Clinical Manifestations Of 12 Cases Of Chronic Obstructive Pulmonary Disease Complicated With Acute Pulmonary Thromboembolism

Objective:To explore the characteristics of the clinical manifestation and the imaging, diagnosis, treatment and prognosis of Chronic obstructive pulmonary disease(COPD) complicated with acute pulmonary thromboembolism(PTE), which would increase the physicians'understanding of it.Methods:A survey was conducted on twelve COPD complicated with PTE patients who were hospitalised in Sir Run Run Shaw Hospital between January of 2003 and December of 2008. Then a retrospective analysis was performed on the clinical manifestation, physical examination records, lab tests results, images, treatment logs and prognosis of these patients.Results:All twelve patients had dyspnea of different degrees, chest distress and palpitation. Several patients had symptoms like chest pain and cough. One patient had small amounts of hemoptysis. In the physical examination, apart from three patients'records with no abnormal signs, different abnormal signs were shown in other patients, including asymmetrical lower limb swelling in six patients, distention of jugular vein in eight patients,3/6 degrees of blowing murmur in the second area of auscultation of aortic valve in five patients. Meanwhile, Wells Score indicated five patients with high risk, four moderate risk and three low risk. Cardiac Dopler ultrasound suggested five patients with severe pulmonary hypertension (three of them also had severe atrioventricular valve reflux), four with moderate pulmonary hypertension, the left three with mild pulmonary hypertension. Of the twelve patients, ten were performed CTPA after admission, four of them showed pulmonary artery filling defect above the segment level, the other eight patients were performed V/Q scan, which indicated different extents of ventilation/perfusion mismatch, and diagnosed PTE. Three out of eight patients showed slow blood flow in the lower limb in Dopler ultrasound. D-dimer were measured when the patients were admitted, results showed only one patients with >10mg/L,others were between 0.2-0.5mg/L. One patient were diagnosed massive PTE, and was treated with thrombolysis followed by anticoagulation treatment. One patient received a two-month anticoagulation treatment before a respiratory infection took her life, despite intensive treatment. The other ten patients all received a six-month anticoagulation treatment, and their conditions had relieves of different extents.Conclusion:In COPD patients complicated with PTE, the main manifestations include suddenly onset of dyspnea, chest distress and palpitation, chest pain, etc. But cough, purulent sputum, fever are seldom happened. The diagnosis of PTE depends on examinations like V/Q scan, CTPA, cardiac and lower limb Dopler ultrasound, etc. D-dimer did not show noticeable diagnositic indication in these patients. Proper examinations performed at the early stage of PTE are essential to early diagnosis and guiding the following treatments like thrombolysis and anticoagulation according to the patient's condition, which may improve the prognosis and diminish the risk of mortality.