Pulmoner Emboli: Yine de Kolaylıkla Atlanabilir!

Yıl 2010, Cilt: 1 Sayı: 1, 34 - 36, 01.01.2010

Betül Gülalp Tufan Akın Giray Nazan Şen Mehmet Nur Altinors

Öz

Introduction: Pleuritic pain can be misconstrued as renal colic. Case: 32 years old female complained about her flank pain with changeable character for last three days. She had started to get oral treatment as renal colic in another hospital. The vitals were; temperature 36.8°C, pulse 92/min, respiration rate 22/min, blood pressure 130/80 mm/Hg. Physical examination and bedside ultrasonography were unremarkable. The sinuses were not identified on chest x-ray. WBC was 13.40 K/mm3. The biochemistry tests were normal. D-dimer was 98 ug/L (50-228 ug/L). There were bilateral multiple periferic tromboembolus on computerised tomography pulmonary angiography. Bilateral distal extremity venose system colorful Doppler were normal. Right heart cavities and all cardiac functions were normal. The patient without an indication of trombolitic administration was admitted to intensive care with anticoagulation treatment. Conclusion: If there were thrombosis risc factors, they should be evaluated in differential diagnose of pulmonary embolus. Evaluation of history about dyspnea could be the clue. Inexplicable dyspnea was the indication for advanced investigation methods. As symptoms were nonspesific, appropriate management can identify pulmonary embolus without any consultation in a short time, merely.

Anahtar Kelimeler

Pulmonary Embolus

Pulmonary Embolus; Can Be Still Missed Easily

Öz

Introduction: Pleuritic pain can be misconstrued as renal colic. Case: 32 years old female complained about her flank pain with changeable character for last three days. She had started to get oral treatment as renal colic in another hospital. The vitals were; temperature 36.8°C, pulse 92/min, respiration rate 22/min, blood pressure 130/80 mm/Hg. Physical examination and bedside ultrasonography were unremarkable. The sinuses were not identified on chest x-ray. WBC was 13.40 K/mm3. The biochemistry tests were normal. D-dimer was 98 ug/L (50-228 ug/L). There were bilateral multiple periferic tromboembolus on computerised tomography pulmonary angiography. Bilateral distal extremity venose system colorful Doppler were normal. Right heart cavities and all cardiac functions were normal. There was not an indication of trombolitic administration and the patient was admitted to intensive care with anticoagulation treatment. Conclusion: If there were thrombosis risc factors, they should be evaluated in differential diagnose of pulmonary embolus. Evaluation of history about dyspnea could be the clue. Inexplicable dyspnea was the indication for advanced investigation methods. As symptoms were nonspesific, appropriate management can identify pulmonary embolus without any consultation in a short time, merely

Anahtar Kelimeler

Pulmonary Embolus

Kaynakça

• Stein PD. Acute pulmonary embolism. Dis Mon 1994;40:467-523.
• Zubairi AB, Husain SJ, Irfan M, Fatima K, Zubairi MA, Islam M. Chest radiographs in acute pulmonary embolism. J Ayub Med Coll Abbottabad 2007;19:29-31.
• Worsley DF, Alavi A, Aronchick JM: Chest radiograph findings in patients with acute pulmonary embolism: Observatios from the PIOPED Study. Radiology 1993;189:133-136.
• Cvitanic 0, Marino PL: Improved use of arterial blood gas analysis in suspected pulmonary embolism. Chest 1989;95:48-51.
• Stein pd, Henry JW: Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1996;109:78-81.
• Mansencal NM, Vieillard-Baron A, Beauchet A and et al: Triage patients with suspected pulmonary embolism in the emergency department using a portable ultrasound device. Echocar 2008;25:451-456.
• Wolfe TM, Hartsell SC: Pulmonary embolism: Making sense of the diagnostic evaluation. Ann Emerg Med 2001;37:504-514.
• Runza G, La Grutta L, Alaimo V and et al. Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain. Eur J Radio 2007;64:41-47.
• Weiner SG, Burstein JL. Nonspesific tests for pulmonary embolism. Emerg Med Cli Nor Am 2001;19:943-954.