Fulminant pulmonary embolism with fatal outcome in a patient with low clinical prediction scores. (13th June 2018)

• Record Type: Journal Article
• Authors: Degen, Christian; Poechtrager, Severin; Leibundgut, Gregor
• Is Part Of: BMJ case reports. Volume 2018
• Publication Date: 2018-06-13
• Subjects: interventional cardiology -- venous thromboembolism -- adult intensive care -- pulmonary embolism; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2018-224793
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : 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.