title: Massive pulmonary embolus without hypoxemia.
abstract: OBJECTIVE
  To describe a patient who had been taking ibuprofen for 3 days before the diagnosis of a massive pulmonary embolus without hypoxemia.
  
  
  METHODS
  Institutional review board-approved case report.
  
  
  METHODS
  Pediatric intensive care unit.
  
  
  METHODS
  A 16-yr-old male with a history of supraventricular tachycardia.
  
  
  RESULTS
  The patient underwent an electrophysiology study and developed mild shortness of breath and then chest pain 2 and 4 days later, respectively. He took ibuprofen for 3 days. Evaluation 1 wk following the procedure revealed dyspnea and tachycardia. Arterial blood gas in room air was significant for hypocarbia without hypoxemia (Pao2, 108 mm Hg; Paco2, 28 mm Hg). Ventilation perfusion scan and computed axial tomography with intravenous contrast were consistent with a massive pulmonary embolus and left external iliac vein thrombus. He received anticoagulation, thrombolysis, a stent in the left iliac vein, and a filter in the inferior vena cava. Perfusion gradually improved and he was discharged home on oral anticoagulation.
  
  
  CONCLUSIONS
  The absence of hypoxemia (including a normal alveolar-arterial oxygen difference) in our patient with a massive pulmonary embolus may have been related to cyclooxygenase inhibition due to ibuprofen, with improvement in ventilation-perfusion mismatch.
authors.affiliation: Columbia University, College of Physicians and Surgeons, New York, USA.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Baird
authors.forename: Anne
authors.initials: A
authors.lastname: Greene
authors.forename: Charles L
authors.initials: CL
authors.lastname: Schleien
mesh_terms: D000293:Adolescent; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control*; D007052:Ibuprofen / Q000008:administration & dosage*; D008297:Male; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
chemical_list: D016861:Cyclooxygenase Inhibitors; D007052:Ibuprofen