Complex space of Retzius lymphocele resulting in iliac compression and submassive pulmonary embolism after robotic Retzius sparing prostatectomy

Pulmonary embolism (PE) is an important cause of morbidity and mortality and presents with significant diagnostic and therapeutic challenges. Clinical presentation ranges from mild, nonspecific symptoms to syncope, shock, and sudden death. Patients with hemodynamic instability and/ or signs of right ventricular dysfunction are at high risk for adverse outcomes and may benefit from aggressive therapy and support. Therapeutic anticoagulation is indicated in all patients in the absence of contraindications. Thrombolysis should be strongly considered in selected high- and intermediate-risk patients, either by systemic infusion or percutaneous catheter-directed therapy. Other therapeutic modalities, such as vena cava filters and surgical embolectomy, are options for patients who fail or cannot tolerate anticoagulation and/or thrombolysis. This article reviews the assessment and advanced management options for acute PE with focus on high- and intermediate-risk patients.

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Faculty Opinions recommendation of Half-Dose Thrombolysis in Submassive Pulmonary Embolism and Right-Heart Thrombus.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735314592.793557697 ◽

2019 ◽

Author(s):

Joanna Pepke-Zaba

Keyword(s):

Pulmonary Embolism ◽

Right Heart ◽

Submassive Pulmonary Embolism ◽

Half Dose

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“Swirling right ventricular” sign as a marker of right ventricular dysfunction in two patients with submassive pulmonary embolism

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.03.026 ◽

2021 ◽

Author(s):

Tobias Kummer ◽

Arun Nagdev

Keyword(s):

Pulmonary Embolism ◽

Right Ventricular ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Submassive Pulmonary Embolism

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Clinical outcomes of submassive pulmonary embolism thrombolysis—an Indian experience

The Egyptian Heart Journal ◽

10.1186/s43044-020-00123-8 ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Nadeem U. Rehman ◽

Mohd Iqbal Dar ◽

Manish Bansal ◽

R. R. Kasliwal

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Systolic Dysfunction ◽

Massive Pulmonary Embolism ◽

Post Treatment ◽

Control Group ◽

Submassive Pulmonary Embolism ◽

Venous Thromboembolic ◽

Pre Treatment ◽

And Control

Abstract Background Acute pulmonary thromboembolism is the most dangerous presentation of venous thromboembolic disease. The role of thrombolysis in massive pulmonary embolism has been studied extensively, but the same is not there for submassive pulmonary embolism. This study is aimed at evaluating the effects of thrombolysis in acute submassive pulmonary embolism. This was a prospective, case-control, observational study. Patients presenting with acute submassive pulmonary embolism were divided into thrombolysis group and control group depending on whether they received thrombolysis plus anticoagulation or anticoagulation only, respectively. Results A total of 86 patients were included in the study. Forty-two patients were in the thrombolysis group, and 44 patients were in the control group. The mean ± SD age in the control and thrombolysis groups was 63.3 ± 14.7 and 56.4 ± 13.8 years, respectively. The two groups were well matched in sex distribution and associated comorbidities like COPD, active surgery, major trauma, and immobilization. On echocardiography, dilated RA/RV in pre-treatment vs. post-treatment was seen in 20 (45.5%) vs. 20 (45.5%) in the control group and 26 (61.9%) vs. 11 (26.2%) in the thrombolysis group. Similarly, RV systolic dysfunction in pre-treatment vs. post-treatment was seen in 24 (54.5%) vs. 21 (47.7%) in the control group and 22 (52.4%) vs. 8 (19.0%) in the thrombolysis group. Pulmonary artery pressure in pre-treatment vs. post-treatment was 64.4 ± 15.0 vs. 45.9 ± 9.9 mmHg in the control group and 68.3 ± 17.4 vs. 31.4 ± 6.9 mmHg in the thrombolysis group. In control vs. thrombolysis group, there were 5 vs. 1 death, 6 vs. 1 hemodynamic decompensation, and 6 vs. 1 patient needing mechanical ventilation. Conclusion Thrombolysis in submassive pulmonary embolism is associated with better right ventricular functions, lower pulmonary artery pressures, and comparable mortality rates.

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135 Real world outcomes for “intermediate-high” mortality risk patients presenting with submassive pulmonary embolism in a tertiary cardiothoracic centre

10.1136/heartjnl-2019-bcs.132 ◽

2019 ◽

Cited By ~ 1

Author(s):

Paul Brennan ◽

Jaimie Coburn ◽

Dean Carolan ◽

Mark Spence ◽

Timothy Warke ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Mortality ◽

Mortality Risk ◽

Real World ◽

High Mortality Risk ◽

Submassive Pulmonary Embolism ◽

Risk Patients

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A Massive Pulmonary Embolism Treatment Protocol: How Trauma Performance Improvement Affects Outcome Throughout the Hospital System

The American Surgeon ◽

10.1177/000313481007600204 ◽

2010 ◽

Vol 76 (2) ◽

pp. 145-148

Author(s):

Catherine Garrison Velopulos ◽

Mark Zumberg ◽

Priscilla Mcauliffe ◽

Lawrence Lottenberg ◽

A. Joseph Layon

Keyword(s):

Pulmonary Embolism ◽

Sudden Death ◽

Performance Improvement ◽

Pulmonary Embolus ◽

Treatment Protocol ◽

Right Heart Failure ◽

Hospital Performance ◽

Massive Pulmonary Embolism ◽

Hospital System ◽

Submassive Pulmonary Embolism

Trauma performance improvement is the hallmark of a mature trauma center. If loop closure is to be complete, preventable deaths must result in significant change in management and the establishment of protocol-driven improvements so such an instance does not recur. The trauma performance improvement committee reviewed a case of a massive pulmonary embolus and determined that this was a preventable death. The hospital performance improvement committee then initiated a root cause analysis, which led to creation of a treatment protocol for patients with massive or submassive pulmonary embolism. A focused review of the first 6 months of the implementation of the protocol was undertaken. Four patients over a 6-month period had massive or submassive pulmonary embolus. All four had sudden death or near sudden death and were appropriately resuscitated. All four sustained right heart failure. Two patients were treated by catheter-directed fibrinolysis, one with catheter-directed suction embolectomy, and one by surgical pulmonary embolectomy. All survived with full neurologic function. Trauma performance improvement is the model by which all hospital performance improvement should be done. Preventable deaths can result in change, which can have a future impact on survival in potentially lethal scenarios.

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