Pulmonary embolism in a young patient: a case report
DOI:
https://doi.org/10.24265/horizmed.2024.v24n4.15Keywords:
Pulmonary Embolism , Chest Pain , DyspneaAbstract
Pulmonary embolism is one of the leading causes of precordial pain in the hospital setting. We present the case of a 31-year-old male patient who reported sudden precordial pain and dyspnea with minor exertion, a significant elevation of D-dimer and, as revealed by computed tomography angiography (CTA), the presence of a thrombus in the main, segmental and subsegmental pulmonary branches. He underwent an embolectomy, with subsequent recovery and good progress. Pulmonary embolism produces pathophysiological interference with gas exchange and circulation, and the cause of death in these patients is right ventricular failure due to acute pressure overload. The most frequent clinical manifestations and signs are dyspnea, palpitations, chest pain, syncope and hemoptysis, tachycardia, tachypnea and jugular venous distension. The McGinn-White pattern consists of an electrocardiographic trace showing a deep S1 in lead DI, along with a Q wave and an inverted T wave in lead DIII. This electrocardiographic pattern has been reported in 7 % to 19 % of patients presenting with pulmonary embolism. Catheter-directed therapy is the treatment of choice in patients with intermediate risk and proximal thrombus in the pulmonary arteries. This approach includes catheter-directed thrombolysis and mechanical aspiration thrombectomy, yielding favorable results in reducing pulmonary hypertension and improving hemodynamic stability. However, these cases are rare in young people without major risk factors. Prompt management avoids associated complications such as right heart failure and prevents chronic complications.
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References
Kahn SR, De Wit K. Pulmonary Embolism. N Engl J Med [Internet]. 2022;387(1):45–57.
Bastas D, Brandão LR, Vincelli J, Schneiderman JE, Cunningham J, Avila ML. Physical activity for children with deep vein thrombosis and pulmonary embolism on anticoagulation: a scoping review. Res Pract Thromb Haemost [Internet]. 2023;7(2):100094.
Martinez Licha CR, McCurdy CM, Maldonado SM, Lee LS. Current management of acute pulmonary embolism. Ann Thorac Cardiovasc Surg [Internet]. 2020;26(2):65–71.
Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GeertJan, Harjola Veli-Pekka, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J [Internet]. 2020;41(4):543–603.
Yilmazel Ucar E. Update on thrombolytic therapy in acute pulmonary thromboembolism. Eurasian J Med [Internet]. 2019;51(2):185–9.
Real C, Ferrera C, Vázquez-Álvarez ME, Huanca M, Noriega FJ, Gutiérrez Ibañes E, et al. Terapias de reperfusión en pacientes con embolia de pulmón de riesgo intermedio-alto y de riesgo alto: datos de un registro multicéntrico. REC Interv Cardiol [Internet]. 2024;6(3):172-81.
Freund Y, Cohen-Aubart F, Bloom B. Acute pulmonary embolism. JAMA [Internet]. 2022;328(13):1336.
Howard L. Acute pulmonary embolism. Clin Med [Internet]. 2019;19(3):243–7.
Martinez-Cano JP, Escobar SS, Zamudio-Castilla L, Molina MI, Calle-Toro JS, Mejía FM. Symptomatic thromboembolic events after knee arthroscopy. Rev Colomb Ortop Traumatol [Internet]. 2022;36(3):152-7.
Huisman MV, Barco S, Cannegieter SC, Le Gal G, Konstantinides SV, Reitsma PH, et al. Pulmonary embolism. Nat Rev Dis Primers [Internet]. 2018;4(1):18028.
Arias-Rodríguez FD, Armijos-Quintero DA, Beltrán-Vinueza PA, Córdova-Macías DV, Guadamud-Loor JX, Osejos-Moreira WD, et al. Diagnóstico y tratamiento de tromboembolia pulmonar. Revisión bibliográfica. Rev Mex Angiol [Internet]. 2022;50(3):96-109.
Carrilllo-Esper R, Zepeda-Mendoza AD, Carrillo-Córdova JR, CarrilloCórdova CA. McGinn and white sign in pulmonary thromboembolism. Rev Invest Med Sur Mex [Internet]. 2014;21(1):40–2.
Ostrominski JW, Wang CJ, Campia U, Connors JM, Varelmann DJ, Mladinov D, et al. Pulmonary embolism with thrombusin-transit across a patent foramen ovale. Lancet [Internet]. 2023;402(10408):1170.
Altamimi D, Mahra Obaid A, Gadahadh R, Patil S, Rathinavelu B. Enhancing pulmonary embolism thrombectomy outcomes: the impact of forming a PERT group. AJIR [Internet]. 22024;8(1):1-67.
Machanahalli Balakrishna A, Reddi V, Belford PM, Alvarez M, Jaber WA, Zhao DX, et al. Intermediate-Risk pulmonary embolism: a review of contemporary diagnosis, risk stratification and management. Medicina (Kaunas) [Internet]. 2022;58(9):1186.
Trott T, Bowman J. Diagnosis and management of pulmonary embolism. Emerg Med Clin North Am [Internet]. 2022;40(3):565–81.
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