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Abstract
A man in his late 60s with previous chronic obstructive pulmonary disease and insulin-dependent diabetes presented with a 10-day history of shortness of breath and cough and progressive breathlessness accompanied with significant weight loss over 6 months. On examination, it revealed poor swallow, dysphagia for both solid foods and liquids and not taking any regular medications due to problems with swallowing. On further history taking, the patient had a positive first relative family history for oesophageal cancer and lung cancer on the paternal side. Patient acutely desaturated and increased New Early Warning Score during the evening on call, and prominent S1Q3T3 was seen on ECG, which prompted immediate anticoagulation and CT pulmonary angiogram confirmed an acute thrombus with significant right heart strain. This case highlights the importance and sometimes neglected signs of right heart strain and elusive recognition of the S1Q3T3 phenomenon in acutely unwell and deteriorating patients to aid in the diagnosis of pulmonary embolism.
- Cardiovascular medicine
- Thrombosis
- Haematology (incl blood transfusion)
- Resuscitation
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Footnotes
Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content and guarantor: PRR. The following authors gave final approval of the manuscript: PRR.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.