Emergent surgery for massive pulmonary embolism on the basis of clinical diagnosis

We treated a 52-year-old man for a large pleural effusion that had occurred after he fell from a ladder. Upon discharge from the hospital, the patient collapsed and was nonresponsive and hypotensive. We suspected the cause to be pulmonary embolism. When it became evident that this patient would die without emergent intervention, he was taken to surgery. A massive clot was removed from the left pulmonary artery, and multiple smaller clots were removed from both pulmonary arteries. The patient recovered and was discharged from the hospital on the 11th postoperative day. To our knowledge, this is the 1st report of pulmonary embolectomy being performed on the basis of clinical diagnosis alone.