Diagnosing Pulmonary Embolism Using Point-of-Care Ultrasound in a Patient With Malingering and Coccidioidomycosis...

Area of Science:

• Pulmonology
• Infectious Diseases
• Radiology

Background:

• Pulmonary embolism (PE) is a serious condition often presenting with non-specific symptoms.
• Coccidioidomycosis is a fungal infection endemic to certain regions, primarily affecting the lungs.
• Point-of-care ultrasound (POCUS) is increasingly utilized for rapid bedside diagnostics.

Observation:

• A 41-year-old male presented with chest pain, initially suspected to be malingering due to psychiatric history.
• Point-of-care ultrasound (POCUS) revealed right ventricular strain, a D-shaped left ventricle, B-lines, and subpleural consolidations.
• Computed tomography pulmonary angiography confirmed pulmonary embolism (PE).

Findings:

• The patient was diagnosed with concurrent pulmonary coccidioidomycosis and pulmonary embolism (PE).
• No traditional risk factors for PE were identified, with coccidioidomycosis being the sole associated condition.
• Treatment involved apixaban for PE and fluconazole for coccidioidomycosis.

Implications:

• This case underscores the diagnostic value of POCUS in identifying PE, even in atypical presentations.
• The rare association between coccidioidomycosis and PE warrants further investigation.
• Integrating POCUS into clinical practice can expedite diagnosis and management of critical conditions like PE.