Timely diagnosis of pulmonary embolism in a patient with atypical clinical presentation: a case study
DOI:
https://doi.org/10.71068/hs000102Keywords:
pulmonary embolism, diagnosis, atypical presentation, D-dimer, anticoagulation.Abstract
Introduction: This case addresses embolia pulmonar aguda de presentación atípica, a clinically relevant condition in which early recognition, structured assessment, and risk-adapted treatment can substantially modify outcomes. The presentation illustrates how nonspecific or complex findings may delay diagnosis when they are interpreted separately. Objective: To describe the diagnostic reasoning, individualized intervention, multidisciplinary decisions, and clinical evolution of an adult patient with embolia pulmonar aguda de presentación atípica. Case presentation: A 54-year-old patient presented with síncope breve, malestar epigástrico y fatiga súbita sin dolor torácico ni disnea intensa al inicio. Clinical assessment, laboratory testing, targeted imaging, differential diagnosis, treatment, and follow-up were documented sequentially. Results: The integrated evaluation established embolia pulmonar aguda bilateral de riesgo intermedio bajo, con trombosis venosa profunda poplítea izquierda. Management included anticoagulación parenteral inicial, vigilancia monitorizada, transición a anticoagulante oral directo y educación sobre signos de alarma y factores de riesgo. The patient showed estabilidad hemodinámica sostenida, normalización progresiva de la frecuencia cardiaca y saturación, alta al cuarto día y seguimiento sin recurrencia a tres meses. Conclusions: The case highlights the value of linking diagnostic probability, objective severity, repeated reassessment, and individualized treatment. A favorable outcome depended on timely decisions, coordinated care, and a structured follow-up plan rather than on a single diagnostic test or isolated intervention. Clear escalation criteria and patient education supported safe transitions between acute care and outpatient follow-up.
References
1. Khandait H, Harkut P, Khandait V, Bang V. Acute pulmonary embolism: diagnosis and management. Indian Heart J. 2023;75(5):335-342. https://doi.org/10.1016/j.ihj.2023.05.007.
2. Teissandier D, Roussel M, Bannelier H, Freund Y, Catoire P. Contemporary approaches to pulmonary embolism diagnosis: a clinical review. Clin Exp Emerg Med. 2024;11(2):127-135. https://doi.org/10.15441/ceem.23.157.
3. Iwuji K, Almekdash H, Nugent KM, Islam E, Hyde B, Kopel J, et al. Age-adjusted D-dimer in the prediction of pulmonary embolism: systematic review and meta-analysis. J Prim Care Community Health. 2021;12:21501327211054996. https://doi.org/10.1177/21501327211054996.
4. Remillard TC, Kodra A, Kim M. Diagnosis, diagnostic tools, and risk stratification for contemporary treatment of pulmonary embolism. Int J Angiol. 2022;31(3):150-154. https://doi.org/10.1055/s-0042-1756177.
5. Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk stratification in patients with acute pulmonary embolism: current evidence and perspectives. J Clin Med. 2022;11(9):2533. https://doi.org/10.3390/jcm11092533.
6. Machanahalli Balakrishna A, Reddi V, Belford PM, Alvarez M, Jaber WA, Zhao DX, et al. Intermediate-risk pulmonary embolism: contemporary diagnosis, risk stratification and management. Medicina. 2022;58(9):1186. https://doi.org/10.3390/medicina58091186.
7. Maraziti G, Cimini LA, Becattini C. Risk stratification to optimize the management of acute pulmonary embolism. Expert Rev Cardiovasc Ther. 2022;20(5):377-387. https://doi.org/10.1080/14779072.2022.2077194.
8. Rosovsky RP, Grodzin C, Channick R, Davis GA, Giri JS, Horowitz J, et al. Diagnosis and treatment of pulmonary embolism during the coronavirus disease 2019 pandemic: a position paper from the National PERT Consortium. Chest. 2020;158(6):2590-2601. https://doi.org/10.1016/j.chest.2020.08.2064.
9. Freund Y, Cohen-Aubart F, Bloom B. Acute pulmonary embolism: a review. JAMA. 2022;328(13):1336-1345. https://doi.org/10.1001/jama.2022.16815https://doi.org/10.1016/j.chest.2020.08.2064.
10. Ghobadi A, Lin B, Musigdilok VV, Park SJ, Palmer-Toy DE, Gould MK, et al. Effect of using an age-adjusted D-dimer to assess for pulmonary embolism in community emergency departments. Acad Emerg Med. 2021;28(1):60-69. https://doi.org/10.1111/acem.14175https://doi.org/10.1016/j.chest.2020.08.2064.
11. Robert-Ebadi H, Robin P, Hugli O, Verschuren F, Trinh-Duc A, Roy PM, et al. Impact of the age-adjusted D-dimer cutoff to exclude pulmonary embolism: the RELAX-PE study. Circulation. 2021;143(18):1828-1830. https://doi.org/10.1161/CIRCULATIONAHA.120.052780https://doi.org/10.1016/j.chest.2020.08.2064.
12. Blondon M, Le Gal G, Meyer G, Righini M, Robert-Ebadi H. Age-adjusted D-dimer cutoff for the diagnosis of pulmonary embolism: a cost-effectiveness analysis. J Thromb Haemost. 2020;18(4):865-875. https://doi.org/10.1111/jth.14733https://doi.org/10.1016/j.chest.2020.08.2064.
13. Freund Y, Chauvin A, Jimenez S, Philippon AL, Curac S, Fémy F, et al. Effect of a diagnostic strategy using an elevated and age-adjusted D-dimer threshold on thromboembolic events in emergency department patients with suspected pulmonary embolism: a randomized clinical trial. JAMA. 2021;326(21):2141-2149. https://doi.org/10.1001/jama.2021.20750https://doi.org/10.1016/j.chest.2020.08.2064.
14. Khan M, Alter SM, Clayton LM, Hughes PG, Shih RD, Solano JJ. Age adjusted D-dimer cutoffs for pulmonary embolism in a geriatric population utilizing a D-dimer unit assay. Am J Emerg Med. 2022;51:103-107. https://doi.org/10.1016/j.ajem.2021.10.009https://doi.org/10.1016/j.chest.2020.08.2064.
15. Zhang RS, Maqsood MH, Greco AA, Postelnicu R, Mukherjee V, Alviar CL, et al. Efficacy and safety of catheter-based thrombectomy versus catheter-directed thrombolysis in acute pulmonary embolism. Am Heart J. 2024;272:109-112. https://doi.org/10.1016/j.ahj.2024.03.009https://doi.org/10.1016/j.chest.2020.08.2064.
16. Ismayl M, Ismayl A, Hamadi D, Aboeata A, Goldsweig AM. Catheter-directed thrombolysis versus thrombectomy for submassive and massive pulmonary embolism: a systematic review and meta-analysis. Cardiovasc Revasc Med. 2024;60:43-52. https://doi.org/10.1016/j.carrev.2023.10.002https://doi.org/10.1016/j.chest.2020.08.2064.
17. Feroze R, Arora S, Tashtish N, Dong T, Jaswaney R, Castro-Dominguez Y, et al. Comparison of large-bore thrombectomy with catheter-directed thrombolysis for the treatment of pulmonary embolism. JSCAI. 2023;2(1):100453. https://doi.org/10.1016/j.jscai.2022.100453https://doi.org/10.1016/j.chest.2020.08.2064.
18. Rössler J, Cywinski JB, Argalious M, Ruetzler K, Khanna S. Anesthetic management in patients having catheter-based thrombectomy for acute pulmonary embolism: a narrative review. J Clin Anesth. 2024;92:111281. https://doi.org/10.1016/j.jclinane.2023.111281https://doi.org/10.1016/j.chest.2020.08.2064.
19. Wrenn JO, Kabrhel C. Emergency department diagnosis and management of acute pulmonary embolism. Br J Haematol. 2024;205(5):1714-1716. https://doi.org/10.1111/bjh.19725https://doi.org/10.1016/j.chest.2020.08.2064.
20. Benavente K, Fujiuchi B, Virk HUH, Kavali PK, Ageno W, Barnes GD, et al. A practical clinical approach to navigate pulmonary embolism management: a primer and narrative review of the evolving landscape. J Clin Med. 2024;13(24):7637. https://doi.org/10.3390/jcm13247637https://doi.org/10.1016/j.chest.2020.08.2064.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Jean Pierre Velasco Mejía
This work is licensed under a Creative Commons Attribution 4.0 International License.
Articles published in this journal are available under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence. This licence authorises third parties to download, copy, distribute, adapt and reuse the contents, including for commercial purposes, provided that credit is given to the original author of the work.
