Borna Nahid, Niksolat Maryam, Shariati Behnam, Saeedi Vahid, Kamalzadeh Leila
Geriatric mental health research center, Department of Psychiatry, School of Medicine Iran University of Medical Sciences (IUMS) Tehran Iran.
Department of Geriatric Medicine, School of Medicine, Firoozabadi Clinical and Research Development Unit Iran University of medical science Tehran Iran.
Respirol Case Rep. 2023 Mar 16;11(4):e01121. doi: 10.1002/rcr2.1121. eCollection 2023 Apr.
Pulmonary embolism (PE) is the most severe clinical presentation of venous thromboembolism (VTE), which can be challenging to diagnose due to its non-specific symptoms. The overlapping clinical symptoms of Coronavirus disease 2019 (COVID-19) and PE may make distinguishing between the two difficult. Thus, the diagnosis of PE may be delayed or missed, with grave consequences for the patient's outcome and safety. We herein present the case of a 63-year-old Iranian female admitted to our hospital showing symptoms of delirium superimposed on dementia. Soon after her admission, she developed a fever and respiratory symptoms. However, overestimating the likelihood of COVID-19 pneumonia and attributing the patient's symptoms to this disease led to a delayed diagnosis and treatment of pulmonary embolism, resulting in the patient's death. During the COVID-19 pandemic, a high index of suspicion is required for the timely diagnosis of PE, especially in patients with identifiable risk factors. This is specifically true for older patients who cannot express their symptoms due to neurocognitive disorders.
肺栓塞（PE）是静脉血栓栓塞症（VTE）最严重的临床表现，因其症状不具特异性，诊断颇具挑战性。2019冠状病毒病（COVID-19）与PE的临床症状重叠，可能导致二者难以区分。因此，PE的诊断可能会延迟或漏诊，对患者的预后和安全造成严重后果。我们在此报告一例63岁伊朗女性患者，因出现谵妄叠加痴呆症状入住我院。入院后不久，她出现发热和呼吸道症状。然而，过高估计COVID-19肺炎的可能性并将患者症状归因于此病，导致肺栓塞的诊断和治疗延迟，最终患者死亡。在COVID-19大流行期间，对于PE的及时诊断需要高度的怀疑指数，尤其是对于有可识别风险因素的患者。对于因神经认知障碍无法表达症状的老年患者而言，情况更是如此。
