PMC7603563_01
Hemodynamic parameters (MAP and pulse) and respiratory profiles (PaO2/FiO2 ratio and PaCO2) are demonstrated every hour during the 11 days in the ICU for the 49-year-old woman with massive pulmonary embolism. Green arrow indicates the time of systemic thrombolysis. Purple arrow indicates the time of IVC filter implantation. Abbreviations: MAP: middle arterial pressure, PaO2/FiO2 ratio: arterial oxygen partial pressure to fractional inspired oxygen, PaO2: partial pressure of oxygen, PaCO2: partial pressure of arterial carbon dioxide, FiO2: fraction of inspired oxygen, IVC: inferior vena cava.
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fig1
Hemodynamic parameters and respiratory profiles are presented in Figure 1. On days two and three after admittance, the PaO2/FiO2 ratio gradually decreased to the lowest value 14.3 (Figure 1).
Echocardiography before thrombolysis showed severe right ventricular dysfunction with flattened intraventricular septum (*) in parasternal short-axis view (a) and thrombus (arrow) in the right atrium in apical four-chamber view (b).
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fig2
At day three, a mobile structure measuring 1.5 cm x 1.8 cm representing a thrombus was identified in the RA by ECHO (Figure 2).
CTPA demonstrating a thrombus of 11 centimetre in the inferior vena cava. (a) The thrombus in the IVC before thrombolysis (white arrows); (b) the residual thrombus (white arrow) following thrombolysis and after insertion of the vena cava filter (green arrow). Abbreviations: CTPA: computed tomography pulmonary angiogram, IVC: inferior vena cava.
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fig3
A new CTPA showed regression of the extensive central pulmonary embolism, increasing peripheral pulmonary embolism, and a thrombus in the IVC 11 cm (Figure 3).