The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 305
Poster Session
PS 1222 Cardiology
Thread-Like Bone Cement in the Right Side Heart Causing Diffuse Pulmonary Embolism: A Rare Late Complication
Jin Kyung Oh1, Jae-Hyeong Park1, Jae-Hwan Lee1, Jin-Ok Jeong1, Moon Sang Ahn2, Song Soo Kim3
Department of Internal medicine, Chungnam National University School of Medicine, Korea1, Department of General Surgery, Chungnam National University School of Medicine, Korea2, Department of Radiolo- gy, Chungnam National University School of Medicine, Korea3
Pulmonary embolism (PE) is usually associated with deep vein thrombosis (DVT) in the lower extremities. However, foreign bodies in the pulmonary arteries can cause PE, rarely. In this report, we present a case of diffuse PE which was associated with a migrated thread-like structure of the right side heart and pulmonary arteries in a 70 year-old woman. The patient was admitted to the emergency room with a pro- gressive dyspnea for about 2 weeks. On physical examination, there was no evidence of unilateral leg edema. The chest radiography showed high density in T6, T11 and L2 vertebrae suggesting previous percutaneous vertebroplasty (PV). The transthoracic echocardiogram showed about 6cm long hyperechogenic thread like structure, going from the right ventricle (RV) to main pulmonary artery (Fig. 1). Multidetector comput- erized tomography (MDCT) scan demonstrated a long radiopaque thread like structure in the RV, RV outfl ow tract, main pulmonary trunk, right main pulmonary artery and several obstructed pulmonary arteries, pulmonary trunk associated with thread like structure (Fig. 2). The patient underwent several episodes of PV about 2 years ago to treat compression fractures of vertebral body. Based on patient’s past history and interpretation of the MDCT scan, we identifi ed that the thread-like foreign body was the bone cement injected during the previous PV procedure. After being treated with anticoagulation therapy, the patient’s symptoms were relieved, and follow-up CT scan revealed decreased extent of thrombus in the pulmonary arteries. We present this case study to emphasize that clinicians should consider the possibility of PE as a late com- plication, especially those with history of PV.
PS 1223 Cardiology
Resting Diastolic Parameters Predicting Exercise Capac- ity in Patients with Normal Coronary Arteries
Kwang-In Park1, Mi Joo Kim1, Jin Kyung Oh1, Jun Hyung Kim1, Jae Hwan Lee1, Si Wan Choi1, Jin Ok Jeong1, In Whan Seong1, Jae Hyeong Park1
Department of Internal Medicine, Chungnam National University Hospital, Korea1
Background: Exercise capacity is affected by various factors including age, gender, coronary artery disease, and coexisting medical conditions. However, it is unclear the association of resting diastolic indices and exercise capacity in patients with normal coronaries. We want to evaluate the association.
Methods: From September 2011 to September 2013, all consecutive patients under- went treadmill exercise test (TMT) and echocardiography within 1 week were screened.
Patients with signifi cant coronary artery stenosis (diameter stenosis =50%) and signif- icant valvular heart diseases were excluded.
Results: We analyzed total 220 patients (114 males, mean 59±10 years old) with normal coronary arteries confirmed by coronary angiography. Major indication of TMT was chest pain (77%). Their mean exercise capacity in metabolic equivalents (METs) was 9.1±2.9METs, baseline blood pressure was 125±16/70±11mmHg, and heart rate was 69±12/min. Males showed higher METs than females (9.7±2.7 vs 8.4±3.0, P<0.001). METs showed signifi cant correlations with age (r=-0.532, P<0.001), LA size index (r=-0.277, P<0.001), mitral E/A ratio (r=0.305, P<0.001) and mitral E/e’ ratio (r=- 0.369, P<0.001). After adjustment of age and gender, mitral E/e’ ratio demonstrated statistical significance with METs (Standardized coefficient Beta=-0.191, P=0.002).
Moreover, patients with resting E/e’ >15 revealed lesser METs than controls (4.8±0.9 vs. 9.2±2.8, P<0.001).
Conclusions: Among resting diastolic indices, mitral E/e’ ratio showed signifi cant cor- relation with exercise capacity measured with METs after age and gender adjustment.
Baseline mitral E/e’ >15 may be used in the prediction of decreased exercise capacity in patients with normal coronaries.
PS 1224 Cardiology
Sequential Bilateral Rectus Sheath Hematoma after Anticoagulation
In-Ho Yang1, Hyae min Lee1, Hui-Jeong Hwang1, Eun-Sun Jin1, Chang-Bum Park1 Department of Cardiology, Kyung Hee University Hospital at Gangdong, Korea1
Background: Anticoagulation therapy such as warfarin and low molecular weight heparin (LMWH) has numerous indications in atrial fi brillation, deep vein thrombo- sis (DVT), pulmonary thromboembolism (PTE), cardiac valve replacement, and acute myocardial infarction. However, these medications can cause bleeding complications, including rectus sheath hematoma (RSH). We report a case of sequential bilateral RSH after anticoagulation.
Case report: An 84-year-old female admitted to our department after diagnosis of acute PTE. Warfarinization was initiated overlapping with unfractionated heparin. Sud- den abdominal pain developed and blood pressure was 90/50mmHg on 9th hospital day. Hemoglobin level dropped from 11.6 to 7.3 g/dL. Computed tomography imaging showed a left RSH with active bleeding. Urgent coil embolization was done for left inferior epigastric artery. Vital sign and hemoglobin level became stable after embo- lization. We initiated LMWH instead of warfarin in the consideration of acute PTE.
However, recurrent abdominal pain and decrease of hemoglobin level developed on day 2 after change to LMWH. Recheck CT imaging showed a left RSH with embolized coil and a newly developed right RSH. Re-coil embolization was done for right inferior epigastric artery. Vital sign and hemoglobin level became stable after embolization.
The patient discharged without complications.
Conclusion: RSH is a rare but potentially life-threatening condition. Guidelines for reinitiation of anticoagulation are needed in near future and clinical judgement must be weighed between the risks and benefi ts of re-anticoagulation therapy after a diag- nosis of RSH.
