A visualized pulmonary arterial thrombus by using a modified echocardiographic view in an intermediate-risk acute pulmonary embolism patient: A case report

Abstract

Acute pulmonary embolism (APE) is a life-threatening disease with nonspecific clinical signs and symptoms. Rapid and accurate diagnosis is crucial for the clinical management of patients with acute pulmonary embolism. A recommended echocardiography view may be of further help in the diagnosis and evaluation of the change in thrombosis and treatment. We reported a case of a 74-year-old man with a 12-day history of decreased exercise capacity and dyspnea. The patient was diagnosed with intermediate-risk APE as several pulmonary emboli in pulmonary artery were seen in multidetector computed tomographic pulmonary angiography with normal blood pressure and echocardiographic right ventricular overload. And we found a pulmonary artery clot in the right pulmonary artery through transthoracic echocardiography. After 11-days anticoagulation, the patient underwent a reassessment, showed a decrease in RV diameter and pulmonary artery thrombus. This case highlights the significant role that echocardiography played in a patient who presented pulmonary embolism with a stable hemodynamic situation and normal blood pressure. The modified echocardiographic view could provide correct diagnosis by identifying the clot size and location visually. Knowledge of the echocardiography results of APE would aid the diagnosis.

Keywords: acute pulmonary embolism; modified echocardiographic view; pulmonary artery clot.

FIGURE 1

Electrocardiography of the patient. Shows sinus rhythm with first‐degree atrioventricular block, S wave in lead I, q wave and inverted T wave in lead III

FIGURE 2

Imaging examinations of the patient. (A) Two‐dimensional transthoracic echocardiographic image in an off‐axis four‐chamber view demonstrates a venous clot in transit (arrow) in the right atrium. Video S1 corresponds to (A). (B) Two‐dimensional TTE at the level of pulmonary artery shows embolus (arrow) in the right PA (RPA). Video S2 corresponds to (B). (C) CTPA shows pulmonary emboli in right pulmonary artery from the transverse plane. (D) and (E) show decrease in RV diameter and pulmonary artery thrombus after 11‐days treatment. Video S3 corresponds to (D). Video S4 corresponds to (E). Ao, Ascending aorta

FIGURE 3

Acquirement of the modified view. Shows the transducer inclination 30–45 degrees to the chest wall at the second intercostal space immediately to the right of the sternum.