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Muddy clinical waters: a missed pulmonary embolus

Nathaniel Lee1, Simon Rupert Bax

  • 1Worthing Hospital, Worthing, UK.

BMJ Case Reports
|March 14, 2014
PubMed

Insights

Diagnosing pulmonary embolism (PE) is challenging. This case highlights a patient initially misdiagnosed, emphasizing vigilance for PE in septic patients with altered consciousness.

Area of Science:

  • Medical Case Study
  • Pulmonary Medicine
  • Critical Care

Background:

  • Pulmonary embolism (PE) diagnosis can be challenging, with potentially fatal consequences.
  • Clinicians must maintain vigilance for PE, especially in complex patient presentations.

Observation:

  • A patient presented with fluctuating consciousness and sepsis, initially diagnosed with aspiration pneumonia.
  • An exploratory surgery revealed no significant findings, prompting further investigation into the altered consciousness.

Findings:

  • A large pulmonary embolism (PE) was retrospectively diagnosed as the cause of the patient's symptoms.
  • The patient received anticoagulation therapy and experienced a full recovery without pulmonary sequelae.

Implications:

  • Prolonged immobility, sepsis, psychiatric history, recent surgery, and hospitalization are significant risk factors for PE.
  • This case underscores the importance of considering PE in patients with unexplained altered mental status and sepsis.
  • Timely diagnosis and anticoagulation are crucial for favorable outcomes in PE patients.

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