Abstract
Background: Brain stem infarction and pulmonary embolism are both serious life-threatening diseases with extremely high mortality. Central respiratory failure caused bycerebral stem infarction was considered in the initial stage of the disease. Pulmonary embolism (trunk) may have been the second cause of respiratory failure during diagnosis and treatment. The patient improved obviously after active treatment. Although the patient's condition improved significantly after active treatment, it is worth reflecting that if we had detected the right main pulmonary embolism in a timely manner during the first CTA examination, we could have determined whether the patient could benefit more from thrombolysis of the right main pulmonary artery under interventional therapy. Therefore, in clinical work, we should consider the possible complications ofthe patient while focusing on the most life-threatening primary disease.Case presentation:The patient, a 53-year-old female, she was immediately transferred from the emergency department to the ICU. Physical examination: T 37°C, HR 109/min, R 10/min, BP 105/73 mmHg, SpO 2 79%, GCS score 5, E1V2M2, coma. T CTA examination of the cervical blood vessels and cerebral blood vessels was recommended. 2) CTA examination of the cervical blood vessels and craniocerebral blood vessels performed at 10 o'clock on March 23 suggested moderate and severe stenosis at the beginning of the right vertebral artery, severe stenosis at the middle and upper segments of the basilar artery, and severe stenosis at the beginning of the bilateral posterior cerebral artery. Consideration: high possibility of brainstem infarction. After discussion with the family members, they agreed to submit the patient to percutaneous craniography and thrombectomy. 3) Cerebral artery extraction was performed from 23:50 on March 23 to 01:20 on March 24. Intraoperative diagnosis: 1. Cerebral stem infarction. 2. Upper basilar artery occlusion. Postoperative angiography showed that the basilar artery was unobstructed, and the bilateral superior cerebellar artery and posterior cerebral artery had returned to normal. Tirofiban was given 4 ml/h postoperatively. 4) The CT diagnosis room on March 24 reported the results of the vascular CTA scan from 10 'clock on March 23: A filling defect of the right main pulmonary artery and the left lower pulmonary artery lumen was observed. Pulmonary embolism was considered. Color Doppler ultrasound examination of the heart and lower limb vessels was immediately performed, and the interventional department was consulted. Cardiac ultrasonography suggested that there was no obvious thrombus in the right atrium or right ventricle of the patient. she receive anticoagulant and antiplatelet therapy.Conclusions: Central respiratory failure caused bycerebral stem infarction was considered in the initial stage of the disease. Pulmonary embolism (trunk) may have been the second cause of respiratory failure during diagnosis and treatment. The patient improved obviously after active treatment. Although the patient's condition improved significantly after active treatment, it is worth reflecting that if we had detected the right main pulmonary embolism in a timely manner during the first CTA examination, we could have determined whether the patient could benefit more from thrombolysis of the right main pulmonary artery under interventional therapy. Therefore, in clinical work, we should consider the possible complications ofthe patient while focusing on the most life-threatening primary disease.
Diagnostic Delay of Pulmonary Embolism in COVID-19 Patients
