Kumari Rohini, Kaeley Nidhi, Mahalle Aditya S, Tejpal Parina, Ambati Sreevardhan
Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, IND.
Cureus. 2025 Apr 25;17(4):e83001. doi: 10.7759/cureus.83001. eCollection 2025 Apr.
Travel to high altitudes presents unique physiological challenges and can lead to various acute illnesses. Although pulmonary thromboembolism is infrequently documented in these settings, it can be life-threatening if unrecognized. A 54-year-old man with no known comorbidities developed sudden-onset shortness of breath and altered mental status while traveling at high altitudes. Initial evaluation revealed hypoxia, fever, and a markedly reduced ejection fraction on point-of-care ultrasound, with no deep vein thrombosis (DVT) on Doppler studies. Further imaging identified minimal pleural effusion and atelectasis on high-resolution computed tomography of the thorax. Despite a low clinical probability based on scoring systems and a negative D-dimer, clinical suspicion prompted a computed tomographic pulmonary angiography, which confirmed pulmonary thromboembolism in the right lower lobe pulmonary artery. Treatment with apixaban led to symptomatic improvement, and the patient was discharged in stable condition. This case highlights the need to consider pulmonary thromboembolism in the differential diagnosis of respiratory distress at high altitude, where hypoxia and other altitude-related factors may contribute to a hypercoagulable state.
前往高海拔地区会带来独特的生理挑战，并可能导致各种急性疾病。尽管在这些情况下肺血栓栓塞症的记录并不常见，但如果未被识别，它可能会危及生命。一名54岁无已知合并症的男性在高海拔旅行时突然出现呼吸急促和精神状态改变。初步评估显示存在低氧血症、发热，床旁超声显示射血分数明显降低，多普勒检查未发现深静脉血栓形成（DVT）。进一步的影像学检查在胸部高分辨率计算机断层扫描中发现少量胸腔积液和肺不张。尽管基于评分系统临床可能性较低且D-二聚体阴性，但临床怀疑促使进行计算机断层肺动脉造影，结果证实右肺下叶肺动脉存在肺血栓栓塞症。使用阿哌沙班治疗后症状有所改善，患者出院时病情稳定。该病例强调了在高海拔地区呼吸窘迫的鉴别诊断中需要考虑肺血栓栓塞症，在这种情况下，低氧血症和其他与海拔相关的因素可能导致高凝状态。
