Diagnosis and management of acute pulmonary thromboembolism: case report

Authors

DOI:

https://doi.org/10.56294/saludcyt2023389

Keywords:

Pulmonary Embolism, Alveolar Hemorrhage, Respiratory Insufficiency, Hyperosmolar Hiperglycemic State

Abstract

Background: Pulmonary Thromboembolism (PTE) is an important cause of hospitalization, morbidity and mortality. At the present time it represents one of the most frequent cardiovascular diseases.
Case report: a 73-year-old female patient with various comorbidities, who was admitted due to severe respiratory distress and hemodynamic instability, was diagnosed with pneumonia, pulmonary hypertension, and a Computed Axial Tomography revealed a tumor mass with alveolar hemorrhage.
Evolution: during the hospital stay, the patient maintained high oxygen needs and hemodynamic instability despite support maneuvers. The alveolar hemorrhage that she presents determines the prophylactic thrombus treatment. The imaging study indicates a tumor mass associated with alveolar hemorrhage and a very high probability of developing deep vein thrombosis (DVT) and subsequent pulmonary thromboembolism (PTE). Reason for which FAST echo was performed, which evidenced deep vein thrombosis in the right common femoral vein, total occlusion of the superficial femoral artery with preserved flow in the deep femoral artery. Absent distal pulses with arterial flow in monophasic anterior tibial with high diastole IR: 0,6, and Ankle arm index 0,5, posterior echocardiogram with dilation of the right cavities, PSAP of 54 mmHg and McConnel's sign. Patient intervenes with a massive pulmonary thromboembolism that results in death.
Conclusions: pulmonary embolism is a pathology that occurs in 1 per 1000 cases. Individualizing each case can be decisive to safeguard the life of a patient

References

1. Pérez Domínguez Julio Alberto, Ortega Varón Yalili Ramona, Leblanch Pérez Lisett, Medel Avíles Odalis, Rodríguez Peña Marian Maité. Factores influyentes en la muerte por tromboembolismo pulmonar. Multimed. 2021;25(3):e1974.

2. Lucena Romero Joaquín, Laborda Gálvez José L, Rodríguez González Lucía. Tromboembolismo pulmonar como causa de muerte súbita inesperada en personas de 1-35 años. CorSalud. 2017 ;9(3):215-217.

3. Sandoval Jorge, Florenzano Matías. Diagnóstico y tratamiento del Tromboembolismo Pulmonar. Revista Médica Clínica Las Condes. 2015;26(3):338–343. https://doi.org/10.1016/j.rmclc.2015.04.021

4. Miranda GLH, Linares RG, Robaina DS, León R de la CR. Análisis de la producción científica sobre uso de la ecografía en la reanimación cardiopulmonar en Scopus. Data & Metadata 2023;2:37. https://doi.org/10.56294/dm202337.

5. Finkelhor, R., Scrocco, J., Madmani, M., Rovner, A., & Pillai, D. Limitations and Strengths of Doppler/Echo Pulmonary Artery Systolic Pressure–Right Heart Catheterization Correlations: A Systematic Literature Review. Echocardiography. 2014;32(1):10–18. https://doi.org/10.1111/echo.12594

6. Galiè, N., Hoeper, N., Humbert, M., Torbicki T. Guidelines for the diagnosis and treatment of pulmonary hypertension. European Respiratory Journal. 2019;34(6):1219–1263. https://doi.org/10.1183/09031936.00139009

7. Lewis, J., & Hopkins, W. Clinical features and diagnosis of pulmonary hypertension of unclear etiology in adults. UpToDate. 2023. https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-pulmonary-hypertension-of-unclear-etiology-in-adults?search=pulmonary%20hypertension&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

8. Thompson, B. T., Kabrhel, C., & Peña, C. Clinical presentation, evaluation, and diagnosis of the nonpregnant adult with suspected acute pulmonary embolism. UpToDate. 2022. https://www.uptodate.com/contents/clinical-presentation-evaluation-and-diagnosis-of-the-nonpregnant-adult-with-suspected-acute-pulmonary-embolismsectionName=CLINICAL20PRESENTATION&search=pulmonary%20thromboembolism&topicRef=8253&anchor=H456585787&source=see_link#H456585787

9. Raja, A., Greenberg, J., Qaseem, A., Denberg, T., Fitterman, N., & Schuur, J. Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Annals Of Internal Medicine. 2015;163(9):701–11. https://doi.org/10.7326/M14-1772

10. Di Marca, S., Cilia, C., Campagna, A. Comparison of Wells and Revised Geneva Rule to Assess Pretest Probability of Pulmonary Embolism in High-Risk Hospitalized Elderly Adults. Journal of The American Geriatric Society. 2015;63(6):1091–1097. https://doi.org/10.1111/jgs.13459

11. Weekes, A., Thacker, G., Troha, D., Johnson, A., Chanler-Berat, J., Norton, H., Runyon, M. Diagnostic Accuracy of Right Ventricular Dysfunction Markers in Normotensive Emergency Department Patients With Acute Pulmonary Embolism. Ann Emerg Med. 2016;68(3):277–91. https://doi.org/10.1016/j.annemergmed.2016.01.027

12. Rodger, M., Le Ga, G., Wells, P., Baglin, T. Clinical decision rules and D-Dimer in venous thromboembolism: current controversies and future research priorities. Thromb Res. 2014;134(4):763–8. https://doi.org/10.1016/j.thromres.2014.07.031

13. Farm, M., Siddiqui, A., Onelöv, L., Järnberg, I., Eintrei, J. Age-adjusted D-dimer cut-off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays. Journal of Thrombosis and Haemostasis. 2018;16(5):866–875. https://doi.org/10.1111/jth.13994

14. Shopp, J., Stewart, L., Emmett, T., & Kline, J. Findings From 12-lead Electrocardiography That Predict Circulatory Shock From Pulmonary Embolism: Systematic Review and Meta-analysis. Academic Emergency Medicine. 2015;22(10):1127–1137. https://doi.org/10.1111/acem.12769

15. Vinson, D., Ballard, D., Mark, D., Huang, J. Risk stratifying emergency department patients with acute pulmonary embolism: Does the simplified Pulmonary Embolism Severity Index perform as well as the original? J Thromb Research. 2016;148:1–8. https://doi.org/10.1016/j.thromres.2016.09.023

16. Barco, S., Ende-Verhaar, Y., C, B., Jimenez, D., Lankeit, M., Huisman, M., Konstantinides, S., & Klok, F. Differential impact of syncope on the prognosis of patients with acute pulmonary embolism: a systematic review and meta-analysis. European Heart Journal. 2018;39(47):4186–4195. https://doi.org/10.1093/eurheartj/ehy631

17. Marder, V. Thrombolytic Therapy. Consultative Hemostasis and Thrombosis. 2013;3:526–537. https://doi.org/10.1016/B978-1-4557-2296-9.00028-2

18. Jiménez, D., Bikdeli, B., Barrios, D., Morillo, R. Management appropriateness and outcomes of patients with acute pulmonary embolism. European Respiratory Journal. 2018;51(5):1800445. https://doi.org/10.1183/13993003.00445-2018

19. Konstantinides, S., Meyer, G., Becattini, C., Bueno, H. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). European Heart Journal. 2020;41(4):543–603. https://doi.org/10.1093/eurheartj/ehz405

20. Duffett L, Castellucci LA, Forgie MA. Pulmonary embolism: update on management and controversies. BMJ. 2020;370:m2177. https://doi.org/10.1136/bmj.m2177

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Published

2023-05-25

How to Cite

1.
Ortiz Freire EB, Lema Guaraca CA, García Sarmiento PM, Ortiz Freire GE, García Sarmiento MS, Maldonado Cabrera RA. Diagnosis and management of acute pulmonary thromboembolism: case report. Salud, Ciencia y Tecnología [Internet]. 2023 May 25 [cited 2025 Apr. 15];3:389. Available from: https://sct.ageditor.ar/index.php/sct/article/view/281