Features of diagnostics and surgical treatment of right ventricular thrombosis complicated by pulmonary artery thromboembolism (clinical case)

  • R. M. Vitovsky Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
  • P. M. Semeniv National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
  • A. O. Rusnak National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
  • Y. R. Ivanov National Amosov Institute of Cardiovascular Surgery, Kyiv, Ukraine
  • V. F. Onischenko Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
Keywords: heart attack­pneumonia, right ventricular thrombosis, pulmonary embolism

Abstract

The case of differential diagnosis and treatment of a patient with pulmonary embolism (PE), the source of which was the thrombus formed in the right ventricle of the heart, is presented. The peculiarity of this case was the untimely diagnosis of the disease, which simulated pneumonia, the treatment of which did not improve the clinical condition of the patient. Tomography allowed to determine the thrombosis of the right branch of the pulmonary artery and to send the patient to the cardiac surgery center for further treatment. Diagnosis of a probable source of embolism occurred after echocardiography, which revealed a tumor-like lesion of the right ventricle of large size and dense consistency. The results of surgical treatment of the patient, during which extensive formation of the right ventricle was removed, a dense elastic consistency with signs of fragmentation confirmed the prediction of this particular source of pulmonary embolism. Removal of blood clots from the right branch of the pulmonary embolism showed their similar macrostructure with right ventricular formation. The appearance and macrostructure of the formation did not allow to determine with certainty its character. Only histological examination was able to determine the thrombogenicity of the origin of this formation.

The recurrent nature of pneumonia, without the presence of risk factors, in young patients may be the basis for more thorough examination to identify atypical clinical conditions. The restoration of the source of the body is of great importancefor the prevention of its relapse.

Finding the source of pulmonary embolism should necessarily include echocardiography to carefully examine possible lesions of intracardiac structures with the formation of blood clots that may be responsible for its occurrence.

References

  1. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117–71.
  2. 2014 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism. The task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Russ. J. Cardiol. 2015;8:67–110. Russian.
  3. [Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTEC)]. Phlebology. 2015;9(4–2):2–52. Russian.
  4. Kim NH, Delcroix M, Jais X, Madani MM, Matsubara H, Mayer E, et al. Chronic thromboembolic pulmonary hypertension. European Respiratory Journal. 2018;53: 1801915. https://doi.org/10.1183/13993003.01915-2018
  5. Torres A, Cilloniz C. Severe community-acquired pneumonia: Corticosteroids as adjunctive treatment to antibiotics. Community Acquir Infect. 2016;3:1–3.
  6. Chen X. Causes and management of initial treatment failure in patients with community-acquired pneumonia. Community Acquir Infect. 2014;1:65–8.
  7. The Hospitalist [Internet]. Society of Hospital Medicine; c2000–2017 [cited 2019 Oct]. Garrett N. Most in-hospital pneumonia deaths may not be preventable; [about 1 screen]. Available from: https://www.the-hospitalist.org/hospitalist/article/175306/pulmonology/most-hospital-pneumonia-deaths-may-not-be-preventable
Published
2020-01-07
How to Cite
Vitovsky, R. M., Semeniv, P. M., Rusnak, A. O., Ivanov, Y. R., & Onischenko, V. F. (2019). Features of diagnostics and surgical treatment of right ventricular thrombosis complicated by pulmonary artery thromboembolism (clinical case). Ukrainian Journal of Cardiovascular Surgery, (4 (37), 67-71. https://doi.org/10.30702/ujcvs/19.3712/073067-071