What is the clinical evidence from this study?

Study design: Case Report. Population: Submassive Pulmonary Embolism (n=1). Intervention: Endovascular catheter-directed tissue plasminogen activator (tPA) and IVC filter.

What question did this study set out to answer?

To report the clinical presentation, bedside echocardiographic features, and acute management of severe right ventricular dilation caused by submassive pulmonary embolism.

January 1, 2018Journal of Education and Teaching in Emergency MedicineOpen Access

Right Ventricular Dilation in Patient With Submassive Pulmonary Embolism

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Key result

A 73-year-old female with submassive pulmonary embolism and right ventricular dilation was successfully diagnosed using point-of-care ultrasound and treated with catheter-directed tPA.

Population

73-year-old female with a past medical history of tracheobronchomalacia, obstructive sleep apnea, diabetes…

Design

Case_report

Follow-up

7 days

Authors

ADAdrian Diez CBChristopher Bryczkowski

Discussion

Member takes

Implication

May support POCUS and catheter-directed tPA in select submassive PE cases; hypothesis-generating and leaves open need for prospective validation.

Key Points

To report the clinical presentation, bedside echocardiographic features, and acute management of severe right ventricular dilation caused by submassive pulmonary embolism.
Evaluated a 73-year-old female presenting to the emergency department with acute dyspnea, leg swelling, and multiple cardiopulmonary comorbidities (N=1).
Performed point-of-care bedside echocardiography to assess right heart strain, followed by cardiac biomarker testing and chest computed tomography angiography.
Bedside echocardiography revealed severe right ventricular dilation with an enlarged RV-to-LV ratio exceeding 1:1 and no large pericardial effusion.
Laboratory testing demonstrated elevated Troponin T at 0.03 ng/mL (normal ≤ 0.02 ng/mL), and CT angiography confirmed extensive bilateral pulmonary artery filling defects.
The patient underwent emergent endovascular catheter-directed tissue plasminogen activator therapy, had an inferior vena cava filter placed at day 5, and was discharged on day 7.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 73-year-old female with multiple comorbidities including COPD and CHF who presented with submassive pulmonary embolism and right ventricular dilation.

Intervention

Bedside echocardiography (point-of-care ultrasound) followed by CT angiogram, endovascular catheter-directed tissue plasminogen activator (tPA), and inferior vena cava (IVC) filter placement.

Outcome

Diagnosis of submassive pulmonary embolism with right heart strain.

Point-of-care ultrasound demonstrating right ventricular dilation in an acutely dyspneic patient can rapidly raise suspicion for acute pulmonary embolism and expedite definitive diagnosis and treatment.

Cite This Study

Diez et al. (2018) conducted a case report in Submassive Pulmonary Embolism (n=1). Endovascular catheter-directed tissue plasminogen activator (tPA) and IVC filter was evaluated. A 73-year-old female with submassive pulmonary embolism and right ventricular dilation was successfully diagnosed using point-of-care ultrasound and treated with catheter-directed tPA.

synapsesocial.com/papers/6aa2945c990ebc48faa585fc https://doi.org/10.5070/m533039879

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Implication

May support POCUS and catheter-directed tPA in select submassive PE cases; hypothesis-generating and leaves open need for prospective validation.

Right Ventricular Dilation in Patient With Submassive Pulmonary Embolism

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Right Ventricular Dilation in Patient With Submassive Pulmonary Embolism

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Also Consider