Review article
https://doi.org/10.26800/LV-145-supl4-10
Massive pulmonary embolism after liver injury – orientation ultrasound of the right ventricle
Ivan Dželalija
; Klinika za anesteziologiju, reanimatologiju i intenzivno liječenje, KBC Split
Ruben Kovač
Abstract
Liver trauma is a surgical priority in damage control surgery. Severe liver injury is increasing the risk for pulmonary thromboembolism. Thrombosis and haemorrhage can coexist at the same time. Pharmacological thromboprophylaxis increases the risk of bleeding. This case report is about a 35-year-old female patient who, as a participant in a traffic accident, suffered multiple injuries, of which the liver injury caused haemorrhagic shock. On the fourth day of treatment, perihepatic packings were removed and the necrotic 7th and 8th segments of the liver were surgically resected. On the fifth day, an orientational ultrasound of the heart is performed. The right ventricle was larger than the left (RV/LV>1) with signs of right ventricular pressure overload. MSCT angiography detected massive pulmonary embolism. The next day, minimally invasive approach with interventional mechanical thrombectomy was successful and the heart function immediately normalized. The proximity of the necrotic liver, hepatic veins and the right ventricle makes orientational ultrasound of the right ventricle essential in the detection of venous thrombosis.
Keywords
HAEMORRHAGE; LIVER INJURY; PULMONARY EMBOLISM; ECHOCARDIOGRAPHY; RIGHT VENTRICLE
Hrčak ID:
310064
URI
Publication date:
20.11.2023.
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