| Abstract [eng] |
Pulmonary embolism is a life-threatening disease that is usually caused by an obstruction in the pulmonary arteries. It is most commonly related to deep vein thrombosis in the lower limbs and is the most difficult form of venous thromboembolism. Pathological physiology includes pulmonary circulation disturbance, increased pulmonary vessel resistance, and often right ventricular dysfunction. The most common risk factors are long immobilization, surgery, malignancies, pregnancy, inherited blood clotting disease, and prior thrombosis or embolism. Pulmonary embolism can manifest in various clinical symptoms that make it difficult to find an appropriate diagnosis and choose the treatment. The most common symptoms are sudden shortness of breath, pleuritic chest pain, tachypnea, and hemoptysis. Less common and atypical symptoms include prolonged shortness of breath, cough, fever, fatigue, and confusion. In some cases, the manifestation can be asymptomatic. Diagnostics usually rely on a patient's symptoms and evaluation of laboratory test and imaging test results, as well as filling up Geneva or Wells questionnaires. Computed tomography angiography is still the gold standard in pulmonary embolism diagnostics. The treatment depends on risk stratification; however, the most common choice of anticoagulation is direct oral anticoagulants. Early and accurate diagnosis improves patients’ survival rate and reduces residual effects. In this thesis, three clinical cases are discussed that had uncommon clinical manifestations of pulmonary embolism and delayed the selection of the correct diagnosis. In these cases, the distinguishing symptoms were coughing up phlegm, a mild, a few-day-lasting cough, and shortness of breath present only in physical activity. Also, in one clinical case, a computed tomography angiography and ultrasound of the lower limbs' deep veins did not show any changes. During the follow-up visit, anterior and posterior lung scintigraphy, single-photon emission tomography imaging, and computed tomography of the chest were performed. Imaging findings revealed pulmonary artery thromboembolism, and appropriate treatment was initiated. This thesis highlights the difficulty of differential diagnosis of pulmonary embolism, the variety, and the low specificity of clinical symptoms. |
