Available online from MWHC library: 1935 - present, Available in print through MWHC library: 1999 - 2006
BACKGROUND: Massive pulmonary emboli can cause abrupt onset of symptoms simultaneous with large pulmonary artery occlusions. In contrast the temporal relationship between pulmonary vascular occlusion by smaller emboli and the development of pulmonary infarction symptoms is unknown. We describe the time interval between embolization and the onset of clinical symptoms and signs compatible with pulmonary infarction. CONCLUSION: The clinically silent time interval between embolization of a pulmonary artery and the onset of symptoms and signs compatible with lung infarction is 24 hours or greater. Copyright (c) 2017. Published by Elsevier Inc. METHODS: We examined the records of fifty six patients with Hereditary Hemorrhagic Telangiectasia (HHT) undergoing therapeutic balloon embolization of pulmonary arteriovenous malformations (PAVM's) in a single center after noting that some developed symptoms and signs compatible with pulmonary infarction. Because both the times of embolization and the onset of clinical symptoms were documented in medical records, we were able to calculate the time interval between embolic occlusions of vessels and the onset of symptoms. RESULTS: The records of 56 patients undergoing therapeutic embolization for HHT were examined. Five patients developed a single episode of pleuritic pain post embolization and one patient developed episodes of pleuritic pain after each of two separate embolization procedures. Four of these pleuritic pain events evolved into a complex compatible with a pulmonary infarction. The time intervals between embolization and the onset of pleuritic pain in those developing the infarction symptoms and signs were; 24 hours , 48+/-4 hours, 65 hours, and 67 hours.