Virginia Via Research Day Book 2026

Medical Student Research Case Reports

13 DYNAMIC EVALUATION OF SUBMASSIVE PULMONARY EMBOLISM WITH COR PULMONALE

Jacob Gooden, PA-C, OMS-III; Ali Hafiz, MD; Michael Nguyen, MD; Mohammed Choudhry, MD; Edmond Dixon, OMS-III; Emily Hoade, OMS-III; John Massie, OMS-III Corresponding author:ehoade@vcom.edu

VCOM-Virginia, Blacksburg, Virginia

DVT). Troponin peaked at 0.656 ng/mL with a normal pro-BNP. Transthoracic echo confirmed RV strain with moderate RV dilation, reduced RV systolic function, and markedly elevated estimated RVSP > 60 mmHg. Our PERT was a split decision regarding invasive versus conservative therapy (PESI 44 (low risk) and resting oxygen >92% on room air). Heparin was continued for additional 24 hours, and patient was further assessed with ambulatory oximetry. The 6-minute walk was prematurely stopped due to SpO2 of 81%, tachycardia, and tachypnea. PESI increased to 104 (intermediate risk), prompting shift to mechanical thrombectomy. Left pulmonary artery thrombectomy with TPA and aspiration was performed, decreasing pressure from 44 to 25 mmHg. Treatment was transitioned to apixaban with disposition for hypercoagulability workup. Ambulatory oximetry was normal prior to discharge.

Context: Submassive pulmonary embolism is stratified with pulmonary embolism severity index (PESI) score, cardiac biomarkers, right ventricular (RV) strain, and proximity within the pulmonary artery. Our case demonstrates how the PESI score can evolve from rest to ambulation, facilitating clinical decision making within a Pulmonary Embolism Response Team (PERT). Report of Case: A 44-year-old female with no baseline medical history was hospitalized due to dyspnea out of proportion to simple tasks, such as climbing the steps in her house and a near syncopal event while swimming (contradicting her active lifestyle). Initial workup demonstrated unprovoked, bilateral submassive pulmonary emboli extending within the left and right main pulmonary arteries (RV:LV >1 on CTA, likely originating from acute right peroneal

Comments: Our case highlights the importance of dynamic risk evaluation, especially in the setting of absent comorbidities, in seemingly initial low-risk submassive pulmonary emboli. Resting and ambulatory PESI scores could aid in deciding between conservative and invasive management. Catheter-directed thrombectomy facilitates immediate improvements in postoperative central venous pressure, delta RV:LV ratio, and pulmonary artery systolic pressure. At follow-up of 1.5 years, intermediate to high-risk submassive pulmonary emboli were more likely to have normalization of RV function compared to the standard anticoagulation group. IRB Statemen: The authors obtained consent from the patient to use their data for this case report.

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