Payus Alvin Oliver, Rajah Rathika, Febriany Dayang Corieza, Mustafa Norlaila
Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Jalan UMS, 88400 Kota Kinabalu, Sabah, Malaysia.
Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia.
Open Access Maced J Med Sci. 2019 Feb 10;7(3):396-399. doi: 10.3889/oamjms.2019.114. eCollection 2019 Feb 15.
De novo pulmonary embolism (DNPE) is a term used when pulmonary embolism (PE) occur in the absence of deep vein thrombosis (DVT). Most DNPE cases occur in a patient who had a recent injury to the chest.
However, here we report a case of DNPE with a slightly different presentation where there is no preceding trauma and has symptoms that mimic severe pneumonia. He presented with high fever, dyspnoea and pleuritic chest pain. Despite on 10 L of oxygen supplementation via high flow mask and already given bolus intravenous antibiotic, the patient still tachypnoeic and was persistently in type I respiratory failure. His chest X-ray showed consolidative changes. Upon further investigation revealed no evidence of DVT on Doppler ultrasound and normal D-dimer level. Due to the high index of suspicion by the attending physician, PE was suspected and later confirmed with computed tomography pulmonary angiography scan. He was successfully treated with anticoagulation therapy. The objective of this case report is to share the difficult experience of diagnosing PE when the presentation highly atypical and mimics severe pneumonia.
And with such a masquerading presentation, one can easily miss the diagnosis. To the best of our knowledge, there are very few similar cases reported.
新发肺栓塞（DNPE）是指在无深静脉血栓形成（DVT）的情况下发生的肺栓塞（PE）。大多数DNPE病例发生在近期有胸部损伤的患者中。
然而，我们在此报告一例表现略有不同的DNPE病例，该病例无前驱创伤，且症状类似重症肺炎。他表现为高热、呼吸困难和胸膜炎性胸痛。尽管通过高流量面罩给予10升氧气补充并已静脉推注抗生素，但患者仍呼吸急促，持续处于I型呼吸衰竭状态。他的胸部X线显示有实变改变。进一步检查发现多普勒超声未显示DVT证据，D-二聚体水平正常。由于主治医生高度怀疑，怀疑为PE，后来通过计算机断层扫描肺血管造影扫描得以证实。他通过抗凝治疗成功治愈。本病例报告的目的是分享在表现高度不典型且类似重症肺炎时诊断PE的困难经历。
有了这样的伪装表现，很容易漏诊。据我们所知，报告的类似病例很少。
