Masywna zatorowość płucna u 33-letniego mężczyzny ze słabymi czynnikami ryzyka do żylnej choroby zakrzepowo-zatorowej – postępowanie według wytycznych ESC

We present a case of a 33-year-old obese patient with pulmonary embolism (PE), admitted to the hospital with gradually worsening of dyspnea, general malaysia, right lower limb redness and oedema. During examination tachycardia (124/min) and hypoxemia (90% SpO2) were recorded. Laboratory findings revealed elevated levels of D-dimer, cardiac troponin-T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP). Electrocardiography showed clear signs of pulmonary embolism – SIQIIITIII and T-waves inversion in V1-V5. Diagnosis prediction was strengthened by transthoracic echocardiography, which uncovered signs of right ventricle overload and 60/60 sign. Despite little risk factors of venous thromboembolism (VTE), patient was assessed to high clinical probability of PE according to revised Geneva clinical prediction rule. Predisposing condition to VTE could be past COVID-19 infection. Patient was categorized into a group of intermediate-high risk of early mortality, received parenteral anticoagulation with unfractionated heparin and underwent computed tomography pulmonary angiography (CTPA) (class IB), which confirmed the diagnosis in this almost certain case. CTPA can cause many side-effects, including: contrast-induced nephropathy or anaphylaxis, which in such unequivocal situation may be questioned and other, safer methods of PE confirmation could prove their usefulness.