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

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.

Keywords: COVID-19; Case report; Computed tomography angiography; Intermediate-to-high-risk pulmonary embolism; Right ventricular dilatation; Ultrasound-assisted catheter-directed thrombolysis.

Figure 1

CTA showed massive, bilateral acute PE (A and B) and massive dilatation of the RV (C). Pulmonary angiography confirmed massive bilateral PE (D and E) and two EKOS catheters were inserted in the right and left pulmonary arteries under fluoroscopic control (F). Echocardiography on the next day demonstrated complete resolution of RV enlargement with normal RV diameter of 42 mm and function (G). Control CTPA after 2 weeks demonstrated normalization of the RV diameter (H) and small amounts of residual thrombi in the pulmonary arteries (I).