Syncope as a dominant symptom of pulmonary embolism

Abstract

Introduction/aim Clinical signs and symptoms of pulmonary embolism (PE) are non-specific, which is why it is commonly not diagnosed on time or sometimes not diagnosed at all. We are presenting a case of pulmonary embolism manifesting with syncope as a dominant symptom. Case report A 74-year-old female patient was hospitalized at the Clinic for Pulmonary Diseases with PE manifested with syncope. At admission, she was afebrile, tachypneic, with normal cardiac function and normal blood tension. Upon auscultation, breathing was muffled with late inspiration crackles above the base of the left lung. There were no other significant findings. The chest X-ray recorded at admission showed a non-homogenous shadow towards the base of the left lung and minimal pleural effusion. The ECG and echocardiography findings were normal. Partial respiratory insufficiency was verified by the acid-base balance analysis. Inflammatory markers were significantly elevated, with erythrocyte sedimentation rate of 30mm/h, fibrinogen of 8.62g/l and D-dimer of 18.6mg/l. Anticardiolipin IgG and IgM antibodies were negative, as well as beta-2 GPI IgG and IgM antibodies. An MDCT lung angiography was performed because of the elevated values of D-dimer and tachypnea, which showed multiple emboli of various sizes in the distal part of the right pulmonary artery and all lobar branches, as well as an embolus in the lobar branch for the lower lobe of the left lung. After a neurology consult, a head CT was ordered because the patient had suffered from loss of consciousness, but there were no pathological densities in the brain. Colour Doppler Ultrasonography of the blood vessels in the lower extremities showed organized thrombosis of the left femoral vein. A vascular surgeon was consulted and he prescribed anticoagulant therapy and an elastic compressive stocking, with control Colour Doppler Ultrasonography to be performed in six months. Conclusion Although syncope is an easily detectable symptom, it is still an unregulated crossroad of many an internal and neurological disease.