case_images: PMC11298445_01
case_images: Chest x-ray shows right pulmonary artery amputation and bilateral Westermark sign.
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case_images: F1
case_images: Initial chest x-ray during "code blue" activation showed right pulmonary artery amputation and bilateral Westermark sign (Figure 1).
case_images: (A, B) Pulmonary angiography shows a filling defect in both principal pulmonary arteries. (C, D) Final angiography showing improved pulmonary circulation after pharmacoinvasive treatment.
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case_images: F2
case_images: Pulmonary angiography showed a high thrombus burden in both principal pulmonary arteries (Figure 2). We initiated a pharmaco-invasive approach involving manual mechanical fragmentation followed by catheter-directed thrombolysis using 5 mg of alteplase in each pulmonary artery, markedly improving pulmonary circulation (Figure 2).
case_images: Biomarkers on admission and during in-hospital follow-up. Main invasive treatment strategies are also shown. DD gray line, BNP orange line, Hs-cTni blue line. DD, D-Dimer; BNP, B-type natriuretic peptide; Hs-cTni, high sensitivity troponin I; RRT, renal replacement therapy; VA-ECMO; venoarterial extracorporeal membrane oxygenation.
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case_images: F3
case_images: Follow-up laboratories showed DD 140,404 mcg/ml, hs-c-TnI 26,675 ng/L, BNP 32.6 pg/ml, pH 7.33, PCO2 55 mmHg, and lactate 9.4 mmol/L (Figure 3).
case_images: CT angiography. The left pulmonary artery exhibits a partial filling defect in the segmental and subsegmental branches. CT, computed tomography.
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case_images: F4
case_images: On the 14th day, a follow-up pulmonary CT angiography showed partial filling defects at the left pulmonary artery's main bifurcation, extending towards its segmental and subsegmental branches (Figure 4).