Non-cardiogenic acute pulmonary edema in elderly patient with Dressler syndrome associated pulmonary embolism

Pulmonary embolism (PE) complicated with Dressler syndrome is an uncommon event, especially concomitant with non-cardiogenic acute pulmonary edema (NCAPE), which has rarely been described in the literature. The present report describes a classic presentation of this condition with review of its potential mechanisms and management approach. An 80-year-old female with PE presented with progressive exertional dyspnea, mild cyanosis and hypoxemia. Serum marker of acute thrombosis and right ventricular dysfunction were positive. Electrocardiographic changes indicative of RV strain. Echocardiography revealed the presence of right atrial and ventricular dilation, pulmonary hypertension and pericardial effusion. Chest computed tomography showed the interstitial pulmonary edema in bilateral lung field, pericardial and bilateral pleural effusion, and CT angiography revealed pulmonary embolism in the lower right pulmonary branches. She responded to oxygen, anticoagulation therapy and intravenous diuretics. But the outcome still was adverse and died in her home two months after discharge. The present case suggested a very poor prognosis of NCAPE induced by PE, thus identification of potential risk factors for development of thromboembolic complications and risk stratification in high risk population are required necessarily.