CONGRESS ABSTRACT

CLINICAL CASE Remote medical history 48 years old, male. Regular non-competitive sports activity (cycling) with good exercise tolerance. Untreated dyslipidemia, at last laboratory check-up in September 2021 LDL cholesterol 153 mg/dl. Positive family history of carotid vasculopathy (father underwent left carotid revascularization). Recent medical history From about 5 days onset of fever (TC 37.5 – 38.5°C), cough and back pain of punctorial character (VAS 6/10) for which he enters to the ER. Persistently asymptomatic for dyspnea. Denies heart palpitation. Denies lipohymia or syncope. BP 120/80 mmHg. SatO2 95% in room air. E.O. within limits. ECG: Sinus rhythm at 79/minute. On chest X-ray right basal consolidation. Followed admission to pneumology.     During hospitalization, the patient remained hemodynamically stable and asymptomatic. On blood tests PCR 93 mg/dl, procalcitonin 0.5 ng/ml, TnI 341 ng/l, NT-proBNP 189 pg/ml, D-dimer 947 ng/ml. Performed blood culture.  Initiated empiric antibiotic therapy with Ceftriaxone 2gr/day ev and Azithromycin 500mg/day with benefit.  Requested cardiologic evaluation. Asymptomatic patient. ECG: Sinus rhythm at 86/minute. Echocardiogram: Global and segmental left ventricular systolic function within limits, no major valvulopathies. Inferiore vena cava within limits. No pericardial effusion. Right ventricle with dimensions within limits, TAPSE 22 mm, S'TDI 12.6 cm/s, Vd-Ad gradient 36 mmHg, PAPS 41 mmHg. Doubtful right ventricular apex hypokinesis.  Echocardiogram with contrast medium (Sonovue): finding of right ventricular apex akinesia with superimposed intraventricular thrombosis (Figure 1).  Chest CT: right inferior lobar artery embolism with homosedial pulmonary infarction.  Coronarography: coronary arteries free of significant lesions. Apixaban therapy started.     After normalization of clinical-laboratory parameters, the patient was discharged.     Diagnosis: Pulmonary embolism complicated by cardioembolic pulmonary infarction in a patient with a previous undiagnosed acute myocardial infarction.