Cavitary Pulmonary Infarction in a Case of Pulmonary Embolism After Successful Vascular Recanalization

With a history of right pneumonectomy, pulmonary embolism affecting bilateral pulmonary artery is rare and needs to be meticulously managed to prevent pulmonary infarction of the normal lung with a clinical decision regarding thrombolysis. A 64 years male diabetic and hypertensive with a history of right pneumonectomy 10 years back, presented to ER with dyspnea and 2 episodes of syncope with right leg pain and swelling for 3 days. BP was 140/90mmHg and pulse rate of 100/min. SPO2 in room air was 95%. ECG suggested S1Q3T3 with sinus tachycardia. Echocardiogram revealed features of pulmonary embolism. Venous doppler of right leg showed DVT and CT Pulmonary angiogram was suggestive of pulmonary embolism. High-sensitive troponin I and NT-pro BNP were negative. Diagnosis of submassive pulmonary embolism was made. Protecting the normal lung from infarction was of paramount importance. There was no indication for thrombolysis. Treatment with LMWH was initiated and overlapped with the novel oral anticoagulant (NOAC) dabigatran. Symptomatically patient improved along with a reduction in pulmonary arterial hypertension and improved RV function. Post pneumonectomy of one lung, protecting the normal lung from infarction is utmost important in a setting of pulmonary embolism. It is a rare case scenario. Clinical decision regarding thrombolysis should be taken carefully. In this case thrombolysis was not indicated as per guidelines. LMWH, oral anticoagulation and broad-spectrum antibiotic to prevent secondary lung infection are the mainstay in the treatment of submassive pulmonary embolism where thrombolysis is not indicated.

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PULMONARY INFARCTION AND DOWNSTREAM COMPLICATIONS: A SPECTRUM OF CLINICAL MANIFESTATION OF PULMONARY EMBOLISM

CHEST Journal ◽

10.1016/j.chest.2020.08.1855 ◽

2020 ◽

Vol 158 (4) ◽

pp. A2153

Author(s):

Jason Li ◽

Sujith Cherian ◽

Rosa Estrada-Y-Martin

Keyword(s):

Pulmonary Embolism ◽

Clinical Manifestation ◽

Pulmonary Infarction

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Septic Pulmonary Embolism With Pulmonary Infarction From a Pulmonic Valve Endocarditis- A Case Report

CHEST Journal ◽

10.1378/chest.2279416 ◽

2015 ◽

Vol 148 (4) ◽

pp. 148A

Author(s):

Bernadette Magnaye

Keyword(s):

Pulmonary Embolism ◽

Case Report ◽

Pulmonary Infarction ◽

Pulmonic Valve ◽

Septic Pulmonary Embolism

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Clinical Significance Of Pulmonary Infarction In Patients With Pulmonary Embolism

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a6215 ◽

2012 ◽

Author(s):

Seung Ick Cha ◽

Jaehee Lee ◽

Kyung-Min Shin ◽

Jongmin Lee ◽

Yup Hwangbo ◽

...

Keyword(s):

Pulmonary Embolism ◽

Clinical Significance ◽

Pulmonary Infarction

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Right-Sided Infective Endocarditis, Pulmonary Embolism and Infarction in Adult with Uncorrected Ventricular Septal Defect

ACI (Acta Cardiologia Indonesiana) ◽

10.22146/jaci.v6i1.134 ◽

2020 ◽

Vol 6 (1) ◽

pp. 69-72

Author(s):

Cindarwati Mega Riyanto ◽

Anggoro Budi Hartopo ◽

Dyah Wulan Anggrahini ◽

Lucia Kris Dinarti

Keyword(s):

Pulmonary Embolism ◽

Infective Endocarditis ◽

Ventricular Septal Defect ◽

Congenital Heart ◽

Septal Defect ◽

Pulmonary Valve ◽

Heart Defects ◽

Defect Closure ◽

Pulmonary Infarction ◽

Vegetation Removal

Right-sided infective endocarditis (IE) is very rare and mostly occurs in the tricuspid valve, which pulmonary valve involvement in very rare. Most IE of the pulmonary valve occurs in patients with congenital heart defects. we report a case of the complications of pulmonary valve IE and pulmonary embolism which then causes pulmonary infarction in patients with VSD who have not been corrected. This case successfully underwent surgery for endocarditis/vegetation removal and septal defect closure.

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