Introduction: Pulmonary embolism (PE) is a treatable condition, with a low mortality rate (of around 1% in those who are diagnosed with the condition). The risk of recurrent PE is well managed with long term anticoagulation. Past literature suggests that patients who are diagnosed with PE can go on to experience existential anxiety and symptoms suggestive of post-traumatic stress disorder (PTSD). This study aimed to evaluate the mental and emotional experiences of PE patients through the lens of PTSD, and the factors involved in psychological distress following a PE diagnosis. Methods: Semi-structured interviews were conducted with PE patients at the Juravinski Hospital thrombosis clinic in Hamilton, Ontario. Interview questions were based on DSM-5 criteria of PTSD and relevant existing literature. The transcripts were analyzed by two researchers based on an approach that considers both the content of patients’ accounts as well as the way that patients choose to interpret and deliver those accounts, to develop major themes associated with psychological distress. Results: A total of 37 patients, ranging from 28 to 85 years of age, were interviewed. The patients’ accounts suggested that the manner in which a PE diagnosis was delivered by an emergency physician was a significant factor in the degree to which they experienced psychological distress. For example, patients reported focusing on words suggesting that they were ‘a ticking time-bomb’ or that ‘a lot of people don't get through this,’ which introduced a degree of panic. A number of patients continued to focus on these words, months or years after their diagnosis. Some feared that they could have recurrent PE which could lead to death. Diagnoses that were delivered calmly with thorough explanations of why a patient experienced PE-related symptoms and how they will be treated, helped to minimize any subsequent anxiety. Patients initially misdiagnosed with an alternative condition in the ED also expressed feelings of anxiety and distress. The presence of physically and mentally distressing symptoms was also a factor which contributed to mental distress and anxiety regarding a PE recurrence. Conclusion: Caution should be taken in the delivery of PE diagnosis in the emergency department. Over-emphasis on the severity and life-threatening nature of PE should be avoided to reduce psychological distress.

A 20 year-old woman presented with systemic embolisation. On subsequent investigation, she was diagnosed with a congenital left atrial appendage aneurysm. Few case reports are reported in the literature. This cardiac malformation presents a diagnostic challenge in patients with cardiomegaly.

Left main coronary artery aneurysms are very infrequent (0.1%) and the majority is related to atherosclerotic obstructive lesions. We describe a young male having no conventional coronary risk factors presenting with acute inferior wall myocardial infarction. Coronary angiography revealed a prominent aneurysm of the left main coronary artery with selective extension towards the proximal left circumflex artery without associated coronary lesions.

We present detailed results for the motion of a finite-sized gas bubble in a blood vessel. The bubble (dispersed phase) size is taken to be such as to nearly occlude the vessel. The bulk medium is treated as a shear thinning Casson fluid and contains a soluble surfactant that adsorbs and desorbs from the interface. Three different vessel sizes, corresponding to a small artery, a large arteriole, and a small arteriole, in normal humans, are considered. The haematocrit (volume fraction of RBCs) has been taken to be 0.45. For arteriolar flow, where relevant, the Fahraeus–Lindqvist effect is taken into account. Bubble motion causes temporal and spatial gradients of shear stress at the cell surface lining the vessel wall as the bubble approaches the cell, moves over it and passes it by. Rapid reversals occur in the sign of the shear stress imparted to the cell surface during this motion. Shear stress gradients together with sign reversals are associated with a recirculation vortex at the rear of the moving bubble. The presence of the surfactant reduces the level of the shear stress gradients imparted to the cell surface as compared to an equivalent surfactant-free system. Our numerical results for bubble shapes and wall shear stresses may help explain phenomena observed in experimental studies related to gas embolism, a significant problem in cardiac surgery and decompression sickness.

Modern air-nailing tools are known to cause penetrating trauma. We report the unusual case of a pneumatically fired carpenter's nail that penetrated the chest of a 30-year-old man and subsequently embolized from the heart to the left femoral artery without clinical evidence of having entered the heart. The nail was surgically removed, and the patient was discharged from hospital without sequelae after 10 days. This case and the relevant literature are discussed from the perspective of the emergency department investigation and care of such patients.

Ischemia of the leg in a peripartum female is an uncommon condition. Paradoxical arterial embolisation, and arterial dissection, are rarely encountered but recognized causes of this clinical condition. Peripartum cardiomyopathy is a rare life-threatening cardiac condition that can foster intracardiac thrombosis and produce peripheral vascular complications through embolization. We present here the case of a young, healthy, postpartum female who developed acute ischemia of the left leg, and asymptomatic arterial insufficiency of the right lower leg, as the presenting symptoms of peripartum cardiomyopathy, highlighting the fact that ischemia threatening the loss of a limb can be the initial manifestation of peripartum cardiomyopathy.

A 41-year-old multigravida presented at 32 weeks of gestation with polyhydramnios and an anencephalic fetus. Abnormal bleeding as a result of disseminated intravascular coagulation complicated an emergency Caesarean section for severe abdominal pain thought to be due to uterine rupture. Massive transfusion with blood products was necessary and the abdomen packed to control bleeding. The patient was transferred to the intensive care unit where she made a slow but complete recovery. Amniotic fluid embolism with atypical presentation of isolated coagulopathy is the likely diagnosis in this case. The case serves to demonstrate that amniotic fluid embolism may present with symptoms and signs other than the classical pattern of dyspnoea, cyanosis and hypotension.

A 92-year-old female was scheduled for laparoscopic cholecystectomy. Following intraperitoneal carbon dioxide insufflation and removal of her gallbladder, the patient developed serious haemodynamic deterioration associated with a decrease of both end-tidal carbon dioxide concentration (ETCO2) and chest compliance. Carbon dioxide embolism was suspected and the diagnosis was confirmed by aspiration of 20 mL of foamy blood from the central venous line. The patient was successfully resuscitated after discontinuation of carbon dioxide insufflation and ventilation of the lungs with 100% oxygen. Carbon dioxide embolization must always be suspected during laparoscopic surgery whenever sudden haemodynamic deterioration associated with a decrease in ETCO2 and chest compliance occur.

We present a case of pulmonary embolism that occurred during the injection of lipiodol during transcatheter arterial chemoembolization under general anaesthesia. A 7-year-old child suffering from a large hepatoblastoma was admitted for arterial chemoembolization and carcinostatic administration. Pulmonary embolism due to lipiodol during arterial chemoembolization was evident by a sudden fall in oxyhaemoglobin saturation from 100 to 90%. This was associated with a spread of lipiodol into both lungs, particularly the middle lung zones and detected by chest fluoroscopy. Arterial blood gases returned to normal values 1 day later but pulmonary infiltration persisted for 7 days before final clearance. Pulmonary embolism caused by lipiodol during arterial chemoembolization is infrequent, but such a complication could prove fatal. Understanding the risk of pulmonary embolism in patients receiving lipiodol, during and after arterial chemoembolization, and late onset pulmonary injury is important and a close follow-up for several days after arterial chemoembolization is advisable.

Five evergreen subtropical tree species growing under identical environmental conditions were investigated to establish which hydraulic properties are genotypically rigid and which show phenotypic plasticity. Maximum xylem-specific conductivity (ks) correlated well with the anatomical characteristics (conduit diameter and density) for the four angiosperms Tecomaria capensis, Trichilia dregeana, Cinnamomum camphora and Barringtonia racemosa; the anatomy of the gymnosperm Podocarpus latifolius was not assessed. Huber values (functional xylem cross-sectional area [ratio ] leaf area) varied inversely with ks among species. Maximum leaf-specific conductivity was similar in the five unrelated species. Vulnerability of xylem to cavitation differed between species, as did the relationship between transpiration and water potential. Models of these parameters and isolated midday readings confirm that these trees operate at similar maximum leaf-specific conductivity (kl) values. The data are consistent with the hypothesis that conductivity characteristics (kl, ks) are influenced by environment, whereas vulnerability to cavitation is genetically determined.

Embolisms in the vessels of maize axile roots of different types were observed directly after rapid freezing of intact, functioning roots in the field, by cryo-scanning electron microscopy. Quantification of the degree of embolization in each root was made by counting empty and full vessels of both the late and early metaxylem (LMX & EMX), and expressed as percent embolized vessels of the LMX, and %EMX poles containing embolized vessels. Contents of the connecting xylem (CX) at branch root junctions, and of xylem in branch roots were observed also, but not systematically quantified. Records of % embolized vessels were made from dawn to dusk on summer days in Ottawa under moderate irradiance, and in Canberra under high irradiance. Measurements in Canberra were supported by estimates of irradiance, of stomatal conductance, and of chamber balance pressure of bagged and unbagged leaves. Soon after sunrise embolisms appeared in all types of vessel, at balance pressures c. 300–400 kPa, and increased rapidly with increasing irradiance. During the middle of the day % embolized vessels reached a maximum (LMX ≈70% in Ottawa, and ≈80% in Canberra). At all times the EMX vessels were less embolized. The midday maximum was brief in Ottawa, and % embolized vessels fell to a low value during the afternoon. In Canberra the maximum was prolonged into late afternoon. By dusk nearly all vessels were once again filled with sap. The balance pressures measured during vessel refilling in Canberra ranged from 500 kPa to 1200 kPa. At all times of the day sap was seen entering some embolized vessels. Almost all were refilling by mid- to late-afternoon. Such refilling was especially frequent at junctions of branch roots with the axile roots. X-ray microanalysis of the sap entering the vessels, and of the liquid filling or partly filling vessels, showed the concentration of mineral solutes present in the sap was below the threshold of detection (≈12 mM). These results are discussed in relation to current opinions about embolisms and vessel refilling.