Pulmonary thromboembolism with prolonged pulmonary infarction during intensive decongestion for severe heart failure : A case report
- 1Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
- 2Department of Thoracic and Cardiovascular Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
- 3Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea.
Abstract
Rationale:: Pulmonary thromboembolism (PTE) may be overlooked in acute decompensated heart failure because dyspnea, hypoxemia, pleural effusion, and pulmonary infiltrates can mimic refractory congestion. Extensive PTE with pulmonary infarction during intensive decongestion in severe heart failure with reduced ejection fraction (HFrEF) is rarely described.
Patient concerns:: A 50-year-old woman without prior cardiovascular disease presented with several weeks of progressive dyspnea, severe orthopnea, pulmonary edema, pleural effusions, and an oxygen requirement of 5 L/min.
Diagnoses:: Echocardiography showed a severely dilated left ventricle and a left ventricular ejection fraction of 25%, consistent with nonischemic dilated cardiomyopathy. After a cumulative negative fluid balance of 12 L over 48 hours, hypoxemia worsened despite improved congestion. Computed tomography pulmonary angiography confirmed extensive acute PTE with pulmonary infarction.
Interventions:: Systemic thrombolysis with alteplase was administered, followed by unfractionated heparin and transition to a non-vitamin K antagonist oral anticoagulant. Guideline-directed medical therapy for HFrEF was initiated.
Outcomes:: Hemodynamics stabilized, but parenchymal recovery was delayed. Pulmonary infarction showed minimal radiographic improvement at 2 weeks, partial improvement at 1 month, and complete resolution at 2 months. Oxygen therapy was discontinued, dyspnea improved markedly, and left ventricular ejection fraction increased to 37%.
Lessons:: PTE should be suspected when oxygenation worsens despite effective decongestion in severe HFrEF. Pulmonary infarction may require up to 2 months for complete radiographic resolution despite prompt thrombolysis and anticoagulation.
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BibTeX
@article{roh2026pulmonary,
title = {{Pulmonary thromboembolism with prolonged pulmonary infarction during intensive decongestion for severe heart failure : A case report}},
author = {A-Reum Roh and Jong Hyun Baek and Jong-Il Park},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051388},
url = {https://europepmc.org/article/PMC/PMC13727214},
note = {CC BY},
}
RIS
TY - JOUR
TI - Pulmonary thromboembolism with prolonged pulmonary infarction during intensive decongestion for severe heart failure : A case report
AU - A-Reum Roh
AU - Jong Hyun Baek
AU - Jong-Il Park
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051388
UR - https://europepmc.org/article/PMC/PMC13727214
AB - Rationale:: Pulmonary thromboembolism (PTE) may be overlooked in acute decompensated heart failure because dyspnea, hypoxemia, pleural effusion, and pulmonary infiltrates can mimic refractory congestion. Extensive PTE with pulmonary infarction during intensive decongestion in severe heart failure with reduced ejection fraction (HFrEF) is rarely described. Patient concerns:: A 50-year-old woman without prior cardiovascular disease presented with several weeks of progressive dyspnea, severe orthopnea, pulmonary edema, pleural effusions, and an oxygen requirement of 5 L/min. Diagnoses:: Echocardiography showed a severely dilated left ventricle and a left ventricular ejection fraction of 25%, consistent with nonischemic dilated cardiomyopathy. After a cumulative negative fluid balance of 12 L over 48 hours, hypoxemia worsened despite improved congestion. Computed tomography pulmonary angiography confirmed extensive acute PTE with pulmonary infarction. Interventions:: Systemic thrombolysis with alteplase was administered, followed by unfractionated heparin and transition to a non-vitamin K antagonist oral anticoagulant. Guideline-directed medical therapy for HFrEF was initiated. Outcomes:: Hemodynamics stabilized, but parenchymal recovery was delayed. Pulmonary infarction showed minimal radiographic improvement at 2 weeks, partial improvement at 1 month, and complete resolution at 2 months. Oxygen therapy was discontinued, dyspnea improved markedly, and left ventricular ejection fraction increased to 37%. Lessons:: PTE should be suspected when oxygenation worsens despite effective decongestion in severe HFrEF. Pulmonary infarction may require up to 2 months for complete radiographic resolution despite prompt thrombolysis and anticoagulation.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -