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[Pulmonary embolism, prolonged diagnosis in young man]
M Belicová1, M Knazeje, M Lojdlová
1I. interná klinika Jeseniovej Lekárskej fakulty UK a Martinskej fakultnej nemocnice, Martin, Slovenská republika.
Vnitrni Lekarstvi
|January 7, 2005
Summary
Pulmonary embolism (PE) can present with chest pain and dyspnea, mimicking other conditions. Early diagnosis using D-dimer and lung scans is crucial for effective treatment and improved patient outcomes.
Area of Science:
- Cardiology
- Pulmonology
- Vascular Medicine
Background:
- Pulmonary embolism (PE) diagnosis remains challenging despite advances, with high mortality and recurrence rates.
- Substernal or pleuritic chest pain, dyspnea, and syncope are key clinical presentations necessitating consideration of PE.
- Unexplained symptoms like recurrent pleuritic chest pain with pleural effusion can obscure PE diagnosis.
Observation:
- A case of recurrent pleuritic chest pain and pleural effusion initially treated as tuberculous pleuritis is presented.
- Pulmonary embolism was diagnosed based on elevated D-dimer levels and a positive perfusion lung scan.
- Angiography revealed thrombosis in the left subclavian vein as the source of the embolus.
Findings:
- Elevated plasmatic D-dimer and perfusion lung scan confirmed pulmonary embolism.
- Venous thromboembolism risk factor evaluation identified a Prothrombin 20210A mutation.
- Diagnosis of pulmonary embolism led to effective medical treatment.
Implications:
- Highlights the importance of considering pulmonary embolism in patients with unexplained chest pain and pleural effusion.
- Emphasizes the diagnostic utility of D-dimer and perfusion lung scans in complex cases.
- Underscores the need for genetic risk factor assessment in venous thromboembolism management.