Case Report of Pulmonary Embolism with Right Ventricular Strain in a Young Female

Abstract

Acute pulmonary embolism (PE) is when one or more thrombus travel to the lungs and obstruct the pulmonary artery or one of the branches of the pulmonary tree, producing signs and symptoms immediately after the obstruction. Saddle pulmonary embolism (SPE) is a rare type of acute PE that can lead to hemodynamic instability and death. The incidence of pulmonary embolism increases with age. In women, the risk of PE increases with pregnancy, hormonal contraceptives, and hormone replacement therapy. In this case, the patient was in her forties and presented with a sudden episode of continuous dyspnea that worsened over four hours. The dyspnea was associated with palpitations and diaphoresis. The clinical scoring tools had a low pre-test probability for PE. The patient had no risk factors for PE other than being obese. Significant laboratory workup showed troponin of 0.10, D-dimer of 8.10, and a B-type natriuretic peptide (BNP) of 1,160. Her computed tomography angiography (CTA) showed extensive pulmonary emboli in the bilateral main and segmental pulmonary arteries, with findings consistent with right heart strain. The patient was managed with an unfractionated heparin loading dose in the ED based on her weight, followed by a heparin drip. Then, the patient was transferred to a tertiary medical center for further interventions. Prompt recognition and treatment of a submassive PE are fundamental to improving patient mortality and morbidity.

Pulmonary Embolism in a Young African American Male: A Diagnostic Challenge

“…The case reported by Walker et al shares key similarities with our case, as both involve young patients presenting with PE and right ventricular strain, highlighting the importance of considering PE even in younger populations without apparent risk factors [16]. The study by Zakai et Maintaining a high index of suspicion for PE, even in the absence of classic risk factors and with negative hypercoagulable testing, remains crucial.…”

“…Individualized thromboprophylaxis is increasingly recognized as essential in managing VTE, particularly when conventional risk factors may not fully explain thrombotic events. Acknowledging that each patient presents a unique profile of risk factors, comorbidities, and clinical circumstances, tailored thromboprophylaxis maximizes efficacy while minimizing adverse events [16]. Traditional risk assessment tools such as the Wells score may not fully capture nuanced risk factors.…”