Massive pulmonary embolism complicating mild Covid 19 pneumonia: Successful systemic thrombolysis using rt-PA in an elderly patient: A case report.

INTRODUCTION: and importance: Pulmonary embolism (PE) is still a major health concern around the world, and its link with SARS Cov-2 has led to an increase in morbidity, mortality, and ICU hospitalizations. CASE PRESENTATION: We present the case of a 92-year-old man with no prior medical history who admitted to our hospital in a state of acute respiratory failure, echocardiography revealed an acute right heart syndrome with a thrombus in the right atrium, computed tomography pulmonary angiogram revealed bilateral massive pulmonary embolism as well as Covid-19 pneumonia. He was treated with systemic thrombolysis using intravenous rt-PA (recombinant tissue plasminogen activator) with immediate clinical improvement and no hemorrhagic complications. CLINICAL DISCUSSION: In the presence of the SARs Cov-2 infection, several reports have indicated considerable procoagulant events, including life-threatening pulmonary embolism. There are still no current guidelines for the treatment of VTE in COVID-19 patients, but they are largely consistent with non-COVID-19 recommendations. Elderly patients are considered to be at high risk of developing thromboembolic complications, and also and above all are vulnerable to bleeding complications from anticoagulant treatments. CONCLUSION: This case highlight the importance of considering thromboembolic complications despite the severity of the associated SARS-cov-2 pneumonia and the role of prophylactic anticoagulation for Covid-19 patients hospitalized or not.

Rare and Underestimated Association of Pulmonary Embolism and Olanzapine Therapy; Report of Two Cases.

Venous thromboembolic disease (VTD) is a very common and severe pathological condition in which there are many predisposing factors. Olanzapine is a drug frequently used in psychiatric practises; it is thought to increase the risk of VTD. Here, we report two cases, a young man and a woman, with a medical history of schizophrenia treated by olanzapine who developed pulmonary embolism and we did not find any aetiologies of VTD in them. Due to the link between olanzapine and pulmonary embolism, which has been previously described, olanzapine is considered responsible for this problem. Two mechanisms have been reported in the literature in this regard; significant weight gain and lethargy, which are very common side effects of olanzapine. So far, no direct effect of olanzapine on platelet aggregation or coagulation has been found. In patients developing VTD while being treated with olanzapine, discontinuation of olanzapine as a treatment option must be done with an adjustment of antipsychotic treatment and regular monitoring of psychic symptoms. Since the diagnosis of pulmonary embolism is not easy to make in a schizophrenic patient, clinicians should take that in consideration when prescribing these drugs and when facing clinical situations where VTD is suspected.

Acute Myopericarditis in a Patient With Mild SARS-CoV-2 Respiratory Infection.

Herein is presented a case of a 71-year-old woman with mild SARS-CoV-2 respiratory infection who experienced acute myopericarditis diagnosed using clinical, biological, and electrocardiogram data and cardiac magnetic resonance imaging. The presented case highlights the risk of cardiac involvement, even in the absence of severe respiratory COVID-19 infection. The mechanisms involved in acute myocardial injury in SARS-CoV-2 infection are not well known and requires further studies to determine whether it is related to direct myocardial damage by the virus or to a systemic condition.

Nous présentons le cas d'une femme de 71 ans qui présentait une infection respiratoire légère causée par le virus SRAS-CoV-2 et qui a subi une myopéricardite aiguë diagnostiquée à partir de données cliniques, biologiques et électrocardiographiques et d'un examen d'imagerie par résonance magnétique cardiaque. Ce cas met en lumière le risque d'atteinte cardiaque chez les patients atteints de COVID-19, même en l'absence d'infection respiratoire grave. On ne connaît pas bien les mécanismes qui participent à l'atteinte myocardique aiguë chez les patients infectés par le virus SRAS-CoV-2, et des recherches plus poussées sont nécessaires pour déterminer si cette atteinte est causée directement par le virus ou si elle est due à un trouble systémique.

Huge right ventricular mass revealing a testicular nonseminomatous germ cell tumor.

BACKGROUND: Cardiac intracavitary metastases from a testicular cancer are very unusual, and intra-cardiac metastasis is exceptionally the first expression of a noncardiac primary neoplasm. We report a case of a young patient for whom a cardiac symptom led to the diagnosis of a metastatic testicular cancer. CASE PRESENTATION: Our presentation describes an unusual case of a 32 years-old male patient admitted for dyspnea, in whom full examination and tests led to the diagnosis of a huge right ventricular mass revealing a testicular malignant teratoma. As the mass was huge and obstructing the root of pulmonary artery, we had decided to opt for surgical treatment in order to remove the obstruction of the pulmonary trunk. Subsequently, the patient has received systemic adjuvant chemotherapy. CONCLUSIONS: Here, we describe the world's first reported case of intraventricular metastasis from a nonseminomatous germ cell tumor of the testis which occupies almost all the right ventricular volume and extending to the root of pulmonary artery that underwent surgical resection of the ventricular mass before chemotherapy.