#1:
What is your diagnosis?
#2:
What therapy would you suggest for this patient?
Explanation:
The patient has a massive pulmonary embolism that is
occluding the right pulmonary artery. The view is the
midesophageal ascending aorta view with eh right pulmonary artery
roofing the ascending aorta.
Two main therapies exist - thrombolytic therapy or surgical therapy. Surgical therapy is reserved for patients who have a contraindication to thrombolytic therapy or where thrombolytic/anticoagulation therapy is ineffective. While thrombolytic therapy is perferred, sometimes the patient's hemodynamic status is not conducive to waiting for thrombolytic therapy. If the patient is somewhat hemodynamically stable, operative embolectomy has a mortality rate around 11%. If the patient is hemodynamically unstable with moderate/severe right ventricular dilation/dysfunction, hemodynamic collapse, with resuscitation, the mortality rate was 85%.
This patient was hemodynamically unstable and had severe RV dysfunction and required epinephrine infusion to maintain minimal perfusion. We referred the patient to surgery for emergency embolectomy because of the TKA operation would have lead to excessive bleeding from the thrombolytics.
Two main therapies exist - thrombolytic therapy or surgical therapy. Surgical therapy is reserved for patients who have a contraindication to thrombolytic therapy or where thrombolytic/anticoagulation therapy is ineffective. While thrombolytic therapy is perferred, sometimes the patient's hemodynamic status is not conducive to waiting for thrombolytic therapy. If the patient is somewhat hemodynamically stable, operative embolectomy has a mortality rate around 11%. If the patient is hemodynamically unstable with moderate/severe right ventricular dilation/dysfunction, hemodynamic collapse, with resuscitation, the mortality rate was 85%.
This patient was hemodynamically unstable and had severe RV dysfunction and required epinephrine infusion to maintain minimal perfusion. We referred the patient to surgery for emergency embolectomy because of the TKA operation would have lead to excessive bleeding from the thrombolytics.
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