[Massive pulmonary embolism after blunt chest trauma: considerations on pathogenesis and therapy]

A blunt chest trauma may provoke many different kinds of cardiac injury, particularly myocardial contusion, sometimes causing subsequent acute myocardial infarction or cardiac arrest by ventricular tachyarrhythmia in the absence of structural lesions. We describe a case of acute massive pulmonary embolism after a blunt chest impact caused when the patient was kicked by a horse. The patient showed progressive dyspnea three days after the trauma. The diagnosis was reached by non-invasive means and finally confirmed by pulmonary angiography. Because of the contraindication to thrombolytic therapy, we performed percutaneous catheter and guide-wire clot fragmentation with at least partial immediate success and subsequent favorable course. We discuss possible pathophysiological mechanisms to explain this case, which has no precedents in the literature.