Intermediate high risk pulmonary embolism: indications for catheter-directed thrombolysis: a case report

Acute pulmonary embolism (PE) is the third leading cause of cardiovascular mortality and presents a complex treatment challenge and prompt treatment is critical to reduce mortality.Treatment includes supportive measures, anti-coagulation and reperfusion strategies in severe cases.This is the case of a 72 year old patient with past medical history of former smoker, diabetes mellitus type 2 and hyperlipidemia who presented to the emergency department with dyspnea on exertion, shortness of breath and near syncope associated with flu-like symptoms.Differential diagnosis included pneumonia, pulmonary embolism and chronic obstructive pulmonary disease (COPD) exacerbation.Computed tomography angiography (CTA) remarkable for pulmonary embolism involving the right and left main artery.During evaluation Pulmonary Embolism Severity Score (PESI) Class III, classified as intermediate risk.Patient was started on full dose anti-coagulation but, given high risk of deterioration and systemic thrombolytics contraindication, catheter directed embolectomy was performed.In this case we discuss the importance of risk stratification for pulmonary embolism and treatment options.