PMC3542936_01
Initial bedside ultrasound demonstrated thrombus in the RV (a) and the IVC (b). A repeat ultrasound demonstrated acute RV enlargement (c).
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Shortly after arrival, a bedside ultrasound was performed, demonstrating a thrombus in the right ventricle (RV) and inferior vena cava (IVC) (Figures 1(a) and 1(b)). A repeat bedside ultrasound was performed with visualization of an enlarged right ventricle (Figure 1(c)), and an EKG demonstrated a new right bundle branch block (Figure 2), highly suspicious for a massive pulmonary embolus.
EKG demonstrates new right bundle branch block.
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A repeat bedside ultrasound was performed with visualization of an enlarged right ventricle (Figure 1(c)), and an EKG demonstrated a new right bundle branch block (Figure 2), highly suspicious for a massive pulmonary embolus.
CT angiogram of the chest demonstrating bilateral pulmonary embolus.
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The CTA confirmed the diagnosis of bilateral massive pulmonary emboli (PE) (Figure 3), and alteplase was administered at a bolus dose of 0.6 mg/kg over 2 minutes followed by a heparin infusion and admitted to the ICU without further hemodynamic decompensation.
CT angiogram of the chest after thrombolysis and anticoagulation with resolution of visible thrombi.
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However, he was ultimately extubated and discharged home with full neurologic recovery, and a repeat CTA chest demonstrated resolution of pulmonary thrombi (Figure 4).