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A Rare Case of Acute Pulmonary Embolism after Coronary Angiography due to Sand Bag Compression.

ABSTRACT: Pulmonary embolism (PE) is very rare after coronary angiography. We present here a case of acute PE after coronary angiography due to sand bag compression which has not been reported previously. After the femoral sheath removal, patient was immobilized for 6 hours with a sand bag on his right femoral artery area. After the removal of sand bag, patient stood up with the help of a nurse. Immediately after standing up, patient complained sudden onset of dyspnea, lost his consciousness, and suddenly fell on the ground while hitting left occipital region of his head. Clinical, echocardiographic, laboratory, and tomographic findings were compatible with massive PE and we decided to give thrombolytic agent. On the contrary, because he had cranial trauma during syncope and oozing type hemorrhage in his right inguinal region, we administered a total dose of 50 mg alteplase (tissue plasminogen activator) within 2 hours (normal recommended dose is 100 mg). Just after finishing alteplase, clinical, laboratory, and echocardiographic parameters of the patient returned to normal without any complication. Patient was discharged with warfarin treatment 5 days after the event.

SUBMITTER: Kivrak T

PROVIDER: S-EPMC3830577 | biostudies-other | 2013 Dec

REPOSITORIES: biostudies-other

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Project description:PurposeTo evaluate pulmonary embolism (PE) prevalence at CT pulmonary angiography in patients testing positive for coronavirus disease 2019 (COVID-19) and factors associated with PE severity.Materials and methodsA retrospective, single-center study evaluated 62 patients who tested positive for COVID-19 who underwent CT pulmonary angiography between March 13 and April 5, 2020. Another 62-patient cohort who underwent CT pulmonary angiography before the first reported local COVID-19 case was retrospectively selected. The relative rate of CT pulmonary angiography positivity was recorded. For the COVID-19 positive cohort, comorbidities, laboratory values, clinical outcome, and venous thrombosis of the patients were recorded. Two thoracic radiologists assessed embolic severity using the Mastora system and evaluated right heart strain. Factors associated with PE and arterial obstruction severity were evaluated by using statistical analysis. A P value < .05 was considered significant.ResultsOf the patients testing positive for COVID-19, 37.1% had PE, higher than 14.5% of pre-COVID-19 patients (P = .007). d-dimer levels closest to CT pulmonary angiography date correlated with the Mastora obstruction score. Receiver operating characteristic analysis identified optimal sensitivity (95%) and specificity (71%) for PE diagnosis at 1394 ng/mL d-dimer units. The mean d-dimer level was 1774 ng/mL and 6432 ng/mL d-dimer units in CT pulmonary angiography-negative and CT pulmonary angiography-positive subgroups, respectively (P < .001). One additional patient with negative results at CT pulmonary angiography had deep venous thrombosis, thus resulting in 38.7% with PE or deep venous thrombosis, despite 40% receiving prophylactic anticoagulation. Other factors did not demonstrate significant PE association.ConclusionA total of 37.1% of COVID-19 patients underwent CT pulmonary angiographic examinations diagnosing PE. PE can be a cause of decompensation in patients testing positive for COVID-19, and d-dimer can be used to stratify patients in terms of PE risk and severity.Supplemental material is available for this article.© RSNA, 2020.

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A Rare Case of Acute Pulmonary Embolism after Coronary Angiography due to Sand Bag Compression.

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