Wednesday, January 9, 2008

Need to Know

You are examining a 60 year old obese female patient two days after a hip replacement. She is a 50 pack-year smoker currently being treated for breast cancer. As you are examining her, she suddenly becomes short of breath. Her respiratory rate increases to 24 and heart rate increases to 110. In between breaths and coughs, she says, "it hurts when I breathe in." You hand her a tissue and when she coughs again, you see there is blood on the tissue.

She gets an immediate CT angiogram. The abnormalities are shown by the arrows.

Challenge: What is your diagnosis?

Related Questions:
1. What is the significance of the hip surgery?
2. What is the significance of the lung cancer and obesity?

Image shown under fair use.


Alex said...

pulmonary embolism? hx sig for virchow's triad risks.

Craig said...

Need to Know

This is a pulmonary embolism. Patients after a hip surgery will be immobilized (stasis). Both malignancy and obesity are risk factors for PE. The sudden onset dyspnea, tachypnea, pleuritic chest pain, cough, hemoptysis, and tachycardia suggest PE (though nonspecific). The CT angiogram shows filling defects consistent with PE. Deep vein thrombosis is the most common cause of PE. Treatment is often anticoagulation (heparin, LMW heparin, fondaparinux, warfarin) but also includes thrombolysis and surgical intervention.

Sources: Wikipedia, Loyola University Stritch School of Medicine website (