[Bilateral proximal pulmonary embolism without associated hypoxemia. Case report]

Area of Science:

• Critical Care Medicine
• Pulmonary Medicine
• Radiology

Background:

• Pulmonary embolism (PE) is a frequent complication in intensive care units (ICUs).
• PE typically presents with hypoxemia due to ventilation/perfusion (V/Q) ratio disturbances.
• Unexplained fever can be an atypical presentation of PE in trauma patients.

Observation:

• A 43-year-old multiple trauma patient developed proximal and bilateral pulmonary embolism.
• The patient presented with unexplained fever and a negative infectious workup.
• Crucially, the patient exhibited no signs of pulmonary hypertension or hypoxemia despite the extensive PE.

Findings:

• Bilateral proximal pulmonary embolism can occur with preserved gas exchange.
• Normal oxygenation may be maintained by balanced V/Q ratios across both lungs.
• Bilateral bronchoconstriction might contribute to stable V/Q matching in the presence of PE.

Implications:

• The absence of hypoxemia should not rule out pulmonary embolism in critically ill patients.
• Spiral CT scans are valuable for diagnosing PE, even in the absence of typical respiratory symptoms.
• This case expands the clinical spectrum of pulmonary embolism presentations in intensive care settings.