Document Type

Article

Publication Title

Cureus

Abstract

We present a case report of refractory multifactorial shock initially managed as septic shock, requiring multidisciplinary collaboration when the diagnostic pathway was limited by acute kidney injury; the primary learning objective is to highlight clinical decision-making in shock when standard contrast imaging is contraindicated. Echocardiography revealed right ventricular failure with right ventricular thrombus, and pulmonary embolism was strongly suspected but could not be confirmed due to the inability to obtain contrast imaging. Persistent shock prompted a transition from a septic shock-directed strategy to cardiogenic and obstructive shock management. The patient was treated with anticoagulation but was not a candidate for mechanical thrombectomy. The course was complicated by progressive renal failure, and after dialysis was declined by the family, the patient was transitioned to comfort care.

First Page

103900

Last Page

103900

DOI

10.7759/cureus.103900

Publication Date

2-1-2026

Download

Included in

Cardiology Commons

Share

COinS