Clinical and echocardiographic hemodynamic assessment can be crucial in guiding surgical intervention for chronic pulmonary embolism presenting with cardiogenic shock, even when CT angiography does not show changes.
Echocardiographic hemodynamics may inform surgical decisions in chronic PE shock despite unrevealing CT; single case leaves open safety and generalizability.
We describe a 42-year-old man presenting to the emergency department with cardiogenic shock. He had a prior history of acute pulmonary embolism (PE), and had been on anticoagulation for 2 years. Although computed tomographic pulmonary angiography performed at the emergency department showed no change in the extent of PE and did not support a role of surgical treatment, pulmonary embolectomy was recommended by attending physician based on clinical and echocardiographic hemodynamic findings like unstable vital sign and markedly enlarged right ventricle with severely depressed systolic function. Surgery confirmed the presence of fresh thrombi. After surgery, hemodynamic status was progressively improved, but the patient died due to pneumonia and pulmonary hemorrhage.
No takes yet. Share an insight, caveat, or question.
Choe et al. (2011) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: