Pulmonary Vascular Disease: Pulmonary Vascular Disease |

Pulmonary Embolism in a Young Adult: A Case Report FREE TO VIEW

Ying Liu, MD; Lianlian Zhang, MD; Luyao Sun, MD; Qianqian Yu, MD; Zhenxiang Yu, MD
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The First Hospital of Jilin University, Changchun, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A504. doi:10.1016/j.chest.2016.02.526
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SESSION TITLE: Pulmonary Vascular Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: We report the case of a young male adult with PE secondary to deep venous thrombosis that developed during his work as a long-haul truck driver. He was successfully treated with aggressive anticoagulation and antiplatelet treatment.

CASE PRESENTATION: A 27-year-old male long-haul truck driver was admitted to our hospital after a 4-day history of severe chest pain and a 1-day history of sputum contained some blood and swollen left lower extremity. Ambulatory pulmonary computed tomography showed a patchy shadow in the lingula of the left lung, and the edges of both lower lobes showed decreased sharpness. Routine blood test results showed a white blood cell level of 13.17 × 109/L, neutrophil percentage of 72.0%, D-dimer level of 1.11 μg/mL, and fibrinogen level of 5.00 g/L. Color Doppler ultrasound of the veins of both lower extremities demonstrated acute-phase thrombosis in the left common femoral vein, superficial femoral vein, and popliteal vein and lymphedema in the left lower leg. Considering all of these findings, we could not exclude the possibility of acute PE. Computed tomography angiography revealed an intraluminal filling defect low-density transect in the basal segment of the left and right lower pulmonary artery branches and transects low density in the lumen of the left upper lobe pulmonary artery branch, which established the diagnosis. Because his condition was classified as low-risk PE. Anticoagulant therapy was administered. The patient’s chest pain was resolved after 5 days, and the anticoagulant therapy was continued.

DISCUSSION: PE treatment and diagnosis are frequently delayed because of the complex and nonspecific clinical manifestations[1]. Only 30% of patients are diagnosed to PE who accepted to normal test[2]. Young patients have little basic disease, making it more difficult to diagnose PE, so prevention of PE should be paid more attention. The main risk factors for PE are external injuries, bone fractures, and thrombosis in the veins of the lower extremities. Research indicates that 70% to 90% of thrombi in patients with acute PE originate in the peritoneal cavity, pelvic cavity, and deep veins [3]. Thus, we could reduce the incidence of PE if we remove the risk factors. For young patients, external injuries and bone fractures have been evaluated, but vocational factors have been largely overlooked, such as long-haul truck drivers, electric welders, office workers, pipeline fabricators, therfore those in similar professions should exercise their lower extremities often and take regular physical examination.

CONCLUSIONS: It is very important to identify vocational risk factors associated with the development of PE, especially in young adults.

Reference #1: Konstantinides, SV. Acute pulmonary embolism revisited: thromboembolic venous disease. Heart. 2008;94:795-802.

Reference #2: Blann, AD, and Lip, GY. Venous thromboembolism. BMJ. 2006;332:215-219.

Reference #3: Somarouthu, B, Abbara, S, and Kalva, SP. Diagnosing deep vein thrombosis. Postgrad Med. 2010;122:66-73.

DISCLOSURE: The following authors have nothing to disclose: Ying Liu, Lianlian Zhang, Luyao Sun, Qianqian Yu, Zhenxiang Yu

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