A 52-year-old chronic alcoholic and diabetic who is a known case of CAD on medical management, presented with chief c/o right upper limb pain and burning sensation associated with grade 2 breathlessness since 2 days. O/E patient pulses were absent on right upper arm brachial and radial artery. Arterial doppler of right upper limb showed extensive arterial thrombosis from distal axillary artery till radial artery. His 2d echo showed RA and RV dilatation with RV dysfunction. We then did CT pulmonary angio the next day which showed extensive pulmonary thromboembolism.
Immediately we attempted systemic thrombolysis with IV Alteplase and his symptoms of right UL pain and burning decreased. But his dyspnoea didn't relieve and so we did pulmonary thrombus aspiration with penumbra the next day. Patient symptoms of breathlessness relieved. Venous doppler of both the lower limbs showed B/L DVT.…
