[Pulmonary thromboembolism. A clinical case with unusual presentation]

Area of Science:

• Cardiology
• Pulmonology
• Diagnostic Imaging

Background:

• Pulmonary thromboembolism (PTE) is a significant cause of morbidity and mortality.
• Diagnosis can be challenging due to variable and often non-specific clinical presentations.
• This case underscores the difficulties in diagnosing PTE when symptoms overlap with other cardiovascular conditions.

Observation:

• A 60-year-old male presented with chest and epigastric pain, initially misdiagnosed as vasospastic angina despite normal coronary arteriography.
• Recurrent symptoms of dyspnea, chest pain, hypotension, and syncope, along with physical findings, prompted further investigation.
• Echocardiography revealed right heart strain and pulmonary hypertension, while scintigraphy and arteriography confirmed extensive pulmonary embolism.

Findings:

• The patient exhibited unusual clinical findings, including epigastric pain and ECG changes suggestive of myocardial ischemia.
• Diagnostic delays occurred due to initial misdiagnosis and normal coronary arteriography findings.
• Despite aggressive management, the patient succumbed to complications of massive pulmonary embolism.

Implications:

• This case emphasizes the importance of considering pulmonary thromboembolism in patients with atypical chest pain and risk factors, even with initial non-diagnostic cardiac workups.
• It highlights the critical need for timely and accurate diagnosis of PTE to initiate effective treatment and improve patient outcomes.
• The study stresses the review of diagnostic errors in complex cases to enhance clinical practice and patient safety.