case_images: PMC3542936_01
case_images: Initial bedside ultrasound demonstrated thrombus in the RV (a) and the IVC (b). A repeat ultrasound demonstrated acute RV enlargement (c).
case_images: CRIM.EM2012-794019.001.jpg
case_images: PMC3542936_01_CRIM.EM2012-794019.001.jpg
case_images: fig1
case_images: Shortly after arrival, a bedside ultrasound was performed, demonstrating a thrombus in the right ventricle (RV) and inferior vena cava (IVC) (Figures 1(a) and 1(b)). A repeat bedside ultrasound was performed with visualization of an enlarged right ventricle (Figure 1(c)), and an EKG demonstrated a new right bundle branch block (Figure 2), highly suspicious for a massive pulmonary embolus.
case_images: EKG demonstrates new right bundle branch block.
case_images: CRIM.EM2012-794019.002.jpg
case_images: PMC3542936_01_CRIM.EM2012-794019.002.jpg
case_images: fig2
case_images: A repeat bedside ultrasound was performed with visualization of an enlarged right ventricle (Figure 1(c)), and an EKG demonstrated a new right bundle branch block (Figure 2), highly suspicious for a massive pulmonary embolus.
case_images: CT angiogram of the chest demonstrating bilateral pulmonary embolus.
case_images: CRIM.EM2012-794019.003.jpg
case_images: PMC3542936_01_CRIM.EM2012-794019.003.jpg
case_images: fig3
case_images: The CTA confirmed the diagnosis of bilateral massive pulmonary emboli (PE) (Figure 3), and alteplase was administered at a bolus dose of 0.6 mg/kg over 2 minutes followed by a heparin infusion and admitted to the ICU without further hemodynamic decompensation.
case_images: CT angiogram of the chest after thrombolysis and anticoagulation with resolution of visible thrombi.
case_images: CRIM.EM2012-794019.004.jpg
case_images: PMC3542936_01_CRIM.EM2012-794019.004.jpg
case_images: fig4
case_images: However, he was ultimately extubated and discharged home with full neurologic recovery, and a repeat CTA chest demonstrated resolution of pulmonary thrombi (Figure 4).