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Fulminant pulmonary embolism with fatal outcome in a patient with low clinical prediction scores.

  • Degen C Department of Medicine, Kantonsspital Baselland, Liestal, Switzerland.
  • Poechtrager S Department of Medicine, Kantonsspital Baselland, Liestal, Switzerland.
  • Leibundgut G Department of Cardiology, Kantonsspital Baselland, University of Basel, Basel, Switzerland.
  • 2018-06-15
Published in:
  • BMJ case reports. - 2018
adult intensive care
interventional cardiology
pulmonary embolism
venous thromboembolism
Acute Disease
Aged
Angiography
Anticoagulants
Decision Support Techniques
Fatal Outcome
Heart Arrest
Heart Failure
Humans
Lung
Male
Pulmonary Artery
Pulmonary Embolism
Severity of Illness Index
Thrombosis
English We present a case of a 72-year-old man with submassive acute pulmonary thromboembolism. Pulmonary embolism severity index Score and common clinical risk stratification recommended systemic anticoagulation and a clinical course without complications was expected. A primary reperfusion strategy was not indicated by the current guidelines. Under established anticoagulation, the patient was found in cardiac arrest immediately after mobilisation from the bed the next morning. Right heart catheterisation under ongoing resuscitation revealed a complete obstruction of the right pulmonary artery by a big thrombus. Catheter-directed intervention trying to bypass the thrombus with interventional guidewires failed. Ultimately, the patient died from acute right heart failure. The current case raises concern that the prediction scores available for pulmonary embolism may insufficiently predict short-term outcome in isolated patients.
Language
  • English
Open access status
green
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https://sonar.ch/global/documents/92537
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