Clinical and Echocardiography Characteristics of in-situ Pulmonary Artery Thrombosis in Morocco: Case Series about 4 Patients

Abstract

Background: Thromboembolic disease is the third leading cause of cardiovascular death. In recent years, several lines of evidence have indicated the possibility of de novo thrombus generation in pulmonary arteries without deep vein thrombus (DVT) in the lower extremities. Pulmonary artery thrombosis is a very rare diagnostic entity, usually manifested by embolic migration from another venous site, and may form by in situ thrombus. The aim of this study is to evaluate the clinical and echocardiography (TTE) data of pulmonary artery thrombosis in situ (PATIS). This is a mini-series about 4 cases seen in the intensive cardiac care unit (ICCU) at the cardiology department of University Hospital of Ibn Rochd -Casablanca between 01/01/2023 to 01/04/2023. Case Presentation: We present a mini series of 4 patients; 3 women and a man, admitted to the ICCU for high-risk pulmonary artery thrombosis. The mean age of 64 years old. Two patients of the feminine sex had neoplasia, a man sedentary because of a bilateral lymphedema in the lower limbs. The last patient was a woman under ostro-progestatif pills, au total, all of these factors represent probably the main factors of their thromboembolic events. Clinically, all of them had a dyspnea and angina. A bed echocardiography objectifying evidence of acute cor pulmonale associate of right ventricle dysfunction and pulmonary artery thrombosis in situ (PATIS).  we introduce Immediately non-fractional heparin (NFH) after the diagnostic of the PATIS without waiting the results of the thoracic angio-CT, no one initially had thrombolysis. The prognostic was somber, 3 out of 4 patients died from cardiogenic shock during hospitalization. In our opinion, the main effect was for co-morbidities such as age, neoplasia profile and uncontrolled diabetes. Conclusions: There is much theory regarding the pathophysiology of pulmonary artery thrombus in situ, but the main pathogenicity is considered to be local pulmonary factors, including pulmonary vascular endothelial cell dysfunction, hypoxia and inflammation.