Beyond Traditional Risk Factors: Cocaine Abuse and Pulmonary Embolism

Pulmonary embolism (PE) is a critical and potentially life-threatening condition necessitating prompt diagnosis and intervention due to its significant risk of morbidity and mortality. We present a case of a 42-year-old male with a history of cocaine abuse who was admitted with a massive PE (high risk), defined by hemodynamic instability or evidence of significant right ventricular dysfunction. In this case, the severity was suggested by syncope, right heart strain, and elevated cardiac biomarkers. The patient reported sudden onset shortness of breath, sharp chest pain exacerbated by inspiration, and a syncopal episode. Clinical evaluation revealed tachycardia and hypoxemia. Diagnostic tests showed elevated D-dimer levels and signs of right ventricular strain on echocardiography. Computed tomography pulmonary angiography (CTPA) confirmed acute bilateral pulmonary emboli, with a large clot burden predominantly in the right pulmonary artery. The patient underwent a mechanical thrombectomy, which significantly reduced the clot burden and improved pulmonary artery perfusion.