Case presentation:
We present a case of 47-year-old man admitted to the intensive care unit
with a diagnosis of respiratory failure and hemodynamic instability 24
hours after closed fracture of the right leg. Before his admission, a
thoracic CT angiography was done but did not show any sign of acute
pulmonary embolism. During the first hours, he presented a bad evolution
with a respiratory status which failed to respond to high-dose of
vasopressor, oxide nitric and ventilatory support. Therefore, due to the
poor echocardiographic window, transesophageal echocardiography
examination was done in emergency. It revealed high-probability
diagnosis of massive pulmonary embolism based on right ventricular
dysfunction and the presence of thrombus in the right pulmonary artery.
Anticoagulant therapy (non-fractioned heparin) was administrated
immediately achieving a favorable clinical outcome with rapid withdrawal
of dobutamine, nitric oxide and norepinephrine.