Utilizing Point-of-Care Ultrasound for the Management of Massive Pulmonary Embolism in a Young Male: A Case Report

Pulmonary embolism (PE) is a thromboembolic disorder characterized by obstruction of the pulmonary arterial circulation, most commonly due to embolization of thrombi originating from the deep venous system of the lower extremities. Massive PE is a critical condition marked by hemodynamic instability not caused by a new arrhythmia, cardiogenic shock, or circulatory collapse. The patient is a 28-year-old male with no significant medical history who arrived at the Emergency Department with a self-inflicted neck wound. He received initial treatment, including securement of the airway, antibiotics, analgesia, and suturing. After neck exploration and tracheal repair, he was diagnosed with MRSA and ESBL + Klebsiella pneumoniae and treated with IV antibiotics. After 17 days of admission, the patient was discharged home but returned the same day with hypotension, shortness of breath, chest pain, and shock, with hypoxia. Point-of-care ultrasound (POCUS) revealed right ventricular dilatation suggestive of PE, which was finally confirmed with further testing. Echocardiogram confirmed substantial right ventricular and right atrial dilation with an estimated pulmonary artery pressure of 53 mm Hg and a positive McConnell's sign. In conclusion, cardiac POCUS is a non-invasive, quick, and cost-effective imaging technique used in emergency settings to diagnose PE by identifying PE markers. This case report underscores the importance of POCUS in promptly diagnosing PE, emphasizing its role in preventing fatal outcomes due to delayed diagnosis.