The Virtual Hospital: ElectricPE: The Diagnosis of Pulmonary Embolism: Myasthenia gravis

ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 18

Myasthenia Gravis

Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed

This case is a 76 year old male who developed myesthenia gravis 8 months prior to admission. He was admitted to this hospital because of dyspnea on minimal exertion, fatigue and fever. In addition, he complained of decreased muscle strength and lower extremity edema. Venous Doppler ultrasound examinations of both lower extremities were normal.

The chest radiograph showed a vague density in the left upper lobe. A chest CT through that area demonstrated a pleural based, triangular density consistent with pulmonary infarct.

The perfusion scan showed a combination of lobar and segmental defects. The ventilation scan was essentially normal. The scan was read as high probability for pulmonary embolus.

The pulmonary angiogram showed a definite intraluminal filling defect consistent with pulmonary embolus.

Case Assessment
This 67 year old male with myasthenia gravis presented with dyspnea on exertion, fatigue, fever and swollen legs.

1. The chest x-ray was abnormal as is often the case in patients with pulmonary embolus. (REFERENCE) The findings are often non-specific.

2. A high probability V/Q scan is a reliable category and will often obviate the need for further work-up. The clinicians, in this case, opted for further investigation. The reason for the decisions was not clear.

3. Bilateral venography will be normal in up to 30% of cases with proven pulmonary embolus. In those cases the entire thrombus may have migrated from the legs or the source is somewhere above the legs.

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