Case history
Case history
A 65-year-old man presents to the emergency department with acute onset of shortness of breath of 30 minutes' duration. Initially, he felt faint but did not lose consciousness. He describes left-sided chest pain that worsens on deep inspiration. He has no history of cardiopulmonary disease. A week ago he underwent a total left hip replacement and, following discharge, was on bed rest for 3 days due to poorly controlled pain. He subsequently noticed swelling in his left calf, which is tender on examination. His current vital signs reveal a fever of 100.4°F (38.0°C), heart rate 112 bpm, BP 95/65 mmHg, and an O₂ saturation on room air of 91%.
Other presentations
Symptoms that are predictive of PE include chest pain, dyspnea, and a sense of apprehension. Syncope may also occur and is strongly associated with increased clot burden. Important signs include tachypnea with a respiratory rate >16 breaths per minute, fever >100.0°F (>37.8°C), and heart rate >100 bpm.[5]
PE can have mild symptoms or even be asymptomatic. PE has been reported in patients undergoing chest computed tomography for other indications, such as cancer staging.[6][7]
As the symptoms of PE may mimic other conditions, diagnosis is sometimes delayed. In one study, the diagnosis of PE was unsuspected in 70% of those who ultimately died from the condition.[8] Early recognition and aggressive treatment is critical because, among those who died of an unsuspected PE, death occurred within 1 hour in nearly 79% of patients and within 2.5 hours in 93% of patients.[8]
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