A Case of Acute Pulmonary Embolus after mRNA SARS-CoV-2 Immunization

Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is a critical strategy to overcome the COVID-19 pandemic. Multiple SARS-CoV-2 vaccines have been developed in a rapid timeframe to combat the pandemic. While generally safe and effective, rare cases of venous thromboembolism (VTE) have been reported after two adenovirus-based vaccines, the AstraZeneca ChAdOx1 nCoV-19 vaccine and the Janssen Ad.26.COV2.S vaccine, as well as after the Pfizer-BioNTech BNT162b2 mRNA vaccine. Here, we present the case of a patient who developed acute pulmonary emboli (PE) shortly after his second dose of the Moderna mRNA-1273 SARS-CoV-2 vaccine. We report the results of an extensive thrombophilia workup that was normal except for the identification of positive lupus anticoagulant (LA) signals. It is our goal to contribute to the body of knowledge regarding SARS-CoV-2 vaccines and encourage vaccine adverse event reporting so that clinicians can have a full appreciation and awareness of the possible adverse events related to these critical vaccines.

Acute pulmonary embolism

Pulmonary embolism in conjunction with deep venous thrombosis comes under the diagnostic category of venous thromboembolism, a condition with an overall annual incidence of 100–200 per 100 000 people. Acute pulmonary embolus is not uncommon in the critical care population and autopsy series reveal it is frequently undiagnosed this setting. Echocardiography plays a vital role as in the diagnosis and risk stratification, and can be applied in a rapid and non-invasive manner. To assist in appropriately timed management the advanced practitioner needs a wide range of skills using M-mode, 2D, Doppler, and tissue Doppler imaging to fully evaluate the pathophysiological effects of an acute pulmonary embolus.

Highlights from the ERS International Congress 2018: Assembly 13 – Pulmonary Vascular Diseases

The 2018 European Respiratory Society (ERS) International Congress in Paris, France, highlighted the subject of pulmonary vascular disease (PVD). 2018 was an exciting year for the PVD community as it was the first ERS International Congress since the formation of Assembly 13, which is dedicated to PVD, pulmonary embolism and the right ventricle.This article aims to summarise the high-quality studies presented at the 2018 Congress into four subject areas: the use of risk stratification in pulmonary arterial hypertension, the molecular mechanisms and treatment of pulmonary hypertension (PH), understanding and improving the right ventricle in PH, and finally, advances in the field of acute pulmonary embolus.