ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 24
Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed
He did
well until 2 weeks after the trauma when he complained of acute
respiratory distress without cough, chest pain or hemoptysis. His
arterial blood gases on 50% inspired oxygen were as follows: PH 7.50,
PCO2 38 PO2 50.
The chest x-ray now shows a left sided effusion and bilateral
lower lobe densities that silhouette the diaphragms.
These
findings were not present on the prior exam.
Portable perfusion shows reduction in perfusion in the right upper
lobe. 
The angiogram demonstrated a thrombus in the anterior segment of
the right upper lobe. 
Case Assessment
This is the case of a 28 year old male paraplegic who presents with
acute dyspnea and respiratory alkalosis.
1. Dyspnea is a common but not ubiquitous symptom. The sensation of dyspnea may be of short duration (less that one hour). This symptom is often associated with evidence of hyperventilation as in this case respiratory alkalosis.
2. Most patients with pulmonary embolus have a predisposition to deep venous thrombosis. In this case the patient was paraplegic. (REFERENCE)
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