Thrombolytic therapy in a patient with suspected pulmonary embolism despite a negative computed tomography pulmonary angiogram

Respir Care. 2011 Mar;56(3):336-8. doi: 10.4187/respcare.00738. Epub 2011 Jan 21.


We report a case of a 62-year-old male who presented to our intensive care unit with hypoxemia 6 hours after retinal surgery. He had a negative computed tomography (CT) pulmonary angiogram, but an emergency echocardiogram revealed the McConnell sign. He was thrombolysed and had rapid improvement in oxygenation and hemodynamics. Thrombolysis in hemodynamically unstable pulmonary embolism is not controversial, but most algorithms require confirmation of the diagnosis. Our patient had a negative CT pulmonary angiogram but was thrombolysed based on the clinical picture. Autopsy confirmed the diagnosis of multiple pulmonary emboli and unexpectedly discovered a patent foramen ovale that explained paradoxical embolism to the brain.

Publication types

  • Case Reports

MeSH terms

  • Echocardiography
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / therapy*
  • Thrombolytic Therapy*
  • Tomography, X-Ray Computed