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Pulmonary Embolism case presentation (1).pptx
- 1. A case of acuteonset breathlessness Case presentation : Surg SLT Bharath S Nambiar Discussion : Surg Cdr Abhish Mohan
- 2. Contents 01 03 04 02 History Clinical examination InvestigationsTreatment 05 Present status
- 3. Patient particulars ● 52year old serving sailor ● Resident of Tamil Nadu ● Informant : Self & Colleague ● Reliability: Good
- 4. Chief Complaints ● Breathlessness× 3days ● Loss of consciousness on 8/7/24 at 0640hrs for 1-2 minutes
- 5. HOPI ● Dyspnea forthe past three days ● Acute onset, exertional ● MMRC 2 ● No orthopnea/PND ● 01 episode of loss of consciousness ● for 1-2 minutes while climbing stairs of escalator at metro station which was preceded with breathlessness ○ No h/o tonic clonic movements/ post ictal confusion ○ No tongue bite, sphincter incontinence ○ No h/o injury/ bleeding from orifices ● h/o calf pain rt 01 month back, spontaneous resolution
- 6. ● No h/o ○Chest pain/Palpitation/diaphoresis ○ Fever/cough/sore throat/hemoptysis ○ Headache/visual disturbances/ weakness of limbs ○ Trauma to chest wall ○ Loss of appetite/ weight loss
- 7. Past medical history ●No h/o DM/TB/HTN ● No h/o Asthma ● No similar incidents in the past
- 8. Personal history ● Alcoholconsumption for the past 30 years (60 ml hard liquor daily) ● Reformed smoker for last 15years ● Normal bowel , bladder movements ● Normal sleep cycle ● No h/o sudden weight loss
- 9. Treatment history ● Patientwas taken to nearest civil hospital post LOC ● Inj Levetiracetam 500mg iv stat ● Discharged and brought to our hospital against medical advice
- 10. Summary ● 52 yearold male,presented with acute onset breathlessness, 01 episode of loss of consciousness with a recent history of pain and swelling in the right calf ● Clinically he has tachycardia , tachypnea and desaturation with unremarkable systemic examination
- 11. General examination ● Patientwas conscious, oriented to time place person ● Vitals : Temperature : 97⁰F Pulse : 116bpm Bp : 140/90 mmHg RR: 26/min Spo2 : 96% at room air ● No pallor,icterus,cyanosis,clubbing,lymphadenopathy,
- 12. Systemic examination CVS S1S2 heard,nomurmurs RS Accessory musles of resp not in use Normal b/l vesicular breath sounds, no adv sounds P/A Soft and non tender CNS No neurofocal deficits,higher mental function normal
- 13. ECG ● Negative S wavein lead I ● Deep Q wave in lead III ● T-wave inversion (TWI) in lead III ● Troponin I negative S1 Q3T3
- 14. Chest X-ray Chest X-rayAP view Partial inspiration film Cardiomegaly present
- 15. 2D ECHO ● Rightventricle almost dilated equal to left ventricle ● McConnels sign positive ● TAPSE :17-18mm ● MPA no clot
- 16.
- 17. CT Pulmonary Angiography BilateralAcute pulmonary thromboembolism involving distal right main pulmonary artery, right upper lobar artery and bilateral interlobar arteries, more pronounced on right side Dilated pulmonary Artery(more than diam of aorta) Prominent Right ventricle ansd Right atrium
- 18. CDFI Of Rightlower limb ● Echogenic thrombus seen within distal 1/3rd of superficial femoral vein,popliteal vein and proximal 1/3rd of posterior tibial vein ● Chronic deep vein thrombosis of Right lower limb present
- 19. Investigations ● Homocysteine :Above 50 ● Vit B12 : 295.21pg/ml ● Folic acid : 6.31ng/ml
- 20.
- 21. Treatment ● Inj LMWH60mg S/c BD ● Inj Thiamine 500mg BD ● Tab Mecoba 1500ug OD ● Tab Folic acid 5mg OD
- 22. Present Status ● Patientcomfortable ● No breathlessness ● Vitals: Temperature: 98⁰F Bp:128/86mmHg Pulse: 90bpm Spo2:98% ● Started on Apixaban
- 23. ● 2D ECHO:Normal chamber dimensions, No RWMA, Ejection fraction 60% ● Plan: continue anticoagulation, prothrombotic workup and transfer to CHAF Banglore for cardiology review
- 24.