🩺 Clinical Case
54-year-old female
✈️ Long-haul flight 3 days ago
🦵 Right calf pain and swelling
😮💨 Sudden onset breathlessness
📍 Pleuritic chest pain
🚫 No haemoptysis
🔍 EXAMINATION
🌡️ Temp: 37.8°C
❤️ HR: 122 bpm
🩸 BP: 104/68 mmHg
💨 RR: 26/min
🫁 O₂ Sat: 91% on air
🦵 Right calf: warm, tender, swollen
🧪 INVESTIGATIONS
🧬 D-dimer: 3.2 mg/L (raised)
🫁 ABG: pH 7.48 | PaO₂ 7.2 kPa | PaCO₂ 3.1 kPa
📈 ECG: Sinus tachycardia | S1Q3T3 pattern
🩻 CXR: Hampton's hump right lower zone
🫀 Troponin: mildly elevated
❓ QUESTION
Q1. What is the MOST likely diagnosis?
✅ ANSWER
Q1: C) Pulmonary Embolism ✅
❓ FAQs: Pulmonary Embolism
Q1. What is a pulmonary embolism (PE)?
A PE occurs when a blood clot, usually from the deep veins of the leg (DVT), travels to the lungs and blocks a pulmonary artery.
Q2. What are the classic symptoms of PE?
Sudden breathlessness, pleuritic chest pain, tachycardia, and occasionally haemoptysis or syncope in severe cases.
Q3. What ECG finding is associated with PE?
The classic but uncommon finding is the S1Q3T3 pattern; sinus tachycardia is the most frequent ECG abnormality.
Q4. What is the first-line investigation for suspected PE?
D-dimer is used to rule out PE in low-risk patients, while CT pulmonary angiography (CTPA) is the gold standard for confirmation.
Q5. What is the initial management of confirmed PE?
Anticoagulation (e.g., LMWH or DOAC) is started immediately; thrombolysis is considered in massive PE with haemodynamic instability.
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