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Updated: Jun 22, 2026
Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet
Published on: November 4, 2015
Massive pulmonary embolus without hypoxemia
J Scott Baird1, Anne Greene, Charles L Schleien
1Columbia University, College of Physicians and Surgeons, New York, USA.
Objective:
To describe a patient who had been taking ibuprofen for 3 days before the diagnosis of a massive pulmonary embolus without hypoxemia.
Design:
Institutional review board-approved case report.
Setting:
Pediatric intensive care unit.
Patient:
A 16-yr-old male with a history of supraventricular tachycardia.
Results:
The patient underwent an electrophysiology study and developed mild shortness of breath and then chest pain 2 and 4 days later, respectively. He took ibuprofen for 3 days. Evaluation 1 wk following the procedure revealed dyspnea and tachycardia. Arterial blood gas in room air was significant for hypocarbia without hypoxemia (Pao2, 108 mm Hg; Paco2, 28 mm Hg). Ventilation perfusion scan and computed axial tomography with intravenous contrast were consistent with a massive pulmonary embolus and left external iliac vein thrombus. He received anticoagulation, thrombolysis, a stent in the left iliac vein, and a filter in the inferior vena cava. Perfusion gradually improved and he was discharged home on oral anticoagulation.
Conclusions:
The absence of hypoxemia (including a normal alveolar-arterial oxygen difference) in our patient with a massive pulmonary embolus may have been related to cyclooxygenase inhibition due to ibuprofen, with improvement in ventilation-perfusion mismatch.
Insights
This case report highlights a massive pulmonary embolism in a teenager that presented without hypoxemia, potentially due to ibuprofen's cyclooxygenase inhibition improving ventilation-perfusion mismatch.
Area of Science:
- Cardiology
- Pulmonology
- Pharmacology
Background:
- Massive pulmonary embolism (PE) typically presents with hypoxemia.
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can affect prostaglandin synthesis.
Observation:
- A 16-year-old male with supraventricular tachycardia developed shortness of breath and chest pain post-electrophysiology study.
- He received ibuprofen for 3 days prior to diagnosis of massive PE and left external iliac vein thrombus.
- Despite massive PE, the patient exhibited hypocarbia without hypoxemia (Pao2 108 mm Hg).
Findings:
- Massive pulmonary embolism diagnosed via V/Q scan and CT angiography.
- Treatment included anticoagulation, thrombolysis, iliac vein stenting, and inferior vena cava filter placement.
- Patient improved and was discharged on oral anticoagulation.
Implications:
- Ibuprofen's potential cyclooxygenase inhibition may have mitigated hypoxemia in massive PE by improving ventilation-perfusion matching.
- This case suggests a possible protective effect of NSAIDs in certain PE scenarios.
- Further research is warranted to explore the relationship between NSAID use and PE presentation.
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