Tracheobronchial Obstruction Due to Blood Clots in Acute Pulmonary Embolism with Cardiac Arrest Managed with Extracorporeal Membrane Oxygenation

Figures

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  Figure 1.. Echocardiography and contrast-enhanced CT images obtained at admission to the hospital (A, B). The right ventricle was significantly dilated (asterisk), resulting in flattening of the intraventricular septum (arrows). (C, D, E) Emergency CT showed a thrombus in the bilateral pulmonary artery (red arrows) as well as parenchymal infarction in the left lower lobe (yellow arrows). CT: computed tomography

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  Figure 2.. Bronchoscopy findings on the third hospitalization day. (A) The intubation tube was obstructed by a blood clot. (C) Unsuccessful removal of the tracheobronchial blood clot using flexible bronchoscopy, suctioning, and endobronchial forceps.

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  Figure 3.. Contrast-enhanced CT images. Coronal (A, B) and axial (C, D, E, F) images of the chest before removal of a blood clot on the fourth hospitalization day. CT imaging revealed a blood clot obstructing the space from the trachea to the bilateral mainstem bronchi (red arrows). Atelectasis was seen in the bilateral upper lobe, but active bleeding was not found (asterisks). CT: computed tomography

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  Figure 4.. Bronchoscopy findings on the fifth hospitalization day. (A, B) Successful removal of the tracheobronchial blood clot using flexible bronchoscopy, endobronchial forceps, a Fogarty catheter, and urokinase. (C, D) The blood clot was extracted from the tracheobronchial airway.

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  Figure 5.. Contrast-enhanced CT images. Axial (A, B) and coronal (C, D) images of the chest after removal of a blood clot. After successful attempts to remove the blood clot, patency was achieved in the trachea and the bilateral mainstem bronchi (red arrows). CT: computed tomography

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  Figure 6.. CT images before and after the treatment of Klebsiella pneumonia. (A, B) CT images taken on the eighth hospitalization day. A new consolidation, an abscess (red arrows), and porosis (asterisks) were all found in the right lower lobe, suggesting the development of Klebsiella pneumonia. (C, D) CT images taken after treatment with meropenem and ceftriaxone on the 39th hospitalization day. CT: computed tomography