The Virtual Hospital: ElectricPE: The Diagnosis of Pulmonary Embolism: Rheumatic Heart Disease

ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 20

Rheumatic Heart Disease

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

This case is a 46 year old female with a 30 pack year history of smoking and rheumatic fever as a child who was treated with one week of antibiotics because of pleuritic chest pain, cough, blood streaked sputum, leukocytosis (14,000 white cells with a left shift), T 37. Her condition did not improve and she was admitted to this hospital. Her blood gases on admission were PH 7. 45, PC2 28, PO2 65 on room air. Her diffusing capacity was 56% of predicted.

Her chest x-ray showed an area of consolidation on the right. A CT done at the same time showed a R pleural effusion.

The chest CT showed pleural based densities and clots in both ventricles.

Case Assessment
This is 46 year old female who was at risk for pulmonary embolus because of poor cardiac function related to prior rheumatic carditis. She presented with a constellation of symptoms that first suggested pneumonia. Her presenting symptoms were pleuritic chest pain, cough, hemoptysis, leukocytosis.

The diagnosis of pulmonary embolus was made on Chest CT. We have found at our institution that chest CT is often more specific than chest radiography for the diagnosis of pulmonary embolus. (REFERENCE)

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