Massive Central Pulmonary Embolism with Riding Embolus and Concomitant Aortic Arch Embolism—Should We Diagnose Patients Earlier for Blood Clotting Disorders? Case Report
Paradoxical embolism occurs when a clot originates in the venous system and traverses through a pulmonary or intracardiac shunt into the systemic circulation, with a mortality rate of around 18%. The risk factors for arterial embolism and venous thrombosis are similar, but different disease entities...
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MDPI AG
2025-01-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/12/1/26 |
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| author | Anna Lis Paweł Kowalski Marcin Wita Tomasz Zawadzki Tomasz Ilczak Wojciech Żurawiński Mateusz Majewski |
| author_facet | Anna Lis Paweł Kowalski Marcin Wita Tomasz Zawadzki Tomasz Ilczak Wojciech Żurawiński Mateusz Majewski |
| author_sort | Anna Lis |
| collection | DOAJ |
| description | Paradoxical embolism occurs when a clot originates in the venous system and traverses through a pulmonary or intracardiac shunt into the systemic circulation, with a mortality rate of around 18%. The risk factors for arterial embolism and venous thrombosis are similar, but different disease entities can lead to a hypercoagulable state of the blood, including antithrombin III (AT III) deficiency. We report the case of a 43-year-old man with a massive central pulmonary embolism with a rider embolus and concomitant aortic arch embolism with involvement of the brachiocephalic trunk, bilateral subclavian and axillary arteries, and the right vertebral artery, followed by a secondary ischaemic stroke. The Pulmonary Embolism Response Team (PERT) consulted the patient on several occasions; he was treated initially with an intravenous infusion of unfractionated heparin under activation partial thromboplastin time (APTT) and AT III substitution. After several days of hospitalisation and the conversion of pharmacotherapy to oral anticoagulants, the patient was discharged home in a stable condition with recommendations for further follow-up in appropriate clinics. This case highlights the role of in-depth diagnostics for coagulation disorders in patients after pulmonary embolism, especially without known risk factors. |
| format | Article |
| id | doaj-art-1d633eeb9ba649a097770cc8bdcc7097 |
| institution | Kabale University |
| issn | 2308-3425 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-1d633eeb9ba649a097770cc8bdcc70972025-01-24T13:36:02ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-01-011212610.3390/jcdd12010026Massive Central Pulmonary Embolism with Riding Embolus and Concomitant Aortic Arch Embolism—Should We Diagnose Patients Earlier for Blood Clotting Disorders? Case ReportAnna Lis0Paweł Kowalski1Marcin Wita2Tomasz Zawadzki3Tomasz Ilczak4Wojciech Żurawiński5Mateusz Majewski6Emergency Department, Leszek Giec Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, 40-635 Katowice, PolandEmergency Department, Leszek Giec Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, 40-635 Katowice, PolandI Department of Cardiology, Leszek Giec Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, 40-635 Katowice, PolandEmergency Department, Leszek Giec Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, 40-635 Katowice, PolandDepartment of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biala, 43-309 Bielsko-Biała, PolandDepartment of Emergency Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-635 Katowice, PolandEmergency Department, Leszek Giec Upper-Silesian Medical Centre of the Medical University of Silesia in Katowice, 40-635 Katowice, PolandParadoxical embolism occurs when a clot originates in the venous system and traverses through a pulmonary or intracardiac shunt into the systemic circulation, with a mortality rate of around 18%. The risk factors for arterial embolism and venous thrombosis are similar, but different disease entities can lead to a hypercoagulable state of the blood, including antithrombin III (AT III) deficiency. We report the case of a 43-year-old man with a massive central pulmonary embolism with a rider embolus and concomitant aortic arch embolism with involvement of the brachiocephalic trunk, bilateral subclavian and axillary arteries, and the right vertebral artery, followed by a secondary ischaemic stroke. The Pulmonary Embolism Response Team (PERT) consulted the patient on several occasions; he was treated initially with an intravenous infusion of unfractionated heparin under activation partial thromboplastin time (APTT) and AT III substitution. After several days of hospitalisation and the conversion of pharmacotherapy to oral anticoagulants, the patient was discharged home in a stable condition with recommendations for further follow-up in appropriate clinics. This case highlights the role of in-depth diagnostics for coagulation disorders in patients after pulmonary embolism, especially without known risk factors.https://www.mdpi.com/2308-3425/12/1/26pulmonary embolismaortic arch embolismparadoxical embolismhypercoagulabilityantithrombin III deficiencyischaemic stroke |
| spellingShingle | Anna Lis Paweł Kowalski Marcin Wita Tomasz Zawadzki Tomasz Ilczak Wojciech Żurawiński Mateusz Majewski Massive Central Pulmonary Embolism with Riding Embolus and Concomitant Aortic Arch Embolism—Should We Diagnose Patients Earlier for Blood Clotting Disorders? Case Report Journal of Cardiovascular Development and Disease pulmonary embolism aortic arch embolism paradoxical embolism hypercoagulability antithrombin III deficiency ischaemic stroke |
| title | Massive Central Pulmonary Embolism with Riding Embolus and Concomitant Aortic Arch Embolism—Should We Diagnose Patients Earlier for Blood Clotting Disorders? Case Report |
| title_full | Massive Central Pulmonary Embolism with Riding Embolus and Concomitant Aortic Arch Embolism—Should We Diagnose Patients Earlier for Blood Clotting Disorders? Case Report |
| title_fullStr | Massive Central Pulmonary Embolism with Riding Embolus and Concomitant Aortic Arch Embolism—Should We Diagnose Patients Earlier for Blood Clotting Disorders? Case Report |
| title_full_unstemmed | Massive Central Pulmonary Embolism with Riding Embolus and Concomitant Aortic Arch Embolism—Should We Diagnose Patients Earlier for Blood Clotting Disorders? Case Report |
| title_short | Massive Central Pulmonary Embolism with Riding Embolus and Concomitant Aortic Arch Embolism—Should We Diagnose Patients Earlier for Blood Clotting Disorders? Case Report |
| title_sort | massive central pulmonary embolism with riding embolus and concomitant aortic arch embolism should we diagnose patients earlier for blood clotting disorders case report |
| topic | pulmonary embolism aortic arch embolism paradoxical embolism hypercoagulability antithrombin III deficiency ischaemic stroke |
| url | https://www.mdpi.com/2308-3425/12/1/26 |
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