Description
Lung diseases, often known as respiratory disorders, include pneumonia, pulmonary embolism, TB, emphysema, cystic fibrosis, lung cancer, mesothelioma, and pulmonary hypertension.
pulmonary embolism: A deep vein thrombosis, or DVT, which typically develops in the leg, lodges in one of the arteries of the lungs. Many emboli are degraded by the body and disappear on their own, but a major pulmonary embolism can be fatal.
Deep vein thrombosis is the main reason for the majority of pulmonary embolisms (DVT). In this syndrome, blood clots form in the leg veins.
An illness called pneumonia causes the air sacs in one or both lungs to become inflamed. The air sacs could get clogged with phlegm or fluid or pus, producing coughing.
Résumé
- A 77-year-old male with a 25-year history of COPD presented with cough and breathlessness for seven days, experiencing gradual onset, progressive cough with minimal expectoration, and continuous breathlessness even at rest. He had a history of recurrent admissions and was a former smoker. Initial examination showed a respiratory rate of 24, slightly elevated BP, 90% saturation on room air, wheezing, and a chest x-ray indicative of COPD with hyperinflation, but no visible infection.
- The patient was initially treated for a COPD exacerbation with antibiotics, bronchodilators, steroids, and oxygen. He initially responded well, but on the fifth day of admission, experienced a sudden drop in saturation to 74% on room air, a decrease in blood pressure to 88/62 mmHg, and a respiratory rate of 35, indicating respiratory distress. He was transferred to the ICU and placed on NIV support, IV fluids, and vasopressors.
- ECG and ECHO showed no significant cardiac pathology, but D-dimer was slightly elevated. Due to the sudden desaturation in a hospitalized patient with comorbidities, a CT pulmonary angiography (CTPA) was performed to rule out pulmonary embolism (PE). The CTPA revealed a massive pulmonary embolism involving the entire right pulmonary artery.
- The patient was immediately started on thrombolysis followed by low molecular weight heparin (LMWH), and later discharged on NOACs (Non-Vitamin K Antagonist Oral Anticoagulants). This case highlights the importance of considering PE in any patient presenting with unexplained breathlessness, and emphasizes that CTPA is the gold standard for PE diagnosis.
- Acute pulmonary embolism can be classified as massive (hypotension), submassive (RV dysfunction without hypotension), and low-risk. Massive PE, though less frequent (5-10%), is highly fatal with mortality rates of 40-50%. D-dimer is a sensitive but not specific test, and clinical features include sudden dyspnea, syncope, hypotension, and sometimes cyanosis.
- Diagnostic tools include blood tests like D-dimer and cardiac biomarkers, along with imaging modalities like venous ultrasonography, chest X-ray (looking for signs like Westermark sign or Hampton's hump), and the gold standard CT pulmonary angiography. Treatment involves anticoagulation (NOACs or warfarin) and, in cases of hemodynamic instability, re-perfusion through thrombolysis.
- Thrombolysis is indicated for PE patients with hemodynamic instability (hypotension). The use of thrombolysis is considered for patients with RV dysfunction or elevated cardiac biomarkers even if hemodynamically stable. During the diagnostic workup for suspected PE, anticoagulation with enoxaparin (Clexane) can be started if not contraindicated. Oral anticoagulants, specifically NOACs, are the preferred long-term treatment.
- In cases of unprovoked PE (without a clear transient risk factor), long-term anticoagulation should be considered. In pregnant patients suspected of PE, diagnostic and resuscitation protocols should be followed despite the pregnancy, including CT pulmonary angiography if necessary.
Exemple de certificat
À propos des intervenants
Dr Bhagwan Mantri
Pneumologue consultant et spécialiste en soins intensifs
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