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Pulmonary Embolism Patient- Clinical Scenario and Diagnosis-

•A 42 year old lady from murree visited our hospital for the evaluation of her left leg swelling that she noticed about 2 weeks back. While entering through the gate of Holyfamily Hospital she suddenly collapsed and was rushed to Emergency Department, where she regained consciousness but was dyspneic. Her examination was unremarkable except for a respiratory rate of 32/min.
ecgpe

ecgpe

•What is the likely clinical diagnosis? How it can be confirmed? And how will you further evaluate this patient?

Post your answer as comment (scroll down). and answer or further follow up will be presented after 5 answers. 
Answer
D-dimers of the patient were advised



•Patients value:   1600ng/ml
•Normal value:  <200ng/ml


Doppler studies were performed
Venous Doppler left lower limb showed evidence of Deep Venous Thrombosis(DVT)

chest ct scan in pulmonary embolism

•This is a classical scenario of Pulmonary Embolism.
ECG shows Q3T3 pattern in our patient

pulmonary embolism ecg
A classical ECG in a pulmonary embolism patient shows S1Q3T3


•D-dimers are markedly elevated and there is established DVT
•CT chest proved pulmonary embolism, showing hypo dense areas in bilateral main pulmonary arteries territory

CT-scan-report-of-Pulmonary-embolism

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Comments

  1. Dr Haseeb SattarMarch 11, 2012 at 10:53 PM

    This comment has been removed by the author.

    ReplyDelete
  2. Dr Adil RamzanMarch 11, 2012 at 10:55 PM

    Dr haseeb tell about the likely diagnosis.. don't just interpret the ecg. from the history tell the likely diagnosis.. question is what is the likely diagnosis and how will confirm it etc.. :)

    ReplyDelete
  3. Dr Haseeb SattarMarch 11, 2012 at 10:56 PM

    Also there is Q-wave in Lead III

    ReplyDelete
  4. Dr Haseeb SattarMarch 11, 2012 at 11:02 PM

    This comment has been removed by the author.

    ReplyDelete
  5. Dr Haseeb SattarMarch 11, 2012 at 11:27 PM

    This comment has been removed by the author.

    ReplyDelete
  6. Dr Haseeb SattarMarch 11, 2012 at 11:27 PM

    This comment has been removed by the author.

    ReplyDelete
  7. JuGnUMarch 12, 2012 at 12:27 AM

    Yup... The probable diagnosis from the above evidences might be "Cor Pulmonale"

    ReplyDelete
  8. AnonymousMarch 12, 2012 at 12:54 AM

    RIGHT HEART FAILURE ???

    ReplyDelete
  9. AnonymousMarch 12, 2012 at 1:30 PM

    most probably deep vein thrombosis leading to distal embolism in pulmonary artery leading to sudden collapse.
    right heart failure developed afterwards.
    Lower limb doppler ultrasound, duplex scan, venography
    Ecg and Echo for any source of thrombi

    ReplyDelete
  10. Dr Haseeb SattarMarch 13, 2012 at 7:20 AM

    Exactly its Pulmonary embolism as she presentd with sudden collaps wid only one leg sweling with just 2 week history and on ecg one othr thing which favouring PE is Q in III T invrted and S wave in Lead I..so it shows She had DVT of left leg which cause embolism.

    ReplyDelete
  11. Dr Adil RamzanMarch 14, 2012 at 7:37 PM

    lol .. mitral stenosis .. what points went towards mitral stenosis?

    ReplyDelete
  12. AnonymousMarch 14, 2012 at 7:37 PM

    PE

    ReplyDelete
  13. AnonymousMarch 14, 2012 at 8:57 PM

    IT IS MOST PROBABLY RIGHT VENTRICULAR FAILURE SECONDARY TO EMBOLIZATION OF DEEP VEIN THROMBOSIS.

    ReplyDelete
  14. AnonymousMarch 15, 2012 at 2:04 PM

    PE

    ReplyDelete

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