Korean J Med.  2011 Oct;81(4):496-501.

Concurrent Coronary Thromboembolism and Pulmonary Thromboembolism without Right-to-Left Shunt

• Lee MY
• Yoon DH
• Lee CW
• Park KT
• Ryu MS
• Choi HH
• Hong KS

Abstract

A 65-year-old woman was referred for management of chest pain and ST segment elevation on electrocardiography. Emergency coronary angiography revealed a well demarcated thrombus that near totally occluded the mid portion of the left anterior descending artery, with a Thrombolysis In Myocardial Infarction (TIMI) flow grade 1, and a fusiform aneurysm on the left main coronary artery. No significant stenosis was observed after aspiration of the thrombus; however, complete coronary reperfusion by urgent aspiration did not improve her dyspnea and tachypnea. Echocardiography revealed a D-shaped left ventricle; thus, we performed a chest computed tomography scan and diagnosed a pulmonary embolism. The patient's coagulation studies were normal. She was prescribed chronic anticoagulation, and we carried out transthoracic echocardiography using second harmonic imaging with agitated saline. Second harmonic imaging with the Valsalva maneuver revealed no right-to-left shunt. We report here a case of concurrent coronary embolism and pulmonary embolism without right-to-left shunt.

Keyword

Embolism; Pulmonary embolism; Coronary aneurysm; Myocardial infarction

MeSH Terms

Aged
Aneurysm
Arteries
Chest Pain
Constriction, Pathologic
Coronary Aneurysm
Coronary Angiography
Coronary Vessels
Dihydroergotamine
Dyspnea
Echocardiography
Electrocardiography
Embolism
Emergencies
Female
Humans
Myocardial Infarction
Myocardial Reperfusion
Pulmonary Embolism
Tachypnea
Thorax
Thromboembolism
Thrombosis
Valsalva Maneuver
Dihydroergotamine