ABSTRACT

Recurrent pulmonary embolism and progressive pulmonary hypertension leading to right heart failure is a challenging case. Spiral computerized tomography findings are important for diagnosis and decision for appropriate clinical management.

32 year old woman with a history of protein C deficiency and recurrent pulmonary emboli presented to emergency with respiratory distress. Patient was intubated secondary to low arterial partial oxygen pressure and admitted to the intensive care unit. Thoracic computerized spiral tomography showed a large embolus at the pulmonary artery bifurcation. Surgical intervention is not preferred due to respiratory and hemodynamic failure. Patient had an improvement in ventilatory and hemodynamic parameters with medical treatment. She developed high fever on day 4 and died from a cardiopulmonary arrest the next day.

This case report demonstrates that spiral CT is an excellent tool for assessing chronic thromboembolic disease. The use of radiologic imaging in clinical decision for medical management versus selection of patients for thromboembolectomy remains uncertain The reason is that, the surgical therapy is associated with high mortality while, in medical therapy newer agents and combinations are being tried with or without surgery for successful management for this devastating illness.