Massive pulmonary embolism and thrombophilia.
A 32-year-old man presented overnight to the accident and emergency unit with mild breathlessness on exertion. He was found to be hypoxic on room air and his chest x-ray revealed areas of patchy lung consolidation. He was given intravenous antibiotics for presumed community-acquired pneumonia. Unfortunately his condition deteriorated and he remained significantly hypoxic despite high-flow oxygen with ECG evidence of right heart strain. Further questioning revealed a history of protein S deficiency and a strong family history of venous thromboembolic disease. An urgent CT pulmonary angiogram showed an evidence of massive pulmonary embolism and the patient was successfully thrombolysed.
University Hospital Coventry and Warwickshire, Coventry, UK. Iman23@doctors.org.uk
Iman
I
Qureshi
Riwa
R
Meshaka
Claire
C
Donohue
Asad
A
Ali
D000328:Adult; D000792:Angiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000209:etiology; D008297:Male; D010100:Oxygen / Q000097:blood; D018455:Protein S Deficiency / Q000150:complications* / Q000235:genetics; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D010100:Oxygen