Case
A 76-year-old male with history of coronary artery disease and chronic
obstructive pulmonary disease presented to an outside hospital with
acute-onset dyspnea. The patient was hemodynamically stable with initial
laboratory evaluation significant for anion-gap metabolic acidosis,
venous lactate 7.6, D-dimer 11.65, and proBNP 17,056; SARS-CoV-2 RNA
testing was negative. CT angiography of the chest revealed saddle
pulmonary embolus with near complete occlusion of the main pulmonary
arteries and evidence of right ventricle (RV) strain. The patient was
treated initially with intravenous heparin. Despite this, the patient
began experiencing increasing dyspnea with repeat echocardiogram showing
a new 4.8cm-by-1.4cm mobile thrombus in the RA going in and out of the
RV during the cardiac cycle with additional clot extending into the
inferior vena cava (IVC) (Figure 1 ). Due to concerns for distal
embolization causing massive PE, thrombolytic therapy was deferred and
the patient was transferred to our facility for urgent suction
embolectomy using the AngioVac system.