responsible for 50 000 to 100 000 deaths each year in the United States. A pulmonary embolism is an obstruction of the pulmonary artery or one of its branches by a thrombus. The signs and symptoms range from massive pulmonary embolism that results in unstable hemodynamic status to a small peripheral embolus that can be asymptomatic. To aid in the delineation of the types of pulmonary embolism, ...

A 61 year old man developed acute pulmonary embolism while in hospital. His previous and admission electrocardiograms (ECGs) showed a typical left bundle branch block (LBBB) pattern. Immediately after the onset of acute pulmonary embolism, LBBB disappeared from his body surface ECG with sinus bradycardia, normalisation of QRS duration, prolonged QT interval, and marked T abnormalities to the ri...

Thrombus formation in a pulmonary vein stump after pulmonary lobectomy is extremely rare, but can trigger cerebral embolism of unknown cause. We encountered a case of cerebral embolism in a 58-year-old man 2 days after left upper lobectomy. Since intravenous administration of recombinant tissue plasminogen activator was contraindicated, thrombus removal by endovascular reperfusion therapy was p...

There is still considerable debate about the optimal diagnostic imaging modality for acute pulmonary embolism. If imaging is deemed necessary from an initial clinical evaluation such as d-dimer testing, options include nuclear medicine scanning, catheter pulmonary angiography, and spiral CT. In many institutions, spiral CT is becoming established as the first-line imaging test in daily clinical...

Right heart thrombus is a slightly detectable condition. In patients presenting with acute pulmonary embolism, the finding of thrombus in transit has been associated with high in-hospital mortality. We present a case of a 50-year-old male patient with acute pulmonary embolism and a thrombus in transit in the right atrium. We took the decision to perform fibrinolysis with tenecteplase, presentin...

Acute massive pulmonary embolism is a life threatening medical emergency resulting in a high mortality rate. Usually, urgent thrombo-embolectomy is performed using double venous cannulation without circulatory arrest. We describe a patient suffering from acute massive pulmonary embolism that was treated by emergency thrombo-embolectomy. Due to back-bleeding the view into the lobar and segmental...

OBJECTIVE To investigate the prognostic value of echocardiographic findings in patients who present with symptoms suggestive of acute pulmonary embolism. DESIGN 317 patients with clinically suspected pulmonary embolism were prospectively evaluated by echocardiography for the presence of right ventricular afterload stress and right heart or pulmonary artery thrombi. Objective confirmation of p...

Acute massive pulmonary embolism results in a rise in pulmonary vascular resistance and acute right ventricular dilation and systolic dysfunction. In unstable patients who cannot safely undergo computed tomography, echocardiography can often provide direct and indirect evidence of pulmonary embolism. We present a case in which clinical and echocardiographic evidence provided sufficient evidence...

Thrombus-in-transit appears to increase the risk of mortality compared to pulmonary embolism alone and can require alteration in therapeutic plan. We present the case of a biatrial thromboembolus caught in transit across a patent foramen ovale diagnosed by intraoperative transesophageal echocardiogram in a 69-year-old female with acute pulmonary embolism and subsequent acute cerebral infarction...