Massive Pulmonary Embolism Presenting as Obstructive Shock in a Nigerian Woman: A Case Report

Author(s): Bernard B Akpu, Chidimma A Ahaneku, Agbo J Etim, Ezoke J Epoke, David E Elem, Bassey E Ekeng, Edikan B Bassey, Chibueze H Njoku, Victor O Ansa, Clement O Odigwe

Background: Massive pulmonary embolism is a life-threatening emergency associated with high mortality if prompt diagnosis and urgent intervention is delayed, especially in patients presenting in obstructive shock. It usually requires advanced therapies such as systemic thrombolysis, pharmacomechanical catheter-directed therapy, surgical embolectomy and inferior vena cava filter placement. The dearth in skilled manpower, delay in diagnosis, relative unavailability and high cost of fibrinolytics especially in resource poor environments may account for poor clinical outcomes and eventually death in such patients.

Case Presentation: We present a 50-year-old Nigerian woman of Bahumono ethnicity who was admitted into our hospital with complains of sudden onset breathlessness. On presentation, she was tachypneic, tachycardic and hypotensive. D- Dimer and Troponin I levels were elevated. Computed tomography pulmonary angiography (CTPA) with intravenous contrast confirmed the diagnosis of massive pulmonary embolism. She was initially treated with low molecular weight heparin, then thrombolyzed with intravenous alteplase and later discharged on tablet dabigatran. Her symptoms had resolved at the time of discharge and she has remained stable for over 3 months.

Conclusion: Pulmonary embolism, the most serious clinical presentation of venous thromboembolism can become catastrophic when it presents as the massive type. Prompt diagnosis and urgent appropriate medical intervention ensures good clinical outcomes.