**6. Conclusion**

HIT is an important clinical entity to recognize as it creates a prothrombotic state that can lead to a variety of thromboembolic and systemic consequences. These most commonly include DVT and PE, though arterial thrombosis, acute myocardial infarction, stroke, acute adrenal insufficiency, and other serious complications can occur. Patients with HIT given an IV bolus of heparin may experience acute systemic reactions that can simulate pulmonary embolus or sepsis and even lead to cardiac arrest. Treatment includes discontinuation of all UFH and LMWH. A thorough search for surreptitious sources of heparin exposure should be performed. An alternative, non-heparin anticoagulant, such as a DTI should be started. HIT should be considered in patients who develop DVT or PE who are either receiving or have recently discontinued heparin. Intravenous heparin or LMWH should not be utilized to treat thrombosis in these situations. In the future, newer DTI's and possibly factor Xa inhibitors may simplify treatment and reduce cost in managing this condition.

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**12** 

*Serbia* 

**Cavitary Pulmonary Infarct: The Differential** 

Pulmonary infarction is localized destruction (necrosis) of lung tissue by blocking (obstruction of) the arterial blood supply. It follows an embolic event in ~10% of cases. Blockage of pulmonary artery by a clot or air bubble or other particle (called pulmonary embolism) leads to localized damage of lung tissue which results in pulmonary infarction (1, 2). The reasons for this low incidence of pulmonary infarct are the dual blood supply

The predisposing factors for pulmonary infarct include congestive heart failure, pleural effusion, pulmonary infection, atelectasis, hypotension, positive-pressure ventilation, chronic lung disease, central venous catheterization and an immunocompromised state. It is more common in people with chronic heart and lung diseases. Infarction condition may be

Common symptoms include chest pain which may be because of difficulty in breathing, high pulse rate, mild fever, developing of fluid in the lungs, a productive cough (sputum may be blood-tinged). Blockage may also result into circulatory breakdown, like low blood pressure, presence of very little oxygen in the blood. Also, swelling of neck vein and leg, weakness, restlessness, and fainting. In the case of infection as developing complication, there is worsening of the clinical status, persistent fever, malaise, sweating, increasing pulse

Diseases that should be listed in the differential diagnosis include bacterial pneumonia, aspergillosis, tuberculosis, norcardia, actinomycosis, and granulomatous vasculitis. Other unusual etiologies that should be listed in the differential diagnosis include primary or metastatic angiosarcoma or leomyosarcoma and lung cancer invading the main pulmonary

Bacterial pneumonia and pulmonary infarction frequently mimic each other clinically, indicates that most methods for distinguishing between these illnesses are unsatisfactory. Both diseases may give rise to dyspnea, pleuritic pain, tachypnoea, fever, cyanosis, hypotension,

Shaking chills point strongly to bacterial pneumonia. Additional hints are a preceding upper respiratory tract infection followed by gradually increasing malaise and then cough, usually

cough, hemopthysis, jaundice, leukocytosis and similar radiographic abnormalities (8).

systems, as well as oxygenation of the lung tissues via ventilation (3).

rate and leukocytosis (usually more than 20 x 109/l) (5).

**1. Introduction** 

arteries (6,7).

**2. Clinical presentation** 

mild and can be rapidly fatal (4).

**Diagnostic Dilemma – A Case Report** 

Ivanka Djordjevic and Tatjana Pejcic *Clinic for lung diseases; Clinical Center – Nis,* 

