Login
Search
Search
0 Dates
2026
2025
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
CPC 2025
CPC 2026
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Behind the clot: an unconventional cause of acute-on-chronic pulmonary embolism
Session:
Prémio Melhor Caso Clínico
Speaker:
Julien Lopes
Congress:
CPC 2026
Topic:
---
Theme:
---
Subtheme:
---
Session Type:
Sessão de Prémios
FP Number:
---
Authors:
Julien Oliveira Lopes; Bárbara Lacerda Teixeira; André Grazina; João Reis; Pedro Costa; Melanie Ferreira; Luís Almeida Morais; Ana Galrinho; Eugénia Pinto; Paulo Calvinho; Pedro Coelho; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">A 63-year-old patient with no relevant past medical history presented to the emergency department with a two-week history of exertional dyspnea. Chest CT scan raised suspicion for acute pulmonary embolism (PE), and anticoagulation with enoxaparin was initiated. On day 4, clinical deterioration occurred, requiring escalation to high-flow oxygen therapy and a repeat CT showed extensive central thrombosis at the main pulmonary artery (PA) trunk, with left-sided extension to the origin of the inferior branches and complete distal thrombosis of the right lower lobe, representing progression compared with the previous study. Laboratory evaluation revealed elevated high-sensitivity troponin I (77 ng/L) and NT-proBNP (5,000 pg/mL). Bedside echocardiography showed right ventricular dilatation with systolic dysfunction (TAPSE 14 mm), markedly elevated estimated sPAP (120 mmHg) with a TAPSE/sPAP of 0.12 and preserved left ventricular systolic function with D-shape. An acute-on-chronic intermediate–high-risk PE was presumed, and the patient was transferred to our center for further evaluation. Following multidisciplinary discussion involving the PERT, pulmonary hypertension (PH), and cardiac surgery teams, and after CT scan review, the possibility of pulmonary artery angiosarcoma with superimposed PE was raised. Cardiac MRI revealed a voluminous mass within the main pulmonary artery trunk, without invasion of adjacent structures, with tissue characteristics consistent with acute to subacute thrombus. Given progressive clinical deterioration requiring inotropic support, a decision to advance to pulmonary thromboendarterectomy was made. Intraoperatively, a large mass was identified within the pulmonary artery, associated with chronic thrombus exhibiting infiltrative involvement of the vascular wall. Frozen-section analysis demonstrated thrombus of mixed ages and atypical cells. Complete excision was achieved in the main pulmonary artery, with subtotal resection and concomitant thromboendarterectomy in the right pulmonary artery. Postoperative invasive sPAP was 40 mmHg. The patient was extubated 36 hours postoperatively and transferred to the ward on postoperative day 6, with progressive clinical improvement. Final histopathological examination confirmed PA intimal sarcoma. The patient was discharged on postoperative day 16 with long-term oxygen therapy and referred for oncology consultation. PA sarcoma is a rare cause of group 4 PH, and this case reinforces the importance of multidisciplinary assessment in patients with atypical or progressive PE. Although associated with a poor prognosis, surgical management in specialized centers may relieve right ventricular obstruction, prevent short-term clinical deterioration, facilitate hospital discharge and allow initiation of oncological therapy.</span></span></p>
Our mission: To reduce the burden of cardiovascular disease
Visit our site