Ultrasound-assisted catheter-directed thrombolysis in a patient with COVID-19 infection and bilateral intermediate-to-high-risk pulmonary embolism: a case report

Author:

Korosoglou Grigorios12ORCID,Mouselimis Dimitrios12ORCID,Koenig Elke3,Konstantinides Stavros45

Affiliation:

1. Department of Cardiology, GRN Hospital Weinheim, Vascular Medicine & Pneumology , Röntgenstrasse 1, 69469 Weinheim , Germany

2. Weinheim Imaging Center, Hector Foundation , Röntgenstrasse 1, 69469 Weinheim , Germany

3. GRN Hospital Weinheim, Weinheim, Germany Department of Anesthesiology and Intensive Care Medicine,

4. Center for Thrombosis and Hemostasis, University Medical Center Mainz , Mainz , Germany

5. Department of Cardiology, Democritus University of Thrace , Alexandroupolis , Greece

Abstract

Abstract Background Acute pulmonary embolism (PE) is a common cardiovascular disorder, potentially associated with high morbidity and mortality rates. Case summary Herein, we report on a patient with COVID-19 infection and bilateral PE, who presented after cardiovascular resuscitation with return of spontaneous circulation. Initially, an acute coronary syndrome was suspected but bedside echocardiography showed dilatation of the right ventricle (RV) and RV dysfunction, helping to establish the diagnosis of acute intermediate-to-high-risk PE, which was subsequently confirmed by contrast-enhanced computed tomography pulmonary angiography. The patient was successfully treated using low-dose (12 mg of tissue plasminogen) ultrasound-assisted catheter-directed thrombolysis, which resulted in prompt clinical improvement and reversal of RV dysfunction without bleeding complications. Discussion This case demonstrates the importance of echocardiography for the differential diagnosis of PE and of catheter-directed thrombolysis for its treatment in patients with intermediate-to-high-risk and high-risk PEs.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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