Pulmonary embolism: An Unusual Cause Of Acute Liver Failure

Pulmonary embolism is still a challenging diagnosis and a very high index of suspicion is required. Symptoms and signs of acute right heart failure are still non-specific and often vary according to the precipitating condition. In this particular case, evolving liver failure and severe coagulation disorder as the initial presentation made the management of this patient very challenging and several causes of sudden decompensated liver failure were ruled out. Acute reduction of splanchnic flow was considered but in the context of relative good oxygenation and no history or clinical signs of deep venous thrombosis, the diagnosis of pulmonary embolism was not considered as a primary cause of liver failure and evolving multiple organ failure. Complementary studies, namely echocardiogram and use of a pulmonary artery catheter immediately raised the suspicion of a saddle pulmonary embolus. In view of the findings, an emergency contrast-enhanced spiral computed tomography was performed and the diagnosis of pulmonary embolism was made.