Management of perioperative acute massive pulmonary embolism: A case series

Figures

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  FIGURE 1. A, Traumatic subdural hematoma on the right temporal area of the patient was confirmed using brain computed tomography (CT) (arrow). B, Brain CT on the 11th day of admission, which was performed just before surgery. There was no significant difference in the hematoma volume observed immediately after admission. C, Brain magnetic resonance imaging (MRI) performed before discharge. Hypoxia‐induced encephalopathy was found along with hydrocephalus

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  FIGURE 2. Anesthesia timeline record of the patient showing unstable perioperative vital signs. At 14:40, cardiac compression was performed. At 14:50, central line catheterization and TEE were performed. At 15:15, the cardiothoracic surgeon was called. ECMO insertion was completed at 15:40. ABP, arterial blood pressure (mm Hg); BT, body temperature (°C); HR, heart rate (beats/min); NIBP, noninvasive blood pressure (mm Hg); RR, respiratory rate (breaths/min)

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  FIGURE 3. Chest computed tomography (CT) showing multiple pulmonary emboli (arrow)

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  FIGURE 4. A, Angiography shows pulmonary blood flow reduction (circle) due to the presence of multiple pulmonary emboli. Perfusion only occurs in the right and left upper lobes. B, Angiographic images after catheter‐directed thrombolysis. C and D, The pulmonary blood flow is better than that before the procedure

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  FIGURE 5. A, In the mid‐esophageal ascending aortic short‐axis view of transesophageal echocardiography, the embolus is clearly visible in the right main pulmonary artery (arrow). B, Mid‐esophageal aortic valve short‐axis view shows multiple emboli in the right atrium. (arrow). C, Mid‐esophageal 4‐chamber view shows dilated right ventricle and right atrium chambers and shifted interventricular septum. D, Chest computed tomography. Large pulmonary emboli (arrow) are seen in both main pulmonary arteries