Gaspar Vasco, Silva Bernardo, Ambrioso Inês, Alves Cláudia, Alçada Martim
Internal Medicine Department, Hospital Distrital de Santarém, Santarém, PRT.
Cureus. 2023 Aug 22;15(8):e43937. doi: 10.7759/cureus.43937. eCollection 2023 Aug.
The coronavirus disease 2019 (COVID-19) infection presents with a wild range of clinical manifestations. Increased inflammatory response and thrombotic risk have been described, being pulmonary embolism a potential cause of death in these patients. Pulmonary embolisms with right ventricle thrombus are rare and have higher mortality rates. This case report concerns a rare clinical presentation of a 75-year-old male with a medical history of right renal transplantation 36 years ago, that presented with a ten-day history of asthenia, followed by fever, shortness of breath, and cough since the day before. He was admitted with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia and respiratory insufficiency. The next morning the patient worsened, he presented with hypotension, tachycardia, severe refractory hypoxemia, and chest pain. Contrast CT showed a massive pulmonary embolism with a right ventricle thrombus, confirmed by an echocardiogram. Anticoagulation and IV fluids were started, and the patient was transferred to the ICU. He developed obstructive shock, so thrombolysis was performed with a full dose of alteplase. The outcome was good with complete recovery. Posterior investigation excluded other causes for pulmonary embolism. The severity of pulmonary parenchymal disease secondary to COVID-19 correlates with thromboembolic complications, which demand a swift response to avoid death. An abrupt deterioration in oxygenation should raise suspicion for PE in COVID-19 patients, and mostly in the presence of hypotension and tachycardia. In our case report, there was a massive pulmonary embolism with a rare right ventricle thrombus that had a good outcome with medical treatment.
2019冠状病毒病（COVID-19）感染表现出广泛的临床表现。已有研究描述了炎症反应增加和血栓形成风险，肺栓塞是这些患者潜在的死亡原因。伴有右心室血栓的肺栓塞很少见，死亡率更高。本病例报告涉及一名75岁男性的罕见临床表现，该患者36年前有右肾移植病史，出现乏力10天，自前一天起出现发热、气短和咳嗽。他因严重急性呼吸综合征冠状病毒2（SARS-CoV-2）肺炎和呼吸功能不全入院。第二天早上，患者病情恶化，出现低血压、心动过速、严重难治性低氧血症和胸痛。对比增强CT显示巨大肺栓塞伴右心室血栓，超声心动图证实。开始抗凝治疗并静脉补液，患者被转入重症监护病房。他发生了梗阻性休克，因此用全剂量阿替普酶进行了溶栓治疗。结果良好，患者完全康复。后续调查排除了肺栓塞的其他原因。COVID-19继发的肺实质疾病的严重程度与血栓栓塞并发症相关，这需要迅速做出反应以避免死亡。COVID-19患者出现氧合突然恶化时应怀疑肺栓塞，尤其是在存在低血压和心动过速的情况下。在我们的病例报告中，存在巨大肺栓塞伴罕见的右心室血栓，经药物治疗后预后良好。
