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Abstract: This article describes a middle-aged male patient who presented to our emergency department with complaints of fever, chest pain, and hemoptysis for 1 week. CTA of the pulmonary arteries was performed, suggesting: multiple filling defects in both arterial branches, and pulmonary artery embolism was considered. The patient was given anti-inflammatory, asthma, sputum, anticoagulation, improvement of microcirculation, promotion of venous return and other symptomatic treatment. 1 week later, the patient’s symptoms were significantly relieved, and 14 days later, the symptoms disappeared and the patient was discharged. 3 days later, the outpatient reexamination of pulmonary artery CTA showed no significant abnormalities.
Basic information】Male, 43 years old
Disease Type】Pulmonary artery embolism
Hospital】Liaoning Provincial People’s Hospital
Date of Consultation】December 2021
Treatment plan] Oxygen + intravenous medication (low molecular weight heparin calcium injection + levofloxacin hydrochloride for injection + cefazoxime sodium for injection + vincristine glucose injection + Yunnan Baiyao + diazoxide injection)
[Treatment Period] 14 days of hospitalization, 3 months of outpatient review
Treatment effect】Significant relief of symptoms, no obvious complaints on review
I. Initial consultation
A 43-year-old patient, Uncle Li, came to the emergency department with fever, chest pain and hemoptysis for 1 week. The patient started to have fever 1 week ago, with a maximum temperature of 38℃, accompanied by chills, shortness of breath and hemoptysis, which started with blood in the sputum and later appeared as a whole mouth of red blood sputum, accompanied by right-sided chest pain, and since the onset of the disease, the patient did not have nausea, vomiting, abdominal pain, diarrhea, frequent urination, urgent urination and painful urination, but had poor appetite and sleep, and his bowel movements were as usual. The patient had left lower extremity deep vein thrombosis for 2 years and had not taken oral anticoagulant drugs regularly for the past 6 months. In the emergency room, CTA of the pulmonary arteries showed multiple filling defects in both branches of the pulmonary arteries, and pulmonary embolism was considered. Physical examination: slightly tachypnea, no cyanosis of the lips, no dry rales in both lungs.
II. Treatment history
After admission, the relevant tests were completed. Blood gas analysis showed that the partial pressure of oxygen was 75.9 mmHg, and the ultrasound of the veins of the left lower extremity showed that there was no significant abnormality in the deep veins of the left lower extremity, and the left saphenous vein was thrombosed. The patient was given oxygen, low molecular weight heparin calcium injection for anticoagulation, levofloxacin hydrochloride for injection and ceftizoxime sodium for injection for anti-inflammation, and vincristine glucose injection for improving microcirculation. Yunnan Baiyao was used to stop bleeding, and Dizoxin injection was used to stop pain. After 1 week of medication, the patient’s chest pain, hemoptysis and shortness of breath improved significantly, and the fever was relieved with a maximum temperature of 37.6℃. After 2 weeks, the patient had no fever, slight chest pain, no hemoptysis or shortness of breath, and normal body temperature.
III. Treatment effect
After giving the patient regular medication, the patient’s symptoms were gradually relieved, the body temperature decreased after 3 days, the symptoms of shortness of breath and coughing up blood improved, the symptoms of chest pain were obviously relieved after 1 week, there was no longer whole mouth hemoptysis, only occasional blood in sputum, the body temperature returned to normal, there was occasional fever, the highest temperature was 37.6℃. At 14 days of hospitalization, the patient’s symptoms were basically relieved, with mild chest pain, no hemoptysis and shortness of breath, and normal body temperature, so he was discharged from the hospital. 3 months later, on outpatient review, the patient had no obvious complaints of discomfort, and the CTA results of the pulmonary arteries suggested that there were no obvious abnormalities in the bilateral pulmonary arteries. The patient was instructed to continue the medication for 3 months and to come back to the hospital for a review.
IV. Notes
We are glad that after active treatment, the patient’s symptoms were recovered and all indicators were improved, but we still continue to take medication after discharge to prevent disease recurrence.
1.Patients should take oral anticoagulant drugs regularly after discharge, if there is no risk of bleeding, they should take them for at least 6 months, and review them every 3 months in outpatient clinic, and pay attention to review the venous ultrasound of lower limbs when reviewing them, and do not stop or reduce the dosage by yourself to avoid recurrence of thrombosis and re-embolism.
2, after discharge from hospital, pay attention to diet and living, advise patients to eat a light diet, absolutely quit smoking and drinking, eat more milk, eggs, lean meat and other high-quality protein, eat more fresh fruits and vegetables, and try to avoid high salt, high sugar, high fat food intake.
3. After discharge from the hospital, patients should be progressively active and avoid high-intensity activities for 3 months to avoid lack of oxygen, in addition, pay attention to more rest and avoid prolonged sitting, standing and walking.
V. Personal insight
Pulmonary artery embolism is a common invisible clinical killer and one of the most dangerous vascular surgery diseases, mostly caused by lower limb deep vein thrombosis dislodged and blocking the pulmonary artery, and severe pulmonary artery embolism can lead to sudden death. If patients have sudden onset of chest pain with hemoptysis and dyspnea, the possibility of pulmonary embolism should be considered, especially for patients with previous lower limb DVT or recent sudden onset of lower limb swelling and pain, the possibility of pulmonary artery embolism should be highly suspected. Once the above situation occurs, it is necessary to go to the vascular surgery department with the ability to save the patient as soon as possible to avoid delaying the disease, and usually after active treatment, the same patient can achieve good treatment results.