Ahaneku Chidimma A, Akpu Benard B, Njoku Chibueze H, Elem David E, Ekeng Bassey E
Department of Internal Medicine, Respiratory Unit, University of Calabar, Teaching Hospital, Calabar, Nigeria.
Department of Internal Medicine, Cardiology, Unit, University of Calabar, Teaching Hospital, Calabar, Nigeria.
Egypt J Intern Med. 2023;35(1):8. doi: 10.1186/s43162-023-00193-5. Epub 2023 Feb 6.
Large numbers of elderly patients are admitted to hospitals in acute confusional states. In many, the underlying causes are easily found; in some, correct diagnosis is difficult. Pulmonary embolism (PE), the most serious clinical presentation of venous thromboembolism, is often misdiagnosed because of its non-specific features including delirium.
A 73-year-old woman was admitted to our hospital in a confused state with no obvious risk factors of PE. D-dimer levels were elevated and contrast-enhanced high-resolution computed tomography (HRCT) of the chest confirmed the diagnosis of PE. She was treated with enoxaparin and discharged on dabigatran. Her symptoms had resolved at the time of discharge, and she has been stable for over three month's follow-up visit.
PE should be regarded as a differential in elderly patients with an acute confusional state despite the absence of obvious risk factors. Investigating for and treating when confirmed may save a life.
大量老年患者因急性意识模糊状态入院。许多患者的潜在病因很容易找到；有些患者则难以做出正确诊断。肺栓塞（PE）是静脉血栓栓塞最严重的临床表现，由于其包括谵妄在内的非特异性特征，常被误诊。
一名73岁女性因意识模糊状态入院，无明显肺栓塞危险因素。D - 二聚体水平升高，胸部增强高分辨率计算机断层扫描（HRCT）确诊为肺栓塞。她接受了依诺肝素治疗，出院时服用达比加群。出院时她的症状已缓解，随访三个月以上病情一直稳定。
尽管没有明显危险因素，对于处于急性意识模糊状态的老年患者，也应将肺栓塞视为鉴别诊断之一。确诊后进行检查和治疗可能挽救生命。
