What's the Diagnosis? By Dr. Loran Hatch
A 60 yo F w/ a history of breast cancer presents to the ED with progressively worsening SOB over the past week. She denies chest pain. On exam, BP is 130/75, HR 105 and spO2 is 98%. EKG is nonischemic and labs reveal hsTrop 21,22 and proBNP 800. CTA chest is obtained. What's the diagnosis? (scroll down for answer)
Answer: Bilateral Pulmonary Emboli
- Manifestation of venous thromboembolism causing obstruction in pulmonary arteries
- Can be categorized into low risk/nonmassive, intermediate risk/submassive and high risk/massive based on hemodynamic stability, RV function (on CTA or echo), and troponin/BNP levels (according to American College of Chest Physicians and AHA)
- European Society of Cardiology guidelines further incorporate simplified pulmonary embolism severity index (sPESI) which uses 6 criteria to predict short term related PE mortality (in hospital or 30 day)
- sPESI scoring: 1 point given for following- age > 80, history of cancer, history of chronic cardiopulmonary disease, HR > 110, SBP < 100mmHg, spO2 < 90%
- For review on management of PE, check out previous EM daily post here!
Rali PM, Criner GJ. Submassive pulmonary embolism. Am J Respir Crit Care Med. 2018;198(5):588-598.