Conservative treatment for patients with high-risk massive pulmonary embolism

Rationale: Acute pulmonary embolism (PE) is the most serious complication of venous thromboembolism. A high-risk PE is associated with high mortality as it may manifest as shock. Although there is a guideline, sometimes it cannot be implemented optimally. Therefore, conservative treatment is given. In this article, we report 2 cases of high-risk PE treated conservatively with anticoagulants. Patient concerns: In the first case, a 54-year-old woman presented with a chief complaint of sudden dyspnea. She had a history of open left supracondylus femur fracture. In the second case, a 53-year-old woman presented with chief complaints of sudden dyspnea and atypical right sided chest pain. She had a history of neglected right collum femur fracture. Diagnoses: Diagnosis of PE was made in both cases based on the results from electrocardiogram, chest X-ray, and echocardiography evaluation. In addition, computed tomography pulmonary angiography was also performed in the first case. Interventions: Conservative treatment with anticoagulant was chosen because of limited resources for surgery or intervention since both patients refused thrombolytic therapy and refused to be referred. Outcomes: The symptoms of both patients were resolved, and the clinical condition was improved. Imaging evaluation with TEE and duplex ultrasound 1 week later showed good results. Follow-up 3 months afterwards showed that both patients were alive and well without any complaints. Lessons: Acute PE with high-risk condition is life-threatening, that is sometimes difficult to diagnose as it varies in clinical symptoms. Sudden onset dyspnea with signs of shock indicates higher mortality. Echocardiography and computed tomography pulmonary angigraphy evaluation are reliable tools for diagnosis. With Conservative treatment using anticoagulant and routine follow up, patients with acute PE can be managed well.