P376 HIGH RISK PULMONARY EMBOLISM COMPLICATED BY CARDIOGENIC SHOCK

Abstract

Abstract The case concerns a 62–year–old woman with no significant cardiovascular history. In October 2022 the patient had an acute diverticulitis hesitated in ostomy placement (Hartmann surgery). Post surgery was complicated by linezolid–resistant Staphylococcus aureus sepsis. During the hospitalization an incidental low risk pulmonary embolism was detected by CTPA. The patient was discharged with thrombohaembolic prophylaxis (subcutaneous LMWH) to be continued for one month. The day after the end of the prophylaxis (November 24th ) she came to the emergency room because of chest pain, dyspnoea, diaphoresis. Hypotension, tachycardia, metabolic alkalosis and increased serum lactate levels were present. CTPA revealed thrombi in both left and right pulmonary arteries, including main bifurcation branches. Compressive ultrasonography in left popliteal vein resulted positive. Due to recent surgery, although not entirely contraindicated, the patient was judged unfit for systemic thrombolysis and percutaneous catheter–directed treatment with Penumbra Indigo system was performed, with suboptimal result. The woman was therefore moved to intensive care unit due to worsening clinical conditions, and the following day a further percutaneous procedure was performed. During the days CTPA and laboratory data detected a great improvement, and reduction of inotropes, diuretic and high flow oxygen therapy was possible. Meanwhile there was a gain of function in right ventricular contractility, with final TAPSE value of 15, and S’ 8 cm/s. Oral anticoagulation with loading dose and rehabilitation therapy were started . The patient was discharged on November 9th in good health.