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Successful Management of High-Risk Acute Pulmonary Embolism in Patients with Undetected Hepatocellular Carcinoma: A Case Report

Heart Science Journal · Vol. 4 No. 4 (2023) · hlm. 24–30

DOI
10.21776/ub.hsj.2023.004.04.6
ISSN
2721-9984, 2721-9976
Terbit
2023-10-01
Penerbit
Universitas Brawijaya
Bahasa
en

Abstrak

AbstractBackground: Acute pulmonary embolism (PE) as the earliest manifestation of hepatocellular carcinoma (also known as HCC) is an extremely uncommon discovery and a very uncommon illness. It is a serious condition that can be life-threatening and has high morbidity and mortality rates. Despite the high prevalence of PE, the diagnosis is still challenging, mainly due to the unpredictability of symptoms and physical signs and the unexplained cause. The stratification of acute pulmonary embolism is important because it determines the right steps in decision-making.Case Illustration: A 45-year-old man presented to the ER at a private hospital with complaints of sudden shortness of breath after taking a bath. His family brought him to the private hospital 30 minutes after the onset. He came with desaturation and shock conditions. He was assessed as having an acute coronary syndrome (ACS). He got loaded with dual antiplatelets and was referred to our hospital. Because the patient's complaint is not angina but sudden shortness of breath accompanied by desaturation, we rule out ACS. We considered the possibility of a pulmonary embolism, so we performed bedside TTE in the ER and found RV dysfunction and McConnell's sign leading to acute PE. We continued with the CT examination and found a thrombus in the pulmonary artery. We assessed patients with high-risk pulmonary embolism and performed thrombolysis with rTPA. The patient's complaints gradually improved. Initially, we suspected unprovoked PE because we did not find a clear trigger, such as malignancy, prolonged bedriddenness, recent surgery, or old age. We accidentally found HCC from the patient's CTPA evaluation, and HBSAG was reactive.Conclusion: Every case of dyspnea that shows up at an emergency room should have acute PE taken into consideration in the differential diagnosis. In patients with suspected PE without obvious risk factors, we can use CT to triple-rule out ACS, Aortic dissection, and pulmonary embolism. Patients treated with thrombolytic therapy show rapid improvement, which may lead to a lower rate of mortality and morbidity.

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Cholid Tri TjahjonoAfiliasi tidak diketahui22
Mohammad Saifur RohmanAfiliasi tidak diketahui22
Anna Fuji RahimahAfiliasi tidak diketahui20
Ardian RizalAfiliasi tidak diketahui18
Indra PrasetyaAfiliasi tidak diketahui17
Sasmojo WiditoAfiliasi tidak diketahui13
Djanggan SargowoAfiliasi tidak diketahui12
Budi SatrijoAfiliasi tidak diketahui10
Setyasih AnjarwaniAfiliasi tidak diketahui7
Seprian WidasmaraAfiliasi tidak diketahui5
Valerinna YogibuanaAfiliasi tidak diketahui4
Adhika Prastya WikanandaAfiliasi tidak diketahui4
Zainal FathurohimAfiliasi tidak diketahui4
Sawitri SatwikajatiAfiliasi tidak diketahui3
Lukitasari Ayu GaluhAfiliasi tidak diketahui3
Putri Annisa KamilaUniversity of Brawijaya3
Irma KameliaAfiliasi tidak diketahui3
Oktafin Srywati PamunaAfiliasi tidak diketahui3
Imam Mi'raj SuprayogaAfiliasi tidak diketahui3
Wella KarolinaAfiliasi tidak diketahui3
Dea Arie KurniawanAfiliasi tidak diketahui3
Taufieq Ridlo MakhmudAfiliasi tidak diketahui2
Faris Wahyu NugrohoAfiliasi tidak diketahui2
Dyah Ayu IkeningrumAfiliasi tidak diketahui2
Nikhen NoverikeAfiliasi tidak diketahui2
Titin Andri WihastutiAfiliasi tidak diketahui2
Valerinna Yogibuana Swastika PutriAfiliasi tidak diketahui2
Indra Jabbar AzizAfiliasi tidak diketahui2
Muhammad FirdausAfiliasi tidak diketahui2
Danti Utami SetyowatiAfiliasi tidak diketahui2
Malombassi Dharmawan Hadiwidjojo HutomoAfiliasi tidak diketahui2
Ayu Asri Devi AdityawatiAfiliasi tidak diketahui2
Muhammad Rizki FadlanAfiliasi tidak diketahui2
Fahmy RusnantaAfiliasi tidak diketahui2
Ratna PancasariAfiliasi tidak diketahui2
Tri AstiawatiAfiliasi tidak diketahui2
Arif WicaksonoAfiliasi tidak diketahui2

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Sumber metadata: OAI-PMH (metadata jurnal) https://heartscience.ub.ac.id/index.php/heartscience/oai, pertama di-harvest 8 Nov 2026, terakhir terlihat 8 Nov 2026.
Metadata asli (oai_dc) 
<oai_dc:dc xmlns="http://www.openarchives.org/OAI/2.0/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/  http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
	<dc:title xml:lang="en">Successful Management of High-Risk Acute Pulmonary Embolism in Patients with Undetected Hepatocellular Carcinoma: A Case Report</dc:title>
	<dc:creator xml:lang="en">zunardi, Lutfi hafiz</dc:creator>
	<dc:creator xml:lang="en">Kurnianingsih, Novi</dc:creator>
	<dc:creator xml:lang="en">Martini, Heny</dc:creator>
	<dc:subject xml:lang="en">unprovoked</dc:subject>
	<dc:subject xml:lang="en">Acute Coronary syndrome</dc:subject>
	<dc:subject xml:lang="en">acute pulmonary embolism</dc:subject>
	<dc:subject xml:lang="en">thrombolysis</dc:subject>
	<dc:subject xml:lang="en">Hepatocellular carcinoma</dc:subject>
	<dc:description xml:lang="en">AbstractBackground: Acute pulmonary embolism (PE) as the earliest manifestation of hepatocellular carcinoma (also known as HCC) is an extremely uncommon discovery and a very uncommon illness. It is a serious condition that can be life-threatening and has high morbidity and mortality rates. Despite the high prevalence of PE, the diagnosis is still challenging, mainly due to the unpredictability of symptoms and physical signs and the unexplained cause. The stratification of acute pulmonary embolism is important because it determines the right steps in decision-making.Case Illustration: A 45-year-old man presented to the ER at a private hospital with complaints of sudden shortness of breath after taking a bath. His family brought him to the private hospital 30 minutes after the onset. He came with desaturation and shock conditions. He was assessed as having an acute coronary syndrome (ACS). He got loaded with dual antiplatelets and was referred to our hospital. Because the patient's complaint is not angina but sudden shortness of breath accompanied by desaturation, we rule out ACS. We considered the possibility of a pulmonary embolism, so we performed bedside TTE in the ER and found RV dysfunction and McConnell's sign leading to acute PE. We continued with the CT examination and found a thrombus in the pulmonary artery. We assessed patients with high-risk pulmonary embolism and performed thrombolysis with rTPA. The patient's complaints gradually improved. Initially, we suspected unprovoked PE because we did not find a clear trigger, such as malignancy, prolonged bedriddenness, recent surgery, or old age. We accidentally found HCC from the patient's CTPA evaluation, and HBSAG was reactive.Conclusion: Every case of dyspnea that shows up at an emergency room should have acute PE taken into consideration in the differential diagnosis. In patients with suspected PE without obvious risk factors, we can use CT to triple-rule out ACS, Aortic dissection, and pulmonary embolism. Patients treated with thrombolytic therapy show rapid improvement, which may lead to a lower rate of mortality and morbidity.</dc:description>
	<dc:publisher xml:lang="en">Universitas Brawijaya</dc:publisher>
	<dc:date>2023-10-01</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>https://heartscience.ub.ac.id/index.php/heartscience/article/view/13841</dc:identifier>
	<dc:identifier>10.21776/ub.hsj.2023.004.04.6</dc:identifier>
	<dc:source xml:lang="en">Heart Science Journal; Vol. 4 No. 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac Care Unit ICCU; 24-30</dc:source>
	<dc:source>2721-9984</dc:source>
	<dc:source>2721-9976</dc:source>
	<dc:source>10.21776/ub.hsj.2023.004.04</dc:source>
	<dc:language>en</dc:language>
	<dc:relation>https://heartscience.ub.ac.id/index.php/heartscience/article/view/13841/377</dc:relation>
	<dc:rights xml:lang="en">Copyright (c) 2023 Lutfi hafiz zunardi</dc:rights>
</oai_dc:dc>