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Pulmonary Infarction: In the Beginning: The Natural History of Pulmonary Infarction.

Peter B Terry1, Philip Clay Buescher2

  • 1Division of Pulmonary, Critical Care, and Sleep Medicine, The Johns Hopkins Hospital, Baltimore, MD.

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Summary
This summary is machine-generated.

The time between pulmonary artery embolization and the onset of symptoms of lung infarction is at least 24 hours. This study investigated the temporal relationship in patients with hereditary hemorrhagic telangiectasia (HHT).

Keywords:
hereditary hemorrhagic telangiectasiapleurisypulmonary embolismpulmonary infarction

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Area of Science:

  • Cardiovascular Medicine
  • Pulmonary Medicine
  • Interventional Radiology

Background:

  • Massive pulmonary emboli cause sudden symptoms coinciding with large pulmonary artery occlusions.
  • The temporal relationship between smaller emboli, pulmonary vascular occlusion, and pulmonary infarction symptoms is not well understood.
  • This study addresses the time interval between embolization and the onset of clinical symptoms indicative of pulmonary infarction.

Purpose of the Study:

  • To determine the time interval between pulmonary arteriovenous malformation (PAVM) embolization and the onset of symptoms compatible with pulmonary infarction.
  • To investigate the temporal relationship in patients with hereditary hemorrhagic telangiectasia (HHT).

Main Methods:

  • Retrospective analysis of 56 patients with HHT who underwent therapeutic balloon embolization of PAVMs.
  • Calculation of the time interval between documented embolization procedures and the onset of clinical symptoms.
  • Identification of patients experiencing symptoms consistent with pulmonary infarction post-embolization.

Main Results:

  • Five patients with HHT reported pleuritic pain post-embolization; one experienced pain after two separate procedures.
  • Four of these patients developed symptoms consistent with pulmonary infarction.
  • The time intervals between embolization and symptom onset ranged from 24 hours to 67 hours (specifically 24, 48±4, 65, and 67 hours).

Conclusions:

  • A clinically silent interval of 24 hours or greater exists between pulmonary artery embolization and the development of symptoms and signs of lung infarction.
  • This finding is relevant for understanding the clinical presentation of pulmonary infarction following interventional procedures.