title: Thrombolysis in acute nonmassive pulmonary embolism: potential role of multidetector-row spiral computed tomography in decision making.
abstract: In the setting of suspected or confirmed nonmassive pulmonary embolism (PE), transthoracic echocardiography (TTE) is an important tool to identify patients who could benefit from thrombolytic therapy, because of right ventricle (RV) dysfunction, and to monitor the dynamic response of the RV to reperfusion therapy. Unfortunately, certain patient characteristics such as obesity, lung disease, postsurgical state, or respiratory distress often lead to inadequate ultrasonographic imaging quality. In such patients, multidetector-row spiral computed tomography (MSCT) may become even more important. We present a female obese patient with acute nonmassive PE in whom TTE did not allow a reliable evaluation of the RV. Conversely, MSCT, beyond a direct demonstration of intravascular thrombi, detected multiple signs suggesting RV dysfunction. According to these findings, thrombolysis was safely performed, obtaining a rapid clinical improvement and a regression of RV dysfunction.
authors.affiliation: Cardiology Unit, Gorizia Hospital, Gorizia, Italy. gnucifora@cardionet.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Nucifora
authors.forename: Piero
authors.initials: P
authors.lastname: Pellegrini
authors.forename: Fjoralba
authors.initials: F
authors.lastname: Hysko
authors.forename: Raheleh
authors.initials: R
authors.lastname: Rashidi
authors.forename: Diran M
authors.initials: DM
authors.lastname: Igidbashian
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D036542:Tomography, Spiral Computed / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents