CHEST Guidelines-A-93-Year-Old-Man-With-Submassive-Pulmonary-Emboli (1)

A-93-Year-Old-Man-With-Submassive-Pulmonary-Emboli (1)

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A 93-year-old man presented to the emergency department with sudden shortness of breath and lightheadedness. He had a history of hypertension and stage 3 chronic kidney disease. Examination revealed elevated respiratory distress and abnormal lab results, including high lactic acid and troponin I levels, indicating stress or damage to the heart. A CT angiogram of the chest showed pulmonary emboli in both pulmonary arteries extending into segmental branches, along with right heart strain and severe right ventricular dilation.<br /><br />The initial treatment included intravenous heparin, and catheter-directed thrombolysis was planned. However, the patient reported left gluteal pain with swelling due to a fall. A point-of-care ultrasound (POCUS) was conducted, revealing a potential intramuscular hematoma in the gluteal region, which contraindicated thrombolytic therapy due to bleeding risks.<br /><br />The POCUS findings led to the cancellation of thrombolytic therapy to avoid further complications. Instead, consideration was given to alternative treatments such as inferior vena cava filter placement, highlighting the important role of POCUS in the emergency setting. A follow-up CT scan confirmed the presence of the hematoma.<br /><br />This case demonstrates the crucial role that bedside ultrasounds can play in identifying potential sources of bleeding and preventing life-threatening complications, particularly in critically ill patients. Using POCUS as a rapid diagnostic tool, particularly in cases of trauma or before administering treatments like thrombolytics, can greatly influence patient management and outcomes. The training of healthcare providers in utilizing POCUS for skin and soft tissue evaluations can expedite diagnosis and decision-making, offering significant clinical advantages in critical care environments.

Keywords

pulmonary embolism

point-of-care ultrasound

thrombolytic therapy

intramuscular hematoma

inferior vena cava filter

emergency medicine

right ventricular dilation

chronic kidney disease

bedside ultrasound

patient management