Dhabhar Jeyhan, Mehta Varshil, Desai Nimit, Dawoodi Sameer, Zaman Sojib Bin
Department of Internal Medicine, MGM Medical College, Navi Mumbai, India.
Department of Internal Medicine, Dr. L. H. Hiranandani Hospital, Mumbai, India.
F1000Res. 2019 Feb 14;8:182. doi: 10.12688/f1000research.18202.2. eCollection 2019.
A 24-year-old male was presented to us with sudden onset of chest pain and dyspnea for the past one hour. There was no history of calf pain, trauma, surgery, prolonged immobilization, long-haul air travel, bleeding diathesis or any other co-morbidity. The patient denied any addiction history. The heart rate was 114 beats/min, and blood pressure was 106/90 mmHg. Electrocardiogram showed tachycardia with S Q T pattern. The left arterio-venous Doppler study was suggestive of a thrombus in popliteal vein and sapheno-popliteal junction. The CT-Pulmonary Angiogram scan was suggestive of a massive pulmonary thromboembolism. The patient was thrombolysed with Intravenous Alteplase immediately and was put on tab Rivaroxaban for maintenance. He was later discharged after being stable. Unprovoked venous thromboembolism (VTE) is very rare and has the potential to lead to pulmonary embolism which could be disastrous, especially in young adults. We present such a case where unprovoked VTE was diagnosed and treated. This case suggests that high clinical suspicion is the key for the diagnosis of acute pulmonary embolism, especially in the absence of history suggestive of deep vein thrombosis.
一名24岁男性因过去一小时突然出现胸痛和呼吸困难前来就诊。既往无小腿疼痛、外伤、手术、长期制动、长途航空旅行、出血素质或任何其他合并症病史。患者否认有任何成瘾史。心率为114次/分钟，血压为106/90 mmHg。心电图显示心动过速伴SQT图形。左下肢动静脉多普勒检查提示腘静脉和隐股腘静脉交界处有血栓形成。CT肺动脉造影扫描提示大面积肺血栓栓塞。立即对患者进行静脉注射阿替普酶溶栓治疗，并给予利伐沙班片维持治疗。病情稳定后患者出院。无诱因静脉血栓栓塞（VTE）非常罕见，有可能导致肺栓塞，这可能是灾难性的，尤其是在年轻人中。我们报告了这样一例无诱因VTE的诊断和治疗病例。该病例表明，高度的临床怀疑是诊断急性肺栓塞的关键，尤其是在没有提示深静脉血栓形成病史的情况下。
