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acute pulmonary embolism

added by Emmel

acute pulmonary embolism
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Posted By: TLL240 (1844 days ago)

Recently did a similar TTE on a 19 yr. old female with family history
of clotting, Nuva Ring user and smoker. No DVT's seen on bilat
legs...thanks for sharing!

Posted By: Emmel (1949 days ago)

Hello Pablo!

In ultrasound study I found a deep venous
thrombosis in v. superficialis dex. Unfortunately there was a
complicated fracture of femoral neck with bleeding complication. The
patient was immobilised (only wheelchair-mobilised) for years
therefore the patient had a high risk for thrombosis and pulmonary
embolism. The fracture was after drop ou of the wheelchair, but no one
could tell us, what happened exactely (the patient lived in a care
home for the elderly.
You´re right: no thormbolysis, no high
dose UFH because of active bleeding. The patient died rapidly after
admission to our ER, No time for embolectomy (but for that you also
need therapeutical treatment with UFH). It was a bad case.

Posted By: ohtusabes (1950 days ago)

very impact clips Jörg. Sistolic flattening...pressure overload./>
This picure was accompanied with legs ultrasound looking dvt?
hip fracture was before or after drop? I tell you this because maybe
was fractured before and dvt begins here.

What treatment
offers to this patient? percutaneous embolectomy? I suppose no
thrombolytics and no heparin because of hip fracture.

He
died? right?

Best and congratulations for your clips/>Pablo


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Added: 20-04-2012
Runtime: 0m 9s
Views: 15292
Comments: 3

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Description

about 90 y old patient with sudden drop down without dyspnoea but hypotension, tachycardia. In TTE I could visualize that echocardiographic picture of RV-ballooning with D-sign of LV. New high grade tricuspid valve insufficiency (PAPs ca. 40 mmHg + CVP) in comparison with prior echocardiographic results. Unfortunately the patient had also a fracture of the right leg with bleeding complication caused by the drop.


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