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This article details the experience at a single center with the evolving trends in management of pulmonary embolism (PE). Treatment is guided by proper identification and risk stratification. Direct oral anticoagulants are now the preferred method for outpatient management of PE, especially in low-risk populations, in which they were used for 56% of discharge medications. PE response teams have grown in popularity and are activated for intermediate and high-risk PE to determine whether advanced therapies are warranted. Intermediate-risk patients were mostly treated with anticoagulation, but approximately 22% received ultrasound-assisted thrombolysis with EKOS. High-risk PE is the most fatal and required advanced therapies in more than 70% of the patients, and 51% received some form of thrombolytic therapy. Objective: Pulmonary embolism (PE) is the third leading cause of cardiovascular death. The objective of this study was to examine the current management of pulmonary embolism at a single academic institution. Methods: With institutional review board approval, we conducted a retrospective chart review of 805 encounters among 775 patients presenting with acute PE from January 1, 2016 to June 30, 2019. We used American Heart Association guidelines for PE risk stratification. Results: In total, 409 patients were given the low-risk designation, 377 of these patients (92%) were anticoagulated with heparin or enoxaparin, and 32 patients (8%) were given a direct oral anticoagulant alone. There were two in-hospital mortalities (0.5%) in the low-risk group; 322 patients were in the true intermediate-risk category (ie, did not progress to high risk), and 320 patients received anticoagulation with heparin or enoxaparin (99.4%). Seventy-three patients (22%) received catheter-directed thrombolysis. There were eight in-hospital mortalities (2.5%) among the intermediate-risk group; eight intermediate-risk patients progressed to high-risk during their hospital stay, resulting in 6 in-hospital mortalities (75%) in this group. There were 66 patients designated as high-risk upon presentation. Sixty patients (91%) received heparin for anticoagulation and 47 patients (71%) required advanced therapies. Fourteen high-risk patients (21%) had bleeding complications, and there were 26 (39%) in-hospital mortalities. Conclusions: The management of PE has evolved, and proper risk stratification is key. Largely speaking, low- and intermediate-risk patients can be treated with anticoagulation, whereas patients with severe right ventricular strain and hemodynamic instability may require more advanced therapies. [ABSTRACT FROM AUTHOR]

(1) Objective: Lung cancer is one of the leading causes of cancer death among men and women across the globe. The accurate and timely diagnosis of lung lesions is of paramount importance for prognosis. This single-center study is the first to assess the diagnostic yield and complication rate of a computed tomography (CT)-guided needle biopsy of pulmonary parenchymal and pleural nodules in an academic training center in the United States. (2) Methods: This is a retrospective study approved by IRB. Patients who underwent CT-guided needle biopsy between 2016 and 2020 were reviewed. A CT-guided needle biopsy involving mediastinal lesions was excluded, focusing only on lung parenchymal and pleural lesions. A CT-guided needle biopsy aborted at any point during the procedure was also excluded from this study. (3) Results: 1063 patients were included in this study; 532 were males, and 531 were females. Lesion size ranged from 0.26 cm to 9.2 cm. 1040 patients received diagnoses, among which 772 had a specific diagnosis, and 268 had nonspecific inflammatory or non-malignant diagnoses. Twenty-three cases were non-diagnostic. Among the patients with specific diagnoses, 691 were malignant, 5 were hamartomas, 30 were fungal infections, 6 were acid-fast-positive organisms, and 40 were unspecified atypical cells. Of the patients that had a malignant diagnosis, 317 were adenocarcinoma, 197 were squamous cell carcinoma, 26 were a neuroendocrine tumor, 45 were non-small cell carcinoma (undifferentiated), 17 were small cell carcinoma, and 89 were other metastatic malignancies to the lung. Various common complications, including pneumothorax (337), hemorrhage (128), and hemoptysis (17), were observed, and 42 of the cases required chest tube intervention; others were treated with observation. Other rare complications observed included hemothorax (4) and oxygen desaturation (2), and there was no death in this series. (4) Conclusions: CT-guided needle biopsy is a reliable diagnostic modality for patients with lung parenchymal and pleural nodules, and it can effectively distinguish between benign and cancerous lesions before invasive procedures such as video-assisted thoracoscopy (VATs) or thoracotomy are planned. Our study showed a higher rate of pneumothorax and pulmonary hemorrhage compared to the rates established in guidelines, attributable to the varying experience level in a busy training academic center. [ABSTRACT FROM AUTHOR]