Dva lica plućne embolije

Abstract

Objective. The aim of this paper is to present two completely different clinical manifestations of pulmonary embolism which the author encountered in the field. In both cases CT angiography confirmed massive embolism. Methodology. The data from medical documentation were used to present cases of two patients with pulmonary embolism. Case report. The first one presents a case of a 62-year-old man who called emergency service because of a sudden intense pressure-like chest pain, accompanied by sweating and tingling in both hands. Physical exam showed tachypnea, SaO2 of 80%, with auscultatory finding of weakened breath sound on left side basal, BP= 110/60 mmHg on both sides. ECG registered sinus rhythm, HR = 90 / min, new incomplete right bundle branch block and flattened T wave in precordial leads. Patient's history revealed an oncologic diagnosis, plaster immobilization on right lower leg and previous pulmonary embolism 9 years ago. The patient was transported to the emergency medical institution, with suspected diagnosis of pulmonary embolism, which was eventually confirmed by CT pulmonary angiography. The other is the case of a 48-year-old man presenting with short-term loss of consciousness followed by spontaneous recovery, which was the reason for contacting the emergency service. Healthy, former active athlete, without any risk factors for cardiovascular disease, also without predisposing factors for the development of deep vein thrombosis. Upon our arrival, he complained only of languor. Physical exam showed eupnea, with normal breath sounds, SaO2 98%, BP= 120/80 mmHg on both sides. The ECG registered sinus rhythm, HR= 110 / min, QS in V1-V3, ST elevation 1mm in V2-V3. The patient was transported to the cardiology department. Because of the hs troponin T= 194, he was admitted to the cardiology ICU with a working diagnosis of acute myocardial infarction. Subsequent CT angiography registered a massive pulmonary embolism. Discussion and conclusion. In order to make the correct diagnosis of pulmonary embolism, it is necessary to keep high level of suspicion. The fact that clinical signs and symptoms are not specific is the reason why PE often isn't diagnosed in time or remains unrecognized in some cases. In field conditions, with limited diagnostic possibilities, establishing the diagnosis of PE is particularly challenging. In all cases of unexplained syncope and tachycardia, the possibility of PE should be considered. We need to think about pulmonary embolism even when risk factors are absent.