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Silent pulmonary embolism in a patient with acute myocardial infarction and type B acute aortic dissection - a case

A Tomaszuk-Kazberuk1, B Sobkowicz, A Lewczuk

  • 1Department of Cardiology, University Hospital in Bialystok, Bialystok, Poland. walkaz@poczta.fm

Advances in Medical Sciences
|April 8, 2010
PubMed

Insights

This case highlights the risk of pulmonary embolism in patients with aortic dissection. Anticoagulant therapy is crucial for bedridden patients, even with aortic dissection, to prevent life-threatening thrombosis.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Pulmonary Medicine

Background:

  • A 69-year-old male patient presented with type B aortic dissection and acute myocardial infarction.
  • Initial conservative management was chosen, withholding prophylactic anticoagulation due to the aortic dissection.
  • Thoracic stent-graft implantation was considered but not immediately performed.

Observation:

  • An elective computed tomography (CT) scan unexpectedly revealed two large thrombi at the pulmonary trunk bifurcation.
  • The patient was asymptomatic for pulmonary embolism despite the presence of significant thrombi.
  • Immediate heparin therapy was initiated upon discovery of the thrombi.

Findings:

  • The patient responded well to heparin therapy, with subsequent imaging showing no residual embolic material.
  • Continuous oral anticoagulation was prescribed post-discharge.
  • The case underscores the potential for undetected thrombosis in patients with aortic dissection.

Implications:

  • This case raises critical questions regarding the necessity of prophylactic anticoagulation in bedridden patients with aortic dissection.
  • Failure to administer anticoagulation prophylaxis could lead to severe clinical outcomes, including pulmonary embolism.
  • The findings suggest a need for revised guidelines on anticoagulation strategies in complex cardiovascular conditions.

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