Palominos-Gutiérrez YA, Montelongo FJ, Galindo-Ayala J, Bocanegra-Flores L, Ballesteros-Flores C, Carmona-Domínguez A

Language: Spanish
References: 16
Page: 170-174
PDF size: 374.06 Kb.

ABSTRACT

We present the case of a 41-year-old woman with morbid obesity, chronic smoking and chronic cor pulmonale due to chronic obstructive pulmonary disease who was admitted to the General Hospital “Las Américas” in Ecatepec, State of Mexico for community-acquired pneumonia. During her hospital stay, she suddenly developed progressive dyspnea, pleuritic pain, and hemodynamic deterioration. The emergency pointof- care echocardiogram showed flattening of the interventricular septum and displacement into the left ventricular cavity with a “D-shape” at end-systole, accompanied by echocardiographic findings consistent with acute right ventricular pressure overload and shock.
Due to the high probability of pulmonary thromboembolism, parenteral thrombolysis was initiated using Alteplase. Significant clinical improvement was observed within the first few hours, and progressive resolution of the “D-shape” sign was seen on subsequent echocardiographic follow-up. A high-resolution CT angiogram of the chest showed pulmonary thromboembolism localized to the segmental branches of the left apex and right base, with a focus of pulmonary infarction and signs of central necrosis. The clinical outcome was satisfactory.
This case illustrates the usefulness of the “D-shape” sign as a dynamic echocardiographic marker in the context of acute pulmonary thromboembolism. Its value for initial diagnosis is highlighted, especially in patients with risk factors such as morbid obesity, chronic smoking and chronic cor pulmonale, allowing for timely therapeutic intervention and evaluation of the therapeutic response to improve the prognosis of complex cases.

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