Pulmonary Embolism without Verified Deep Vein Thrombosis – a Case Report

Case report

Ivana Urošević‚ Nikola Stojanović, Aleksandar Tošić, Miljana Mladenović Petrović

50–52

https://doi.org/10.5937/medrec2601050U

ORCID iDs:             Ivana Urošević                             N/A
Nikola Stojanović                        N/A
Aleksandar Tošić                         N/A
Miljana Mladenović Petrović   https://orcid.org/0009-0003-8063-5873

Abstract

Pulmonary thromboembolism is a clinical and pathophysiological condition that occurs when a thrombus embolus prevents the supply of pulmonary arterial blood to a part of the lung. In 90% of cases, thromboembolism originates from the deep veins of the pelvis, ileofemoral veins, lower leg veins, and less often the veins of the arms and the cavities of the right heart. The basis of this disease is Virch’s triad, which includes blood hypercoagulability, venous stasis and damage to the blood vessel wall. If the patient has a predisposition, he develops pulmonary thromboembolism. The clinical picture of acute massive PTE, when the thrombus embolizes more than 50% of the pulmonary vasculature, is characterized by sudden chest pain, tachypnea, dyspnea at rest, central cyanosis, hypotension, syncope. The aim of the paper is to describe the clinical picture, diagnosis and treatment of a patient with PTE who did not have a single episode of DVT. Anamnestic data and medical documentation of the patient were used. Patient NN, 70 years old, from Knjaževac. She went to the doctor because of severe chest pain. After basic tests, EKG and laboratory tests, she was admitted to the Cardiology Department because of dyspnea, fatigue and chest pain. On admission, she is conscious, oriented, afebrile, dyspnoic, with oxygen saturation around 88%. Blood pressure was 145/90 mmHg. The auscultatory findings were without significant deviations. Based on a PESI score of 90, she was classified as class III, which indicated an intermediate risk of death (3-7% in the next 30 days). In anamnesis vitae – long-term hypertensive patient with two drugs. Color Doppler of the veins of the lower extremities showed no signs of deep vein thrombosis. Laboratory findings showed significantly elevated values ​​of D dimer (14928 ηg/ml, troponin (789-1136ηg/ml), pro BNP (3347pg/ml) and LDH (411U/ml). Other laboratory parameters were within reference values. Due to the severity of the clinical picture and signs of right heart strain, thrombolytic therapy (Actilise, 50mg/50ml i.v.) was administered, after which anticoagulant therapy was continued. therapy with low molecular weight heparin, and Rivaroxaban was suggested at discharge. Pulmonary thromboembolism can occur without evidence of deep vein thrombosis. A negative Doppler vein does not rule out the diagnosis, so it is necessary to carry out additional diagnostics in patients with clinical suspicion. Timely diagnosis, adequate risk stratification and appropriate therapy are key to a favorable outcome.

Key words: pulmonary thromboembolism, deep vein thrombosis, D-dimer, troponin

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