Pulmonary Embolism - A Case Report

Abstract

Introduction:Pulmonary embolism (PE) ranges from incidental, clinically unimportant occurrences to causing sudden death. Virchow's triad of local trauma to the vessel wall, hypercoagulability, and stasis of blood leads to thrombus formation in the leg veins. 1 As thrombi form in the deep veins of the legs, pelvis, or arms, they may dislodge and embolize to the pulmonary arteries with potentially serious consequences. The most common sources of pulmonary emboli are the pelvic veins or deep veins of the thigh. 2 Pulmonary arterial obstruction by clot causes dilatation, dysfunction, and ischemia of the right ventricle. 1 Pulmonary embolism and deep venous thrombosis is responsible for more than 250,000 hospitalizations and approximately 50,000 deaths per year in the United States. Because it is difficult to diagnose, the true incidence of pulmonary embolism is unknown, but it is estimated that approximately 650,000 cases occur annually. 1 Despite this high incidence, the diagnosis of pulmonary embolism continues to be difficult primarily because of the notorious varities of symptoms and signs in its presentation. 2 We present the case of a patient with pulmonary embolism presented with dyspnoea and review the pathophysiology and diagnostic considerations. Case report:Mr. X 68 yrs old pleasant gentleman admitted in CCU of UHL for respiratory distress along with sweating for 2 hours. He had also history of exertional dyspnoea and dyspepsia for last 4 days. He is diabetic, hypertensive and nonalcoholic. On G/E his Pulse-104/min, BP-120/ 90mmHg, RR-20/min and cardiac examination showed that there was a pansystolic murmur over the tricuspid area which increased with accentuated pulmonary component of the second heart sound.Initial investigations showed Hb-14gm/dl,TC-12.3X10 3 /µl, Platelet-222 x10 3 /µl, S,creatinine-1.45mg/dl,H s troponinI423ngm/ml, PT-13.7sec, INR-1.22, APTT-31.2sec, D Dimer4860ng/ml(0-550ng/ml) . Electrocardiography showed sinus tachycardia with SIQ3T3. Chest X-Ray revealed cardiomegaly. 2-D transthoracic echocardiography showed a dilated right side of the heart with a 5.7 cm × 1.4 cm mass in the right pulmonary artery. Valvular morphology was normal with moderate tricuspid regurgitation and moderate pulmonary hypertension. CT pulmonary angiography found pulmonary embolism involving the right pulmonary artery and most of their segmental branches. He underwent a duplex scan of the deep venous system of both lower limbs, which was found to be deep venous thrombosis in left popliteal vein. The patient was treated with streptokinase which was given initially as a loading dose of 250,000 IU over 30 minutes, followed by a dose of 100,000 IU/hour over 72 hours. After initial evaluation, a blood sample was taken to examine the thrombophilia panel [protein C-61IU/dl(70-146IU/dl), protein S-75IU/dl (60-130IU/dl), antithrombin-III-76.7 µg/ml (75-125 µg/ml) ].There his protein C level was low.Further echocardiography was performed and it revealed normal right heart function.After the recovery of the patient from...

Clomiphene- induced pulmonary embolism

“…The clinical presentation of pulmonary embolism can range from asymptomatic incidental findings to sudden cardiac death. About 15% of sudden cardiac deaths are attributed to PE and 25% of cases of PE present as sudden cardiac death [1]. We present a case of PE in a young individual undergoing fertility treatment with clomiphene, with no known risk factors.…”