Bilateral pulmonary embolism and vacuum assisted thrombectomy

Case contributed by Raymond Chieng

Presentation

Fever, cough for 2 days. Shortness of breath for one day.

Patient Data

Age: 70 years
Gender: Female

Massive filling defects seen in bilateral distal main pulmonary arteries, lobar arteries, segmental and subsegmental branches. Almost all branches show no contrast opacifcation.

The main pulmonary trunk and bilateral main pulmonary arteries are dilated.

Lung window: collapsed consolidation and patchy peripheral wedge shaped consolidation at the apicoposterior segment of left upper lobe suggestive of pulmonary infarcts.

Large filling defect seen at right superior pulmonary artery.

Improved flow noted at the right superior pulmonary artery. However, there is still residual filling defect suggestive of chronic thrombus.

Blood clots aspirated after vacuum assisted thrombectomy.

Case Discussion

The patient was shown to have massive bilateral pulmonary embolism on CT pulmonary angiogram. An emergency vacuum-assisted thrombectomy was done. However, only about 30-40% of the blood clots were aspirated. The remaining 60-70% of the blood clots remained in the pulmonary vessels. The patient remained in the ICU after the thrombectomy and passed away a few days later.

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