Objective

This is a case report of a patient with acute massive pulmonary embolism without any symptoms.

Introduction

Pulmonary embolism is the third cause of mortality by cardiovascular disease after coronary artery disease and stroke, and it’s incidance is around 1/1000 per year.

Diagnose of PE is difficult because of variable clinical manifestations and poor specificity and sencitivity of symptoms and signs. PE can be presented with pleuritic chest pain (mostly), acute shortness of breath, hemoptysis or tachypnea and rarely syncop and shock. But asymptomatic massive pulmonary embolism also without deep venous thrombosis is fairly rare except cancer patients.

Case

A 55 year old woman, applied to cardiovascular surgery clinic for her varicose veins. She had a history of hypertension and was taking perindopril (10 mg. per day). She was consulted to our clinic because of her cough which is mildly ongoing for 3 months and for the regulation of hypertension medication. Her BP was 130/80 mmHg and HR was 75 per min. We performed EKG and TTE to the patient routinely and the TTE revealed a normal LV function (LVdD:40 mm, LVsD:23mm, EF: 65%), and left ventricle hypertrophy (IVSdd: 12 mm and PWdd: 13 mm). Right ventricle diameters and systolic and diastolic functions were normal, but a second degree tricuspid insufficiency was noticed with a velocity of 4.2 m per sec. Calculated pulmonary artery pressure was 70 mmHg. (Picture 1). A thorax CT was planned for further examination and diagnosis even though the patient has a low wells score for PE. Thorax CT showed a massive pulmonary embolism in both main pulmonary branches. (Picture 2). Doppler US for both lower exrtemities showed no deep vein thrombosis but a significant reflux at left saphenofemoral junction.