Amin Mehul S, Ershad Rifat, Kadam Nikhil, Khan Zahid
Internal Medicine, Southend University Hospital, London, GBR.
General Medicine, Basildon Hospital, London, GBR.
Cureus. 2023 Nov 26;15(11):e49433. doi: 10.7759/cureus.49433. eCollection 2023 Nov.
Pulmonary embolism is a life-threatening condition that requires urgent treatment. We present the case of a 76-year-old male referred to our medical team with dyspnoea, shortness of breath on exertion, and chest pain. Upon further questioning, the patient reported a two-week history of right-sided parasternal pleuritic chest pain without radiation. He denied any history of haemoptysis, calf swelling or pain, recent surgery, and reduced mobility. The patient had a medical history of bilateral cataracts, glaucoma, and hypertension. Clinical examination was unremarkable except for requiring 2L/minute supplemental oxygen to maintain an oxygen saturation of 94%, and blood tests were unremarkable, including a normal D-dimer. Chest radiography revealed no obvious pathological findings. However, the electrocardiogram showed a right bundle branch, sinus tachycardia, and an S1Q3T3 pattern. A computed tomography pulmonary angiogram confirmed pulmonary emboli within the right lower lobe segmental artery, extending into the bilateral basal segmental branch and posterior basal segmental branch. The patient was commenced on low molecular weight heparin initially followed by rivaroxaban 20 mg once daily. This case highlights the importance of having a high degree of suspicion for pulmonary embolism, and D-dimer is an important screening test that can be normal.
肺栓塞是一种危及生命的疾病，需要紧急治疗。我们报告一例76岁男性病例，该患者因呼吸困难、活动时气短和胸痛被转诊至我们的医疗团队。进一步询问时，患者报告有右侧胸骨旁胸膜炎性胸痛病史两周，无放射痛。他否认有咯血、小腿肿胀或疼痛、近期手术及活动减少的病史。该患者有双侧白内障、青光眼和高血压病史。临床检查无异常，仅需2升/分钟的补充氧气以维持氧饱和度94%，血液检查无异常，包括D - 二聚体正常。胸部X线检查未发现明显病理改变。然而，心电图显示右束支传导阻滞、窦性心动过速和S1Q3T3波形。计算机断层扫描肺动脉造影证实右下叶段动脉内有肺栓塞，延伸至双侧基底段分支和后基底段分支。患者最初开始使用低分子肝素，随后每天服用一次利伐沙班20毫克。该病例强调了对肺栓塞保持高度怀疑的重要性，并且D - 二聚体作为一项重要的筛查试验也可能正常。
