Management of massive pulmonary embolism.

A63-year-old woman was transferred to Brigham and Women’s Hospital with massive saddle pulmonary embolism (PE) diagnosed by chest CT scan. She was being treated at a suburban hospital for ulcerative colitis manifested by 10 episodes of bloody diarrhea daily. The diagnosis of PE was suspected when she suffered sudden onset of syncope and hypotension, followed by arterial oxygen desaturation and tachycardia. Echocardiography showed an extremely dilated right ventricle with septal flattening. At Brigham and Women’s Hospital, she underwent urgent cardiac catheterization. The mixed venous oxygen saturation percentage was in the 50s. Manual injection of contrast agent into the main pulmonary artery confirmed massive bilateral PE. A Gunther Tulip (Cook, Inc) vena caval filter was placed just below the renal veins, and she was taken to the operating room, where she underwent successful emergency pulmonary embolectomy (Figure 1).