Authors: Simon Antoine Sarr, Zoumana Sangaré, Serigne Mor Beye, Fatou Aw, Malick Bodian, Alioune Alassane Ngaidé, Momar Dioum, Mouhamadou Bamba Ndiaye, Alassane Mbaye, Adama Kane, Maboury Diao, Abdoul Kane, Serigne Abdou BA.
Pulmonary embolism is a common condition that can be difficult to diagnose due to clinical polymorphism. Doppler echocardiography, beyond the evaluation of hemodynamic repercussion on the right ventricle, may reveal intra-cardiac thrombi. If the unfavorable prognosis of these situations is well established, their management is far from being consensual. We report the case of a 70-year-old patient who was referred to us for electrophysiological exploration in the face of a brief, repetitive, syncope, spontaneously resolving loss of consciousness without biting of the tongue or loss of urine, associated with intense palpitations. The initial electrocardiogram recorded a short PR and broad QRS. Upon physical examination we found a right heart failure syndrome. During the clinical evaluation, an episode of syncope had occurred with cardiovascular collaps. The per-critical electrocardiogram recorded an isorhythmic dissociation with enlarged QRS and a progressive shortening of the PR interval. Transthoracic Doppler echocardiography showed dilatation of right cavities with moderate alteration in right ventricular systolic function, presence of numerous mobile thrombi in the right atrium, and a serpentine thrombus at the bifurcation of the pulmonary artery. Fibrinolysis was initiated with streptokinase and was followed by anticoagulation. The immediate progress was favorable with a disappearance of the syncope and normalization of the electrocardiogram. Subsequent computed tomography (CT) revealed massive bilateral proximal and segmental pulmonary embolism associated with signs of pulmonary hypertension. Venous Doppler ultrasound showed a right popliteal thrombosis. Doppler echocardiography of control performed on the third day noted the disappearance of thrombi; the size of the right ventricle and its systolic function had returned to normal.
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