PDF(Pubmed)
Abstract：
Pulmonary embolism (PE) is a potentially life-threatening condition that presents with a spectrum of clinical symptoms ranging from asymptomatic to hemodynamic instability. The early diagnosis in the emergency department is often challenging. Although the association between patent foramen ovale (PFO) and thromboembolic events in patients with PE is well-documented, the significance of the presence of PFO in patients with PE may be underrecognized. In addition, the occurrence of right ventricular thrombus (RVT) in PE is a rare but significant complication with implications for disease management. We report a case of acute-on-chronic PE with concurrent bilateral renal infarction due to a paradoxical embolus, alongside RVT. A 35-year-old male presented at our emergency department with complaints of sudden onset abdominal pain. Bilateral renal infarction was identified on a contrast-enhanced computed tomography (CT). Point-of-care ultrasound showed suggestive findings of PE and RVT. Subsequently, a pulmonary CT angiography confirmed bilateral PE, a PFO, and RVT. The patient was effectively managed with thrombolytic therapy, with extracorporeal membrane oxygenation on standby. This case highlights the need to recognize the diverse clinical manifestations of PE and the importance of considering coexisting PFO and RVT in affected patients. The diagnosis of PE can be complex when symptoms overlap with arterial thrombosis, such as renal infarction secondary to a PFO. In addition, RVT, although uncommon, is a serious complication in patients with PE that may require careful evaluation for thrombolytic or anticoagulant therapy. It is critical to consider the possibility of a PFO in all cases of PE, even in the absence of arterial embolism, and to promptly evaluate for RVT prior to initiating treatment.
摘要：
肺栓塞（PE）是一种潜在的危及生命的疾病，具有从无症状到血流动力学不稳定的一系列临床症状。急诊科的早期诊断通常具有挑战性。尽管PE患者卵圆孔未闭（PFO）与血栓栓塞事件之间的关联已得到充分证明，PE患者中存在PFO的重要性可能被低估.此外,PE中右心室血栓(RVT)的发生是一种罕见但显著的并发症,对疾病管理有影响.我们报告了一例因矛盾栓塞引起的急性慢性PE并发双侧肾梗塞的病例，在RVT旁边。一名35岁的男性出现在我们的急诊科，抱怨突然发作的腹痛。在对比增强计算机断层扫描（CT）上发现了双侧肾梗塞。护理点超声显示PE和RVT的暗示性发现。随后，肺CT血管造影证实双侧PE，PFO,和RVT。患者通过溶栓治疗得到有效治疗，体外膜氧合备用。该病例强调需要认识到PE的不同临床表现，以及在受影响患者中考虑PFO和RVT共存的重要性。当症状与动脉血栓形成重叠时，PE的诊断可能很复杂。如继发于PFO的肾梗死。此外,RVT,虽然不常见,是PE患者的严重并发症，可能需要仔细评估溶栓或抗凝治疗。在所有PE情况下，考虑PFO的可能性是至关重要的，即使没有动脉栓塞,并在开始治疗前及时评估RVT。
