Pulmonary Embolism Masquerading as Severe Pneumonia: A Case Report
BACKGROUND: De novo pulmonary embolism (DNPE) is a term used when pulmonary embolism (PE) occur in the absence of deep vein thrombosis (DVT). Most DNPE cases occur in a patient who had a recent injury to the chest.
CASE PRESENTATION: However, here we report a case of DNPE with a slightly different presentation where there is no preceding trauma and has symptoms that mimic severe pneumonia. He presented with high fever, dyspnoea and pleuritic chest pain. Despite on 10 L of oxygen supplementation via high flow mask and already given bolus intravenous antibiotic, the patient still tachypnoeic and was persistently in type I respiratory failure. His chest X-ray showed consolidative changes. Upon further investigation revealed no evidence of DVT on Doppler ultrasound and normal D-dimer level. Due to the high index of suspicion by the attending physician, PE was suspected and later confirmed with computed tomography pulmonary angiography scan. He was successfully treated with anticoagulation therapy. The objective of this case report is to share the difficult experience of diagnosing PE when the presentation highly atypical and mimics severe pneumonia.
CONCLUSION: And with such a masquerading presentation, one can easily miss the diagnosis. To the best of our knowledge, there are very few similar cases reported.
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Stein PD, Beemath A, Matta F, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med. 2007; 120:871. https://doi.org/10.1016/j.amjmed.2007.03.024 PMid:17904458 PMCid:PMC2071924
Remy-Jardin M, Pistolesi M, Goodman LR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society. Radiology. 2007; 245:315. https://doi.org/10.1148/radiol.2452070397 PMid:17848685
Anderson DR, Kahn SR, Rodger MA, et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA. 2007; 298:2743. https://doi.org/10.1001/jama.298.23.2743 PMid:18165667
Gibson NS, Sohne M, Gerdes VE, Nijkeuter M, Buller HR. The importance of clinical probability assessment in interpreting a normal d-dimer in patients with suspected pulmonary embolism. Chest. 2008; 134(4):789-93. https://doi.org/10.1378/chest.08-0344 PMid:18641091
Tapson VF, Hockberger RS. Treatment, prognosis, and follow-up of acute pulmonary embolism in adults. UpToDate, Waltham, MA (consultado 20-02-2017).
Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141:e419S.
Chow FC, Chan YC, Cheung GC, Cheng SW. Mid- and long-term outcome of patients with permanent inferior vena cava filters: a single center review. Ann Vasc Surg. 2015; 29:985. https://doi.org/10.1016/j.avsg.2015.01.009 PMid:25757994
Lucena J, Rico A, VÃ¡zquez R, et al. Pulmonary embolism and suddenâ€“unexpected death: Prospective study on 2477 forensic autopsies performed at the Institute of Legal Medicine in Seville. Journal of forensic and legal medicine. 2009; 16(4):196-201. https://doi.org/10.1016/j.jflm.2008.08.015 PMid:19329075
Van Gent JM, Zander AL, Olson EJ, et al. Pulmonary embolism without deep venous thrombosis: De novo or missed deep venous thrombosis? Journal of Trauma and Acute Care Surgery. 2014; 76(5):1270-4. https://doi.org/10.1097/TA.0000000000000233 PMid:24747459
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