BMJ Case Reports 2018; doi:10.1136/bcr-2018-224793
  • Unexpected outcome (positive or negative) including adverse drug reactions

Fulminant pulmonary embolism with fatal outcome in a patient with low clinical prediction scores

  1. Gregor Leibundgut2
  1. 1 Department of Medicine, Kantonsspital Baselland, Liestal, Switzerland
  2. 2 Department of Cardiology, Kantonsspital Baselland, University of Basel, Basel, Switzerland
  1. Correspondence to Dr Gregor Leibundgut, Gregor.Leibundgut{at}
  • Accepted 5 May 2018
  • Published 13 June 2018


We present a case of a 72-year-old man with submassive acute pulmonary thromboembolism. Pulmonary embolism severity index Score and common clinical risk stratification recommended systemic anticoagulation and a clinical course without complications was expected. A primary reperfusion strategy was not indicated by the current guidelines. Under established anticoagulation, the patient was found in cardiac arrest immediately after mobilisation from the bed the next morning. Right heart catheterisation under ongoing resuscitation revealed a complete obstruction of the right pulmonary artery by a big thrombus. Catheter-directed intervention trying to bypass the thrombus with interventional guidewires failed. Ultimately, the patient died from acute right heart failure. The current case raises concern that the prediction scores available for pulmonary embolism may insufficiently predict short-term outcome in isolated patients.


  • Contributors CD: discussion. SP: case presentation. GL: supervising and review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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