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Department of Emergency, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
Department of Emergency, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
Department of Emergency, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
Department of Emergency, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
A 66-year-old woman with a history of hyperlipidemia presented to the emergency department after a epileptic seizure episode for nearly 1 min. She had a normal temperature, pulse rate was 77 beats/min, blood pressure was 85/40 mm Hg, and pulse oximetry was 92% on room air.She felt chest tightness when exercise for 1 week. Laboratory test was significant for cardiac troponin I level of 0.12 ng/ml, B-type natriuretic peptide lever of 866.96 pg/ml, D-dimer lever of 2520 ng/ml. She had a head computerized tomography of no cerebral hemorrhage or infarction. The emergency physician prescribed sodium valproate to Control the seizures. And the physician performed point-of-care ultrasonography (Fig. 1 and Video 1). Diagnosis was confirmed with computer tomography pulmonary angiography (CTPA, Fig. 2).
Fig. 1Parasternal short axis view of transthoracic echocardiography showing “D”sign:the compressed left ventricle, abnormal septal shape(arrow),and the dilated right ventricle(star).
Acute Pulmonary embolism. CTPA scan demonstrated Extensive pulmonary embolism in both pulmonary artery trunk. Intravenous Alteplase rt-PA were administered. After 10 days hospitalization, she was discharged from hospital with Rivaroxaban.6 months after discharge date, the follow-up CT scan showed no pulmonary embolism (Fig. 3).
Fig. 3Follow-up CTPA showing no filling-defect of bilateral pulmonary artery Trunk.
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