Severe Pulmonary Thromboembolism Occurred To A Young Man With Minor Trauma As Lower Extremity Soft Tissue Contusion:a Case Report And Literature Review

Pulmonary embolism (PE) is one of the most common and critical disease with high mortality in clinical work. Timely diagnosis and treatment are key factors in ensuring benign prognosis and survival. However, it remains really difficult to diagnose pulmonary embolism since its clinical symptoms and signs in presentation are frequently nonspecific. Especially, syncope as the main symptom of pulmonary embolism in a previously healthy patient without typical predisposing factors to embolism is extremely rare and is easy to misdiagnosis and missed diagnosis in clinical practice. We report a pulmonary embolism with syncope as the main clinical symptom inducing by lower limb soft tissue contusion in a previously healthy young male patient. A26-year-old previously healthy male patient was admitted to the Vasculocardiology Department, with the chief complaint of repeatedly amaurosis and a transient syncope, about one month later since his lower limb tissue blunt contusion. After admission, laboratory examination revealed hypoxemia, a high D-Dimer level and positive myocardial injury markers. Transthoracic echocardiography revealed right ventricular expansion with right heart overload, pulmonary hypertension and slightly tricuspid regurgitation. Lower limb vascular doppler ultrasound demonstrated deep venous thrombosis of the left lower extremity. Computed tomography pulmonary angiography (CTPA) confirmed embolism in bilateral pulmonary artery trunk and branches. Following the final diagnosis, the patient timely received both local and systematic urokinase thrombolytic therapy combined with temporary inferior vena cava (IVC) filter implant. The patient presented with poor oxygenation and dyspnea after interventional operation. CTPA reexamination revealed that multiple thrombosis in bilateral main pulmonary artery trunk and branches, accompanied with pulmonary infarction. The patient got better and treated with oral warfarin anticoagulation post-discharge following the treatment with small dose urokinase systemic thrombolysis, low molecular heparin+warfarin anticoagulation, respiratory support, etc. CTPA was reexamined again about one month after discharge which suggested not seen obvious abnormal signs. The patient discontinued taking oral warfarin one year later with normal CTPA reviewed during this period. Nevertheless, recurrence of left lower extremity deep vein thrombosis occurred to the patient with symptoms of the left lower limb swelling and pain after follow-up for two years. Thus the patient was recommended treat with oral warfarin long-term anticoagulant. Follow-up of the patient to March31,2015, no obvious discomfort and other adverse events recurred again. Associated literatures were reviewed and we summarized the experience during the diagnosis and treatment in this case. Raised awareness of physicians and early diagnosis and treatment were considered to be very important for improving prognosis and outcome of pulmonary embolism.