Pulmonary embolism in young age

Abstract

Introduction. One of the risk factors for pulmonary embolism is age > 40 years. Lately, more and more cases of thromboembolism occur at a young age, that requires special attention in diagnosis and treatment. Objectives. The purpose of this article was to analyze the clinical case of thromboembolism at a young age. Material and methods. Our patient B., 33- year-old male was urgently hospitalized with the chest pain when breathing in, shortness of breath, blood-streaked sputum cough and body temperature up to 37-38.5 °С. 17.12.18 the bone immobilization of the right fibula due to a fracture was performed. 30.12.18 - the patient felt compressive pain in the right side of the chest, shortness of breath, blood-streaked sputum cough. An ambulance was called, but the patient was not hospitalized. Since 31.12.2018 till 05.01.2019 – body temperature rose to 38°C. 06.01.19 - a recurrence of initial symptoms. 07.01.19 - the chest pain intensified, patient was transported by ambulance to a hospital. During the examination: vesicular breathing, weakened in the lower sections, mostly on the right, respiratory rate -20/min, heart rate 100 beats/min, blood pressure 120/70 mm Hg. The main diagnosis: thromboembolism of the lobar arteries of the right lung. Class I, very low risk (43 points by PESI scale – Pulmonary Embolism Severity Index, 5 points by the Padua prediction score). Complication: right-sided inferior infarction-pneumonia. Concomitant diagnosis: fracture of the right fibula. Recommended treatment: rivaroxaban 12 mg; eplerenone 50 mg, ceftriaxone 1 g bid intravenous injection (IV), levofloxacin 500 mg IV, oxygen therapy. Results. Laboratory and instrumental studies were carried out. Laboratory tests revealed an increased in leukocytes, erythrocyte sedimentation rate, ALT, troponin І. ECG: right axis deviation. Computed tomography (CT) of the chest: CT signs of thromboembolism of the arteries of the right lung, right-sided inferior infarction-pneumonia, changes are more typical for an inflammatory process in the initial stage. Ultrasound examination of the abdominal organs and kidneys: diffuse changes of the liver parenchyma, traces of fluid in the right pleural cavity. Conclusions. Prolonged immobilization in young patients can be only one risk factor for the formation of pulmonary embolism. In order to predict possible complications in patients with pulmonary thromboembolism, it is necessary to take into account the initial state of the patient and associated diseases in each case.