Case by Chye Chung Thanks for the case which is a good case to discuss.
28 years old Malay man who is in an army, presented with sudden onset of shortness of breath and localised pleuritic chest pain for 1 day. He also has non-productive cough and with an episode of haemoptysis, low grade fever without chills and rigors and rashes. He had previous history of trauma to the knww and ACL repair done 2 months ago. No history of pneumonia, PTB, recent air travel or long journey drive. No other medical illness.
Physical examination was unremarkable and lungs clear with no loud P2
D-dimer 300
Plt 409
PT12.9, aPTT 29.2 INR 1.07
pH7.469, pCO2 72.0, HCO3- 25.8, BE 3.3 O2 sat 95.4%
CXR normal
Would anyone like to comment on the ECG and CTPA ?
Thanks again to Chye Chung for the post !
5 comments:
1. ECG- sinus tachycardia with the rate of 107 beats/min.
There is the 'SI QIII TIII' pattern- deep S waves in lead I, pathological Q waves in lead III, inverted T waves in lead III.
This ECG is indicative of pulmonary embolism.
2. CTPA below tracheal bifurcation shows intraluminal filling defect consistent with a clot/embolus within the right pulmonary artery.
Not good in CT interpretation:)
Totally agree with shuyu on the sinus tachycardia of 115 bpm and the S1Q3T3 which indicates pulmonary infarct due to pulmonary embolism.
On CTPA, there is a defect in the filling of R- pulmonary artery which extend almost towards the left pulmonary artery(to the bifurcation of pulmonary trunk) and also bilateral segmental defects.
It is very suggestive of pulmonary embolism.
Yes, massive pulmonary embolism
Pulmonary embolism is the blockage that occurs suddenly in the lung artery. This leads to difficulty in oxygen flow. This causes deep vein thrombosis and also causes damage to the other organs of the human body.
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