Halo 194 (Jan 2019)
Pulmonary embolism associated with Hodgkin lymphoma
Abstract
Introduction/Objective Pulmonary embolism is a pathological condition occurring as a result of medium or small pulmonary artery branch obstructions with a thrombus or other material (fat, air, amniotic fluid, pieces of tissue etc.) which enter the pulmonary circulation through the right heart, carried by venous blood. This report presents a rare case of pulmonary embolism in a patient suffering from Hodgkin lymphoma. Case report the Emergency Medical Aid Team intervened on a 65 year old woman suffering from Hodgkin lymphoma, who had suddenly developed significant difficulty in breathing and tachycardia. During examination the patient was conscious, afebrile, with normal skin and mucous membrane colour, was capable of active movement, had tachycardia (130 beats per minute) with normal heart sounds and no murmurs and tachy-dyspnoea with 29 respirations per minute, on auscultation with pronounced vesicular breath sounds and no other pathological findings. High blood pressure was recorded (160/95mmHg) and blood oxygen saturation was 92%. The ECG recording manifested no pathological signs and a complete absence of the McGinn-White sign (S1Q3T3). Based on Wells' score, the patient had medium probability of being diagnosed with pulmonary embolism. She was admitted to the Cardiology department of the Clinical Hospital Centre Zvezdara, where high levels of D-dimer were diagnosed (12263). The X-ray findings revealed hilar congestion and hilar pulmonary stasis. The pulmonary embolism protocol demanded that a pulmonary angioscan be performed and it revealed micro thromboembolism of pulmonary artery branches up to the level of segmental arteries, mainly on the right. The patient was treated during the course of two weeks under the diagnosis of pulmonary embolism of the micro embolism type with relatively small repercussions on the heart and hemodynamic. She was discharged in good health. Conclusion: As the prehospital setting does now allow many diagnostic possibilities, even in patients with atypical findings it is imperative to keep in mind the patient's history of a malignant disease, which can potentially be the cause of pulmonary embolism. If unrecognized, in 10% of the cases pulmonary embolism can result in death within the hour of the first symptom onset.
