Tag Archives: pulmonary embolism

An Incident of a Massive Pulmonary
Embolism following Acute Aortic Dissection. A Case Report

Sofia Fernandes1, Mariana Rodrigues1, Catarina Barreiros1, Hugo Côrte-Real2, Ricardo Ferreira2, Ângelo Nobre2

1. Department of Anesthesiology, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
2. Department of Cardiothoracic Surgery, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal

DOI: 10.2478/jccm-2021-0001

Acute aortic dissection and acute pulmonary embolism are two life-threatening emergencies. The presented case is of an 81-year-old man who has been diagnosed with an acute Stanford type A aortic dissection and referred to a tertiary hospital for surgical treatment. After a successful aortic repair and an overall favourable postoperative recovery, he was diagnosed with cervical and upper extremity deep vein thrombosis and was anticoagulated accordingly. He later presented with massive bilateral pulmonary embolism.

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Pulseless Electrical Activity Arrest as the First Symptom of Testicular Cancer with Subsequent Phlegmasia Cerulea Dolens

Shane Belvedere

Department of Vascular Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria, Australia

DOI: 10.2478/jccm-2019-0009

Introduction: Phlegmasia cerulea dolens (PCD) is a severe, rare complication of deep vein thrombosis, which is characterised by compartment syndrome, arterial compromise, venous gangrene, and shock. Prothrombotic states are the primary risk factor for PCD, which, in most cases, is associated with pulmonary embolism and carries a high mortality.
Case report: A 46-year-old male presented following a pulseless electrical activity (PEA) arrest due to saddle pulmonary embolism (PE). He subsequently developed PCD and venous gangrene secondary to inferior vena cava obstruction, in the setting of a new diagnosis of testicular germ cell tumour.
Discussion: PEA arrest, as the initial presenting problem in malignancy, is rare. It is extreme for the first indication of cancer to be a PEA arrest from massive PE. While hypoxic brain injury from the cardiac arrest precluded intervention in this case, a surgical approach entailing en bloc resection of aortocaval metastasis, with subsequent IVC reconstruction, followed by lower limb venous thrombectomy would have been favoured as it was considered that an endovascular approach would not have been successful.
Conclusion: A case of a patient with phlegmasia cerulea dolens secondary to testicular cancer, who presented following PEA arrest is described.

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Acute Pulmonary Embolism in a Teenage Female – A Case Report

Iulia Armean1, Lorena Elena Meliț1,2, Iunius Simu3, Carmen Duicu1,2

1 Emergency Clinical County Hospital Tîrgu Mureș, Pediatrics Clinic No. 1, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy Tîrgu Mureș, 1st Department of Pediatrics, Tîrgu Mureş, Romania
3 Emergency Clinical County Hospital Tîrgu Mureș, Radiology Department, Tîrgu Mureş, Romania

DOI: 10.2478/jccm-2018-0015

Thrombophilia represents a tendency towards excessive blood clotting and the subsequent development of venous thromboembolism (VTE). VTE is a rare condition in children that comprises both deep venous thrombosis (DVT) and pulmonary embolism (PE). This paper reports the case of a 16-year-old girl, admitted to the Pediatrics Clinic No. 1, Tîrgu Mureș, Romania, for dyspnea, chest pain and loss of consciousness. Her personal history showed that she had had two orthopedic surgical interventions in infancy, two pregnancies, one spontaneous miscarriage and a recent caesarian section at 20 weeks of gestation for premature detachment of a normally positioned placenta associated with a deceased fetus. Laboratory tests showed increased levels of D-dimers. Angio-Computed Tomography (Angio-CT) showed multiple filling defects in both pulmonary arteries, establishing the diagnosis of PE. The laboratory tests were undertaken to assist in the diagnoses of a possible thrombophilia underlined a low level of antithrombin III. Antiphospholipid syndrome was ruled out and genetic tests revealed no specific mutation. Anticoagulant therapy was initiated with unfractionated heparin and afterwards subcutaneously low molecular heparin was prescribed for three months. Later it has been changed to oral therapy with acenocoumarol. The patient was discharged in good general status with the recommendation of life-long anticoagulation therapy. Thrombophilia is a significant risk factor for PE, and it must be ruled out in all cases of repeated miscarriage.

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