Acute Pulmonary Embolism in 24 year old male: A Case StudyAshley TannerNatalie NewmanNicale Yarbrough

Anatomy• Lungs• Heart

Legs Inferior Vena Cava Right Atrium Right Ventricle Pulmonary Artery

Pulmonary Embolism (PE)

•An embolus that is obstructing a pulmonary artery.1

•An embolus can be fatty tissue, a blood clot, air, or tumor cells.

•Early detection is necessary because it obstructs blood flow to the heart which causes infarction.

Case Study• 24 yr old male• Symptoms for over 1 year

▫ Chest Pain▫ Dyspnea▫ Laying down to sitting up

• 3 day hospitalization• Differential Dx

▫ Allergies▫ Myocardial Infarction

• Chest X-ray, EKG, CTPA

Risk Factors

• Age• BMI?• Congestive heart failure • Active malignant

neoplasm • Chemotherapy • Hx superficial vein

thrombosis • Hx varicose vein

procedure • Chronic renal disease?• Neurologic disease with

extremity paresis

• Previous central venous catheterization or transvenous pacemaker placement

• Trauma• Surgery• Anesthesia• Nursing home• Hospitalization

within 90 days.2

PE Trends

• Incidence rates increased markedly with age for both males and females3,4

• Study found that the incidence of PE actually decreased in across their 25-year study in both males and females3

Diagnosis

•Early diagnosis is fundamental, because immediate treatment is highly effective.5

•Signs and Symptoms▫Chest pain▫Dyspnea▫Coughing▫Shortness of breath

•Diagnosing takes a combination of clinical assessment and diagnostic imaging

Diagnostic ImagingTransverse CTPA Oblique CTPA Frontal

Radiograph

29-year old male with no significant medical history, all pictures are showing the right upper lung.6

Treatment

•Embolectomy-Surgical intervention to remove the embolism.

•Thrombolytic therapy-pharmacologic agents used to break up the embolism.7

▫Urokinase▫Streptokinase▫tPA (tissue plasminogen activator)

•Heparin-Blood thinning agent to stop the growth of the thrombosis.

•Warfarin-Same functions as heparin.

Prognosis

•Untreated PE is associated with a 30% mortality rate. Treated PE mortality rate is only 8%.1

•One study demonstrated that PE patients reported a worse quality living then the general population.8

•In another study that was done on a sample 399 patients, 33 patients had a recurrence of pulmonary embolism within the year of follow-up.1

Discussion

•There are many differential diagnoses to chest pain that pulmonary embolism is often overlooked.

•From an Athletic Trainer point of view we need to be aware if any athlete are on any anti-coagulants.

•Early detection is key for a better prognosis.

References 1. Carson, J. L., Kelley, M. A., Duff, A., Weg, J. G., Fulkerson,

W. J., Palevsky, H. I., ... & Terrin, M. L The clinical course of pulmonary embolism. New England Journal of Medicine, 1992; 326(19), 1240-1245.

2.Heit, J. A., Silverstein, M. D., Mohr, D. N., Petterson, T. M., O'Fallon, W. M., & Melton III, L. J. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Archives of internal medicine, 2000; 160(6), 809.

3.Silverstein, M. D., Heit, J. A., Mohr, D. N., Petterson, T. M., O'Fallon, W. M., & Melton III, L. J. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Archives of internal medicine, 1998, 158(6), 585.

4.Goldhaber, S. Z., Visani, L., & De Rosa, M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). The Lancet, 1999 353(9162), 1386-1389.

References Ctd.

5. Squizzato, A., Rancan, E., Dentali, F., Bonzini, M., Guasti, L., Steidl, L., ... & Ageno, W. Diagnostic accuracy of lung ultrasound for pulmonary embolism: a systematic review and meta‐analysis. Journal of Thrombosis and Haemostasis. 2013

6. Casullo, J., & Semionov, A. Reversed halo sign in acute pulmonary embolism and infarction. Acta Radiologica,2013; 54(5), 505-510.

7. Wan, S., Quinlan, D. J., Agnelli, G., & Eikelboom, J. W. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism a meta-analysis of the randomized controlled trials. Circulation, 2004; 110(6), 744-749.

8. van Es, J., den Exter, P. L., Kaptein, A. A., Andela, C. D., Erkens, P. M., Klok, F. A., ... & Middeldorp, S. Quality of life after pulmonary embolism as assessed with SF-36 and PEmb-QoL. Thrombosis research, 2013; 132(5), 500-505.