title: An unusual presentation of a massive pulmonary embolism with misleading investigation results treated with tenecteplase.
abstract: Background. There is no foolproof strategy to identify a pulmonary embolism (PE) in the emergency department, and atypical presentations are common. Negative test results may mislead physicians away from the diagnosis of PE. Objectives. The current report aims to raise awareness of an unusual presentation of massive PE and its diagnosis and management, in the face of limited evidence in the scientific literature. Case Reports. We report the case of a patient with a negative D-Dimer and a negative Computed Tomography contrast angiography of the chest who was diagnosed twenty-seven hours later with a massive PE, as suggested by a bedside echocardiography. The patient was successfully treated with tenecteplase (TNK). Conclusions/Summary. Pulmonary embolism frequently presents atypically and is often a diagnostic challenge. There is limited literature about the treatment of massive PE. Further research on bedside echocardiography for diagnosing PE in unstable patients is warranted. In addition, further study into new thrombolytic agents like tenecteplase in the context of massive and submassive PE is warranted.
authors: Department of Emergency Medicine, Vancouver General Hospital, University of British Columbia, Room 3300 910, West 10th Avenue, Vancouver, BC, Canada V5Z 1M9.
authors: David
authors: D
authors: Migneault
authors: Emergency Department, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Avenue, Room B2.117, Montreal, QC, Canada H3G 1A4.
authors: Zachary
authors: Z
authors: Levine
authors: Emergency Department, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Avenue, Room B2.117, Montreal, QC, Canada H3G 1A4.
authors: François
authors: F
authors: de Champlain