Abstract
BACKGROUND: Pulmonary embolism is a common cause of morbidity and mortality in the United States. A nonspecific clinical presentation makes it challenging to diagnose, and management varies significantly depending on a risk-benefit assessment, the patient's current clinical status, and institutional practices. CASE PRESENTATION: Multidisciplinary appraisal led to differing use of tissue plasminogen activator (tPA) infusion for 2 patients at intermediate-risk for pulmonary embolism. Both cases demonstrated favorable outcomes and improved right ventricular function after treatment. One patient underwent systemic tPA infusion and demonstrated resolution of pulmonary hypertension and symptoms after 24 hours. A second patient received localized tPA infusion for 24 hours and had a marked decrease in clot burden and pulmonary artery pressure gradient. CONCLUSIONS: These cases illustrate the variety and complexity of management of patients with intermediate-risk pulmonary embolism and highlight the role institutional pulmonary embolism response teams may have in these scenarios.