Management of acute pulmonary embolism following chest trauma in a resource limited setting – A case report

Abstract

Introduction: Pulmonary embolism is a known complication among trauma patients and contribute to significant mortality and morbidity. In the setting of trauma, the signs and symptoms of VTE may be masked. Therefore, a high index of suspicion and timely intervention can improve outcome.
 Presentation of case: A 57-year-old healthy female presented with a history of fall from a train, into a gap between the train and the platform. She had sustained cerebral contusions in the frontal lobes and right sided lung contusion. She was resuscitated and managed in the trauma ICU and send to a ward.
 She desaturated in the ward and followed by a cardiac arrest. Bed side 2D echocardiogram and CT pulmonary angiogram were suggestive of PE. Thrombolysis was followed by clot retrieval. Patient was discharged home on day 13 after cardiac arrest on warfarin therapy.
 Discussion: Causes for PE are multi-factorial. Failure to initiate prophylaxis therapy for deep vein thrombosis in trauma victims is a major cause for PE. Management of PE in a haemodynamically unstable patient with a background history of trauma is challenging. Neuro-imaging revealed bi frontal cerebral contusions hence, the treatment of choice was clot retrieval. However, due to limited resources and logistics, medical thrombolysis was initiated with the involvement of a multidisciplinary team. Clot retrieval was initiated within 14 hours of diagnosis.
 Conclusion: Clinical suspicion and early diagnosis of PE can improve outcomes. Management is challenging in a low & middle income countries, where resources are limited. In the presence of contraindications and failed thrombolysis, clot retrieval remains an important aspect in the management of PE.