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Case Report

An Unusual Presentation of an Unprovoked Pulmonary Embolism; Diagnostic Challenges in the Emergency Department

Pallavi Sehgal, Resident, Department of Emergency Medicine Max Hospital, Vaishali, Ghaziabad, Uttar Pradesh - 201012 , Pallavi Sehgal1 , Sarat Kumar Naidu2 , Dheeraj Bhaskaran Nair3

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Indian Journal of Emergency Medicine 4(2):p 177-179, April-June 2018. | DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4218.23

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Abstract

Pulmonary embolism is a life-threatening condition and in most cases the presentation is typical with h/o pleuritic chest pain, breathlessness and h/o prolonged immobilization. However unusual presentations are not very rare and its awareness can avoid delay in its diagnosis and prevent mortality. A 23 years old male presented to ER with non-specific complaints of right upper quadrant pain and fever for 2 days. His vital signs were within normal limits apart from tachycardia and all initial investigations were normal. Due to his increased breathlessness, Well’s score was checked but it was zero. However D-dimer was done which showed high values 1000ng/ml following which CTPA was performed that showed multiple right sided pulmonary emboli. He was then started on LMWH and Direct thrombin inhibitor and was discharged after 4 days. The purpose of publishing this case is to make physicians aware of the unusual presentations of pulmonary embolism and that too in a patient who did not have any known risk factors.

Keywords: Pulmonary Embolism; Unusual Presentation; Abdominal Pain; S1Q3T3; CTPA; Well’s Score; LMWH; UFH.

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4218.23

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