case_images: PMC11128567_01
case_images: Patient's treatment course.
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case_images: Figure 1 is a timeline of the clinical condition progress and major management of the patient.
case_images: Results of the patient's echocardiography. (A) Indicates enlargement of the right heart in the patient; (B) Shows thrombus echoes in the main pulmonary artery of the right lung (red arrow).
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case_images: Echocardiogram findings (after V-A ECMO initiation) included right heart enlargement, thrombus echoes observed within the main pulmonary artery of the right lung (Figures 2A,B), with a left ventricular internal diameter in diastole (LVIDd) of 29.3 mm, left ventricular internal diameter in systole (LVIDs) of 26.4 mm, and a left ventricular ejection fraction (LVEF) of 22.8%.
case_images: Results of the cranial CT scans during the patient's hospital stay. (A) Results of the patient's cranial CT on Day 1. (B) Results of the patient's cranial CT on Day 6. (C) Results of the patient's cranial CT on Day 9. (D) Results of the patient's cranial CT on Day 11. (E) Results of the patient's cranial CT on Day 15. (F) Results of the patient's cranial CT on Day 35.
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case_images: Cranial CT scan showed no evidence of intracranial hemorrhage (Figure 3A). On the sixth day, under ECMO support, the patient completed a head, chest, and abdominal CT assessment, unexpectedly revealing cerebral hemorrhage (Figure 3B), thought to likely result from the combined effects of pre-CPR fall history and heparin anticoagulation; the presence of an edema halo around the hemorrhage suggested the bleeding had been present for several days and was relatively stable. On the ninth day, a follow-up cranial CT scan reassuringly showed no significant increase in intracranial hemorrhage (Figure 3C). On the 11th day, after confirming no increase in intracranial hemorrhage via cranial CT scan (Figure 3D), our team decided to wean the patient off sedation and initiate ventilator weaning exercises; the patient successfully awoke and was able to follow commands. The medical team closely monitored the patient's intracranial hemorrhage condition (Figure 3E) until on the 21st day of hospitalization, the patient was switched to low-molecular-weight heparin anticoagulation therapy (0.4 ml q12 h). Ultimately, the patient was discharged in improved condition after 35 days of treatment, with follow-up cranial CT scans showing the hemorrhage had essentially been absorbed (Figure 3F).
case_images: Results of multiple angiographies during the patient's treatment period. (A) Images of the patient's pulmonary angiography. (B,C) Images after treatment of the patient's pulmonary embolism. (D) Images after the patient's first balloon pulmonary angioplasty (BPA) treatment. (E,F) Images after the patient's second balloon pulmonary angioplasty (BPA) treatment.
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case_images: The procedure revealed the thrombus to be hard in texture (considered white thrombus), with multiple attempts at aspiration and excision achieving suboptimal results, yet successfully restoring blood flow in the apical and anterior segments of the left pulmonary artery and the right upper pulmonary artery (Figures 4A-C). On the seventh day of hospitalization, the patient underwent pulmonary angiography and balloon pulmonary angioplasty, with wire-guided balloon dilation restoring blood flow in the basal segment of the right lower lobe (Figure 4D). ECMO treatment, on the 14th day of hospitalization, our medical team decided to perform pulmonary angiography and balloon pulmonary angioplasty again and precisely dilated the balloon in the basal and upper arterial segments of the patient's right lung to enhance ventilation-perfusion matching (Figures 4E,F). Eventually, on the 15th day of hospitalization, the patient's oxygen saturation significantly improved, pulmonary artery pressure dropped from 49 mmHg to 28 mmHg (as measured by bedside ultrasound), and after multiple weaning assessments, V-V ECMO was successfully removed.