Abstract
We describe a case of a young male who presented with acute onset progressively worsening shortness of breath for four days duration. He used to smoke cigarettes, and his profession required prolonged periods of standing. He underwent a two-dimensional echocardiogram showing right ventricular (RV) strain and computed tomography (CT) showing thrombus in the left major pulmonary artery. His pulmonary embolism severity index (PESI) score was high, predicting higher short-term mortality. Treatment options including risks and benefits were discussed with the patient, and he underwent catheter-directed thrombolysis (CDT) with rapid resolution of symptoms, oxygen saturation, and pulmonary artery pressures (PAP). He was discharged home safely after successful treatment of his condition.
Highlights
Pulmonary embolism (PE) remains an underdiagnosed and life-threatening clinical condition [1]
We present a case of a young male with submassive PE treated with catheter-directed thrombolysis (CDT) with alteplase
Treatment options can be grouped into systemic full-dose thrombolysis, systemic low-dose thrombolysis, catheter-directed interventions, anticoagulation alone, and surgical treatment
Summary
Pulmonary embolism (PE) remains an underdiagnosed and life-threatening clinical condition [1]. Myocardial causes such as myocardial infarction or cardiomyopathy such as dilated or restrictive cardiomyopathy can be excluded by the combination of history, physical examination, and ECG and echocardiogram. Initial inferior vena cava (IVC) angiogram was done through a hand injection with iodinated contrast through the femoral venous sheath This step is important to avoid missing any thrombus in route of catheter advancements and avoid catastrophic outcomes where the thrombus present in IVC can be further advanced to the heart and pulmonary circulation. His effort tolerance continues to be unlimited, and he did not show any signs of chronic thromboembolic pulmonary hypertension
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