The Variability in the Clinical Presentation of Acute Pulmonary Embolism: A Case Series

Authors

  • OKORIE ANYA LIMI HOSPITAL ABUJA
  • DR. AJAYI Central Michigan University
  • DR. AJIBOLA Limi Hospital Cardiocare
  • DR. NDAKOTSU Limi Hospital Cardiocare
  • DR. ODEKPE Limi Hospital and Maternity, Abuja.
  • DR. ODUGBEMI Al-Sahan, General Hospital, Kingdom of Saudi Arabia

DOI:

https://doi.org/10.60787/tnhj.v22i3.603

Keywords:

Deep venous thrombosis, D-dimer, multi-detector computed tomography pulmonary angiography, MD-CTPA, Pulmonary embolism, PE

Abstract

Background: Acute pulmonary embolism (PE) occurs when a thrombus dislodges from a peripheral part of the body to block any of the branches of the pulmonary artery. Depending on the size of the embolus and the underlying disease state, its presentation can range from being asymptomatic to presenting with sudden death. Its variable nature of presentation frequently leads to a missed diagnosis and increased morbidity or mortality from PE. This series aims to highlight some of the variable presentations of acute pulmonary embolism with the objective of stimulating a high index of suspicion, which can lead to early diagnosis and treatment.

Method: The electronic medical records of 3 patients in a private hospital in Abuja were selected for the series, together with a review of the existing literature. Consent to use patient information was obtained from the patients, and the approval for the case series obtained from the head of the department of research of the hospital.

Result: The clinical presentation of acute PE was highly variable in all 3 cases, with the least symptomatic case having a saddle-embolus lodged at the bifurcation of the pulmonary artery. Electrocardiographic tracings were also different in all 3 cases.

Conclusion: The prognosis of PE depends on early diagnosis and treatment. Mortality and morbidity from this condition can be reduced with a background knowledge of its variable clinical presentation and a high-index of suspicion.

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Author Biographies

OKORIE ANYA, LIMI HOSPITAL ABUJA

A graduate of Abia State University curently working as an Emergency medical officer in Limi Hospital abuja.

Experienced in management of cardiovascular diseases and use of the cath lab, but passionate about emergency medical services and disaster medicine.

An astute clinician and a clinical researcher

DR. AJAYI, Central Michigan University

Clinical Researcher, Department of Public Health, Central Michigan University. USA

DR. AJIBOLA, Limi Hospital Cardiocare

Senior Medical Officer & Qulaity Assurance Officer, Limi Hospital Cardiocare, Abuja. Nigeria

DR. NDAKOTSU, Limi Hospital Cardiocare

Senior Medical Officer, Limi Hospital Cardiocare, Abuja. Nigeria.

DR. ODEKPE, Limi Hospital and Maternity, Abuja.

Senior Medical Officer, Limi Hospital and Maternity, Abuja. Nigeria.

DR. ODUGBEMI, Al-Sahan, General Hospital, Kingdom of Saudi Arabia

Emergency Medical Officer, Al-Sahan General Hospital, Kingdom of Saudi Arabia.

References

Uchechukwu C, Wilson K, Lowe R et al. Pulmonary Embolism. Physiopedia.2.Piazza G, Goldhaber S. Acute Pulmonary Embolism Part 1: Epidemiology and Diagnosis. Circulation. 2006;114: e28–e32.

Ouellette D, Harrington A, Kamangar N. Medscape: Pulmonary embolism: Epidemiology. 2020 Sept.

Andersson T, Soderberg S. Incidence of acute pulmonary embolism, related comorbidities and survival; analysis of a Swedish national cohort. BMC Cardiovasc Discord 17, 155 (2017). https://doi.org/10.1186/s12872-017-0587-1.

Gupta R, Ammari Z, Dasa O, et al. Long-term mortality after massive, submassive, and low-risk pulmonary embolism. Vascular Medicine. 2020;25(2): 141-149. Doi: 10.1177/1358863X19886374.

Morrone D, Morrone V. Acute Pulmonary Embolism: Focus on the Clinical Picture. Korean Circ J. 2018 May;48(5):365-381. Doi: 10.470/kcj.2017.0314.

West J, Goodacre S, Sampson F. The value of clinical features in the diagnosis of acute pulmonary embolism: Systematic review and meta-analysis, QJM. International Journal of Medicine. 2007;100(12): 763-769. https://doi.org/10.1093/qjmed/hcm113

Carson JL, Kelley MA, Duff A et al. The clinical course of pulmonary embolism. N Engl J Med. 1992 May 07;326(19): 1240-5.

Girard P, Decousus M, Laporte S et al. Diagnosis of pulmonary embolism in patients withproximal deep vein thrombosis: specificity symptoms and perfusion defects at baseline and during anticoagulant therapy. AM J Respir Crit Care Med. 2001; 164:1033-7.

Sadeghi A, Brevetti GR, Kim S et al. Acute massive pulmonary embolism: role of the cardiacsurgeon. Tex Heart Inst J. 2005;32(3):430-3. PMID: 16397945; PMCID: PMC1336727.

Vyas V, Goyal A. Acute pulmonary embolism. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560551/

Huisman M, Klok F. How I diagnose acute pulmonary embolism: Blood. 2013;121(22): 4443-4448. https://doi.org/10.1182/blood-2013-03-453050

Patel P, Patel P, Bhatt M et al. Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism. Blood advances. 2020 Sep 22;4(18):4296-311.

Tapson VF. Acute pulmonary embolism.N Engl J Med. 2008 Mar 6. 358(10): 1037-52. [Medline].

Boka K, Soo Hoo G. Pulmonary Embolism Clinical Scoring Systems. Medscape. 2020 Dec.

Roy P, Douillet D, Penaloza A. Contemporary management of acute pulmonary embolism. Trends in Cardiovascular Medicine. 2022;32(5): 259-268. https://doi.org/10.1016/j.tcm.2021.06.002.

Konstantinides SV, Meyer G, Becattini C et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4): 543-603.

Levis JT. ECG Diagnosis: Pulmonary Embolism. Perm J. 2011;15(4): 75. PMID: 22319421.

Rashid M, Al Mogbil M, Shah I, Moin S, Aquil N. Classic S13T3 in Lobar Pneumonia, otherwise popularly associated with Pulmonary Embolism. International J of Advances in Case Reports. 2015;2(11):684-685.

Shopp D, Stewart L, Emmett T, Kline J. Findings From 12-lead Electrocardiography That Predict Circulatory Shock from Pulmonary Embolism: Systematic Review and Meta-analysis. Academic Emergency Medicine. 2015 Oct;22(10):1127-37.

Konstantinies S, TorbickiA, Agnelli G et al. 2014 ESC guidelines on the diagnosis and management of Acute Pulmonary Embolism. Rev Esp Cardiol. 2015;68: 6410.1016/j.rec.2014.12.002.

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Published

2022-10-21

How to Cite

ANYA, O., AJAYI, E., AJIBOLA, S., NDAKOTSU, A., ODEKPE, U., & ODUGBEMI, O. (2022). The Variability in the Clinical Presentation of Acute Pulmonary Embolism: A Case Series. The Nigerian Health Journal, 22(3), 325–335. https://doi.org/10.60787/tnhj.v22i3.603

Issue

Section

Case Report and Series
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