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71 y/o man, shortness of breath and syncope

Presentation

A 71-year-old man presented with shortness of breath and syncope. His history included an episode of phlebitis one year prior to this presentation. A ventilation/perfusion lung scan, obtained to explore the possibility of pulmonary embolism, was markedly positive. An echocardiogram showed right ventricular dilatation with systolic pulmonary artery pressure elevated to 64 mm Hg.

Given the clinical picture of right heart strain in the presence of massive pulmonary embolism, the patient was treated with tissue plasminogen activator (TPA) at the regimen of 100 mg continuous infusion over 3 hours, then was switched to intravenous heparin and eventually begun on oral warfarin sodium (Coumadin). One week later, a second perfusion scan showed marked decrease in the perfusion defects, and on a repeat echocardiogram the systolic pulmonary pressure was in the range of 40 mm Hg.

Images

Initial Perfusion Lung Scan
Ventilation Study
Follow-up Perfusion Lung Scan

Description of Findings

Full case report

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