe erneuter embolischer Ereignisse. In einzelnen Fällen ist die möglichst rasche Ursachenfindung der akuten Lungenembolie bereits zwingend für die adäquate initiale Therapie. So ist bei der akuten pulmonalen Embolie auf dem Boden von verschleppten Fremdkörpern die chirurgische Entfernung in der Regel erforderlich.

Abstract

Acute pulmonary embolism of nonthrombotic origin is rare. The clinical course is often fatal. The triggers of the so-called nonthrombotic pulmonary embolism (NTPE) are multiple: human cells (adipocytes, amniotic cells, trophoblasts, tumor cells), bacteria, fungi, parasites, gases, and debris. According to retrospective studies, one has to assume that many pulmonary embolisms are not diagnosed correctly and promptly. Based on an extensive literature overview, this paper summarizes the possible triggers of a NTPE. A prompt and correct diagnosis of a pulmonary embolism can be life-saving. Identifing the trigger of a pulmonary embolism is crucial for the following therapy and further prophylaxis. In some cases, the trigger of the pulmonary embolism determines the initial therapy. In cases of acute pulmonary embolism because of debris, a surgical approach is inevitable in most cases.

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Literatur

  1. King MB, Harmon KR (1994) Unusual forms of pulmonary embolism. Clin Chest Med 15:561–580

    PubMed  CAS  Google Scholar 

  2. Jorens PG, Van Marck E, Snoeckx A, Parizel PM (2009) Nonthrombotic pulmonary embolism. Eur Respir J 34:452–474

    Article  PubMed  CAS  Google Scholar 

  3. Sincina I, Pankratz H, Bise K, Matevossian E (2010) Forensic aspects of post-mortem histological detection of amniotic fluid embolism. Int J Legal Med 124:55–62

    Article  Google Scholar 

  4. Lippi G, Cervellin G, Franchini M, Favaloro EJ (2010) Biochemical markers for the diagnosis of venous thromboembolism: the past, present and future. J Thromb Thrombolysis. DOI:10.1007/s11239-010-0460-x

  5. Lippi G, Favaloro EJ (2008) Cardiac biomarkers in pulmonary embolism. Thromb Haemost 99:1134–1136

    PubMed  CAS  Google Scholar 

  6. Fred HL, Harle TS (1970) Septic pulmonary embolism. Am Fam Physician GP 1:81–87

    PubMed  CAS  Google Scholar 

  7. Roberts WC, Buchbinder NA (1972) Right-sided valvular infective endocarditis: a clinicopathologic study of twelve necropsy patients. Am J Med 53:7–19

    Article  PubMed  CAS  Google Scholar 

  8. Huang RM, Naidich DP, Lubat E et al (1989) Septic pulmonary emboli: CT-radiographic correlation. AJR Am J Roentgenol 153:41–45

    PubMed  CAS  Google Scholar 

  9. Sözener ZC, Kayal A, Atasoy C et al (2008) Septic pulmonary embolism: three case reports. Monaldi Arch Chest 128:162–166

    Google Scholar 

  10. Sakuma M, Sugimura K, Nakamura M et al (2007) Unusual pulmonary embolism: septic pulmonary embolism and amniotic fluid embolism. Circ J 71:772–775

    Article  PubMed  Google Scholar 

  11. Murphy RA, Miller WT Jr (1996) Pulmonary mucormycosis. Semin Roentgenol 31:83–87

    Article  PubMed  CAS  Google Scholar 

  12. Lioulias A, Kotoulas C, Kokotsakis J, Konstantinou M (2001) Acute pulmonary embolism due to multiple hydatid cysts. Eur J Cardiothoracic Surg 20:197–199

    Article  CAS  Google Scholar 

  13. Kardaras F, Kardara D, Tselikos D et al (1996) Fifteen year surveillance of echinococcal heart disease from a referral hospital in Greece. Eur Heart J 17:1265–1270

    PubMed  CAS  Google Scholar 

  14. Varela-Duran J, Riede UN (1980) Cardiac echinococcosis with pulmonary embolism. Pathol Res Pract 170:252–257

    PubMed  CAS  Google Scholar 

  15. Fabian TC (1993) Unravelling the fat embolism syndrome. N Engl J Med 329:961–963

    Article  PubMed  CAS  Google Scholar 

  16. Schnaid E, Lamprey JM, Viljoen MJ et al (1987) The early biochemical and hormonal profile of patients with long bone fractures at risk of fat embolism syndrome. J Trauma 27:309–311

    Article  PubMed  CAS  Google Scholar 

  17. Richards RR (1997) Fat embolism syndrome. Can J Surg 40:334–339

    PubMed  CAS  Google Scholar 

  18. Patil N, Wakankar H (2008) Morbidity and mortality of simultaneous bilateral total knee arthroplasty. Orthopedics 31:780–789

    Article  PubMed  Google Scholar 

  19. Walker NM, Bateson T, Reavley P, Prakash D (2008) Fatal fat embolism following femoral head resection in total hip arthroplasty. Hip Int 18:332–334

    PubMed  CAS  Google Scholar 

  20. Guardia SN, Bilbao JM, Murray D et al (1989) Fat embolism in acute pancreatitis. Arch Pathol Lab Med 113:503–506

    PubMed  CAS  Google Scholar 

  21. Gravante G, Araco A, Sorge R et al (2008) Pulmonary embolism after combined abdominoplasty and flank liposuction: a correlation with the amount of fat removed. Ann Plast Surg 60:604–608

    Article  PubMed  CAS  Google Scholar 

  22. Rayburg M, Kalinyak KA, Towbin AJ et al (2010) Fatal bone marrow embolism in a child with hemoglobin SE disease. Am J Hematol 85:182–184

    PubMed  Google Scholar 

  23. López-Sánchez M, Alvarez-Antonán C, Arce-Mateos FP et al (2010) Single lung transplantation and fatal fat embolism acquired from the donor: management and literature review. Clin Transplant 24:133–138

    Article  PubMed  Google Scholar 

  24. Meyer JR (1926) Embolia pulmonar amnio caseosa. Bras Med 2:301–303

    Google Scholar 

  25. Sakuma M, Sugimura K, Nakamura M et al (2007) Unusual pulmonary embolism: septic pulmonary embolism an amniotic fluid embolism. Circ J 71:772–775

    Article  PubMed  Google Scholar 

  26. Knight M, Tuffnell D, Brocklehurs P et al (2010) Incidence and risk factors for amniotic-fluid embolism. Obstet Gynecol 115:910–917

    Article  PubMed  Google Scholar 

  27. Kramer MS, Rouleau J, Baskett TF et al (2006) Amniotic-fluid embolism and medical inductioon of labour: a retrospective, population-based cohort study. Lancet 368:1444–1448

    Article  PubMed  Google Scholar 

  28. Abenhaim HA, Azoulay L, Kramer MS, Leduc L (2008) Incidence and risk factors of amniotic fluid embolisms: a population-based study on 3 million births in the United states. Am J Obstet Gynecol 199:49.e1–49.e8

    PubMed  Google Scholar 

  29. Clark SL, Hankins GDV, Dudley DA et al (1995) Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol 172:1158–1167

    Article  PubMed  CAS  Google Scholar 

  30. Burrows A, Khoo SK (1995) The amniotic fluid embolism syndrome: 10 years experience at a major teaching hospital. Aust N Z J Obstet Gynaecol 35:245–250

    Article  PubMed  CAS  Google Scholar 

  31. Conde-Agudelo A, Romero R (2009) Amniotic fluid embolism: an evidence-based review. Am J Obstet Gynecol 201:445.e1–445.e13

    Article  PubMed  Google Scholar 

  32. Perozzi KJ, Englert NC (2004) Amniotic fluid embolism: an obstetric emergency. Crit Care Nurse 24:54–61

    PubMed  Google Scholar 

  33. Mahshid N, Ahmad S, Nahid M, Afshin F (2009) Sudden cardiac arrest during caesarean section-a possible case of amniotic fluid embolism. Middle East J Anesthesiol 20:315–317

    PubMed  Google Scholar 

  34. Montagnana M, Franchi M, Danese E et al (2010) disseminated intravascular coagulation in obstetric and gynecologic disorders. Semin thromb Hemost 36:404–418

    Article  PubMed  Google Scholar 

  35. Imanaka H, Takahara B, Yamaguchi H et al (2010) Chest computed tomography of a patient revealing severe hypoxia due to amniotic fluid embolism: a case report. J Med Case Reports 4:55

    Article  PubMed  Google Scholar 

  36. Saphir O (1947) The fate of carcinoma emboli in the lung. Am J Pathol 23:245–253

    PubMed  CAS  Google Scholar 

  37. Sakuma M, Fukui S, Nakamura M et al (2006) Cancer and pulmonary embolism: thrombotic embolism, tumor embolism and tumor invasion into a large vein. Circ J 70:744–749

    Article  PubMed  Google Scholar 

  38. Ma SQ, Lin Y, Ying HY et al (2010) solid malignancies complicated with pulmonary embolism: clinical analysis of 120 patients. Chin Med J (Engl) 123:29–33

    Google Scholar 

  39. Kane RD, Hawkins HK, Miller JA, Noce PS (1975) Microscopic pulmonary tumor emboli associated with dyspnea. Cancer 36:1473–1482

    Article  PubMed  CAS  Google Scholar 

  40. Veinot JP, Ford SE, Price RG (1992) Subacute cor pulmonale due to tumor embolization. Arch Pathol Lab Med 116:131–134

    PubMed  CAS  Google Scholar 

  41. Soares FA, Pinto AP, Landell GA, Oliviera JA de (1993) Pulmonary tumor embolism to arterial vessels and carcinomatous lymphangitis. A comparativeclinicopathological study. Arch Pathol Lab Med 117:827–831

    PubMed  CAS  Google Scholar 

  42. Winterbauer RH, Elfenbein IB, Ball WC Jr (1968) Incidence and clinical significance of tumor embolization to the lung. Am J Med 45:271–290

    Article  PubMed  CAS  Google Scholar 

  43. Sakuma M, Fukui S, Nakamura M et al (2006) Cancer and pulmonary embolism: thrombotic embolism, tumor embolism and tumor invasion into a large vein. Circ J 70:744–749

    Article  PubMed  Google Scholar 

  44. Jäkel J, Ramaswamy A, Köhler U, Barth PJ (2006) Massive pulmonary tumor microembolism from a hepatocellular carcinoma. Pathol Res Pract 202:395–399

    Article  PubMed  Google Scholar 

  45. Desai NR, Palomino J, Simeone F (2009) A 67-year-old woman with a remote history of breast cancer who presents with dyspnea and chest pain. Chest 136:1160–1163

    Article  PubMed  Google Scholar 

  46. Krüger T, Mustafi M, Nadalin S, Aebert H (2010) Vena cava sarcoma with tumor embolus in the pulmonary artery: surgical treatment. Ann Thorac Surg 90:642–644

    Article  PubMed  Google Scholar 

  47. Parissis H, Akbar MT, Young V (2010) Primary leiomyosarcoma of the right atrium: a case report and literature update. J Cardiothor Surg 5:80

    Google Scholar 

  48. Gabbieri D, Rossi G, Bavutti L et al (2006) Papillary fibroelastoma of the right atrium as an unusal source of recurrent pulmonary embolism. J Cardiovasc Med 7:373–378

    Article  Google Scholar 

  49. Pérez Baztarrica G, Nieva N, Gariglio L et al (2010) Images in cardiovascular medicine. Primary cardiac lymphoma: a rare case of pulmonary tumor embolism. Circulation 121:2249–2250

    Article  Google Scholar 

  50. Ahmed AA, Heller DS (1999) Fatal pulmonary tumor embolism caused by chondroblastic osteosarcoma: report of a case and review of the literature. Arch Pathol Lab Med 123:437–440

    PubMed  CAS  Google Scholar 

  51. Zhao H, Wang HG, Fan QQ et al (2008) Rare pulmonary and cerebral complications after transarterial chemoembolisation for hepatocellular carcinoma: a case report. World J Gastroenterol 14:6425–6427

    Article  PubMed  Google Scholar 

  52. Wu GC, Perng WC, Chen CW et al (2009) Acute respiratory distress syndrome after transcatheter arterial chemoembolisation of hepatocellular carcinomas. Am L Med Sci 338:357–360

    Article  Google Scholar 

  53. Kridel R, Myit S, Pache JC, Gaspoz JM (2008) Pulmonary tumor embolism: a rare case of acute right heart failure with elevated D-dimers. J Thorac Oncol 3:1482–1483

    Article  PubMed  Google Scholar 

  54. Roberts KE, Hamele-Bena D, Saqi A et al (2003) Pulmonary tumor embolism: a review of the literature. Am J Med 115:228–232

    Article  PubMed  Google Scholar 

  55. Veinot JP, Ford SE, Price RG (1992) Subacute cor pulmonale due to tumor embolization. Arch Pathol Lab Med 116:131–134

    PubMed  CAS  Google Scholar 

  56. Souders JE (200) Pulmonary air embolism. J Clin Monit Comput 16:375–383

    Article  Google Scholar 

  57. Levett DZ, Millar IL (2008) Bubble trouble: a review of diving physiology and disease. Postgrad Med J 84:571–578

    Article  PubMed  CAS  Google Scholar 

  58. Orebaugh SL (1992) Venous air embolism: clinical and experimental considerations. Crit Care Med 20:1169–1177

    Article  PubMed  CAS  Google Scholar 

  59. Buckland RW, Manners JM (1976) Venous air embolism during neurosurgery. A comparison of various mthods of detection in man. Anaesthesia 31:633–643

    Article  PubMed  CAS  Google Scholar 

  60. Shapiro G, Green DW, Fatica NS, Boachie-Adjei O (2001) Medical complications in scoliosis surgery. Curr Opin Pediatr 13:36–41

    Article  PubMed  CAS  Google Scholar 

  61. Losasso TJ, Black S, Muzzi DA et al (1992) Detection and hemodynamic consequences of venous air embolism. Does nitrous oxide make a difference? Anesthesiology 77:148–152

    Article  PubMed  CAS  Google Scholar 

  62. Vartikar JV, Johnson MD, Datta S (1989) Precordial doppler monitoring and pulse oximetry during caesarean delivery: detection of venous air embolism. Reg Anaesth 14:145–148

    CAS  Google Scholar 

  63. Derouin M, Couture P, Boudreault D et al (1996) Detection of gas embolism by transesophageal echocardiography during laparoscopic cholecystectomy. Anesth Analg 82:119–124

    Article  PubMed  CAS  Google Scholar 

  64. Michel R (1980) Air embolism in hip surgery. Anesthesia 35:858–862

    Article  CAS  Google Scholar 

  65. Leibowitz D, Benshalom N, Kaganov Y et al (2010) the incidence and hemdynamic significance of gas emboli during operative hysteroscopy: a prospective echocardiographic study. Eur J Echocardiogr 11:429–431

    Article  PubMed  Google Scholar 

  66. Stoloff DR, Isengerg RA, Brill AI (2001) Venous air and gas emboli in operative hysteroscopy. J Am Assoc Gynecol Laparosc 8:181–192

    Article  PubMed  CAS  Google Scholar 

  67. Vesely TM (2001) Air embolism during insertion of central venous catheters. J Vasc Interv Radiol 12:1291–1295

    Article  PubMed  CAS  Google Scholar 

  68. Losusso R, Gelsomino S, De Cicco G (2008) Acute pulmonary embolism after removal of central venous catheter. Int J Cardiol 129:e64–e65

    Article  Google Scholar 

  69. Athar MK, Islam T, Grammes J, Athar MN (2005) Near-fatal pulmonary air embolus from iatrogenic injection of air during contrast administration. QJM 98:231–232

    Article  PubMed  CAS  Google Scholar 

  70. Hirata N, Kanaya N, Yamazaki Y et al (2010) Pulmonary embolism caused by a carbon dioxide blower during off-pump coronary artery bypass grafting. J Anesth 24:114–116

    Article  PubMed  Google Scholar 

  71. Khalil KF, Saeed W (2010) Pulmonary embolism in soldiers serving at high altitude. J Coll Physcians Surg Pak 20:468–471

    Google Scholar 

  72. Levett DZ, Millar IL (2008) Bubble trouble: a review of diving physiology and disease. Postgrad Med J 84:571–578

    Article  PubMed  CAS  Google Scholar 

  73. Barak M, Katz Y (2005) Microbubbles: pathophysiology and clinical implications. Chest 128:2918–2932

    Article  PubMed  Google Scholar 

  74. Flick MR, Perel A, staub NC (1981) Leukocytes are required for increased lung microvascular permeability after microembolisation in sheep. Circ Res 48:344–351

    PubMed  CAS  Google Scholar 

  75. Lachmann B, Eijking EP, So KL, Gommers D (1994) In vivo evaluation of the inhibitory capacity of human plasma on exogeneous surfactant function. Intensive Care Med 20:6–11

    Article  PubMed  CAS  Google Scholar 

  76. Surov A, Wienke A, Carter JM et al (2009) Intravascular embolization of venous catheter-causes, clinical signs and management: a systematic review. J Parenter Enteral Nutr 33:677–685

    Article  Google Scholar 

  77. Rossi SE, Godmann PC, Franquet T (2000) nonthrombotic pulmonary emboli. AJR Am J Roentgenol 174:1499–1508

    PubMed  CAS  Google Scholar 

  78. Sorgente A, Pedrazzini GB, Faletra FF et al (2008) Dislodgement of an Amplatzer occluder device causing iatrogenic pulmonary embolism in a patient with post-infarction ventricular septal defect. Eur Heart J 29:2698

    Article  PubMed  Google Scholar 

  79. Irie W, Furukawa M, Muakami C et al (2009) A case of V-A Shunt catheters migration into the pulmonary artery. Leg Med (Tokyo) 11:25–29

    Article  Google Scholar 

  80. Hill AD, Toner ME, Fitzgerald MX (1990) Talc in a drug abuser. Ir J Med Sci 159:147–148

    Article  PubMed  CAS  Google Scholar 

  81. Khanna D, Drehmer TJ (2001) Intravenous drug abuse mimicking vasculitis. South Med J 94:505–507

    PubMed  CAS  Google Scholar 

  82. Francis RA, Barnes PA, Libshitz HI (1983) Pulmonary oil embolism after lymphography. J Comput Assist Tomogr 7:170–171

    Article  PubMed  CAS  Google Scholar 

  83. Chung JW, Park JH, Im JG et al (1993) Pulmonary oil embolism after transcatheter oily chemoembolization of hepatocellular carcinoma. Radiology 187:689–693

    PubMed  CAS  Google Scholar 

  84. Kull E, Hernandez M, Richter JP et al (1999) Severe pulmonary embolism after obturation of gastric varices with a buty-cyanoacrylate and lipiodol combination. Gastroenterol Clin Biol 23:1095–1096

    PubMed  CAS  Google Scholar 

  85. Wai CT, Lin M, Tan KC (2008) Hepatobiliary and pancreatic: pulmonary embolism after injection therapy for gastric varices. J Gastroenterol Hepatol 23:1306

    Article  PubMed  Google Scholar 

  86. Prytula A, Veereman-Wauters G, Duval EL (2008) Pulmonary embolism due to injection of Histoacryl and Lipiodol during endoscopic sclerotherapy of fundic varices. Acta Gastroenterol Belg 71:387–389

    PubMed  CAS  Google Scholar 

  87. Famularo G, Liberati C, Sebastiani GD, Polchi S (2001) Pulmonary embolism after intra-articular injection of methylprednisolon and hyaluronate. Clin Exp Rheumatol 19:355

    PubMed  CAS  Google Scholar 

  88. Park HJ, Jung KH, Kim SY et al (2010) Hyaluronic acid pulmonary embolism: a critical consequence of an illegal cosmetic vaginal procedure. Thorax 65:360–361

    Article  PubMed  Google Scholar 

  89. Restrepo CS, Artunduaga M, Carrillo JA et al (2009) Silicone pulmonary embolism: report of 10 cases and review of the literature. J Comput Assist Tomogr 33:505–507

    Article  Google Scholar 

  90. Padovani B, Kasriel O, Brunner P, Peretti P (1999) Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJNR Am J Neuroradiol 20:375–377

    PubMed  CAS  Google Scholar 

  91. Bonardel G, Pouit B, Gontier E et al (2007) Pulmonary cement embolism after percutaneus vertebroplasty: a rare and nonthrombotic cause of pulmonary embolism. Clin Nucl Med 32:603–606

    Article  PubMed  Google Scholar 

  92. Rasch A, Sindermann J, Scheld HH, Hoffmeier A (2010) Pulmonary palacos embolism: a case report. Thorac Cardiov Surg 58:437–438

    Article  CAS  Google Scholar 

  93. Jang JS, Lee SH, Jung SK (2002) Pulmonary embolism of polymethylmethacrylate after percutaneous vertebroplasty: a report of three cases. Spine 27(19):E416–E418

    Article  PubMed  Google Scholar 

  94. Freitag M, Gottschalk A, Schuster M et al (2006) Pulmonary embolism caused by polymethylmethaacrylate during percutaneous vertebroplasty in orthopaedic surgery. Acta Anesthesiol Scand 50(2):248–251

    Article  CAS  Google Scholar 

  95. Zaccheo MV, Rowane JE, Costello EM (2008) Acute respiratory failure associated with polymethyl methacrylate pulmonary emboli after percutaneous vertebroplasty. Am J Emerg Med 26(5):636e5–636e7

    Article  Google Scholar 

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  1. Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland

    S. Meinardus, U. Mehlhorn, W. Kasper-König, O. Senbaklavaci, L. Poetini & C.F. Vahl

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  1. S. Meinardus
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Meinardus, S., Mehlhorn, U., Kasper-König, W. et al. Seltene Ursachen akuter, chirurgisch-interventionsbedürftiger Lungenembolien. Z Herz- Thorax- Gefäßchir 25, 66–72 (2011). https://doi.org/10.1007/s00398-011-0845-y

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