Diagnosis and Treatment of Massive Pulmonary Thromboembolism in a Patient with Metastatic Colon Adenocarcinoma

Abstract

Aim: Massive pulmonary thromboembolism (PTE) is one of the cause of unexpected deaths in hospitalized patients. Our aim is to present diagnosis and treatment of massive pulmonary thromboembolism in a patient with pneumonia and cancer. Case: A 52 years old male with a metastatic colon adenocarcinoma, admitted to the emergency department with shortness of breath, one month after the right hemicolectomy and chemotherapy. The physical examination of the patient: general condition was bad and he had tachypnea, tachycardia, and rals in the left lung bases and leukocyte: 21.000 K/ml, CRP: 28mg/dl, Ph:7.46, PaO2:56.6, PaCO2:23.2, SO2:%82, HCO3:19.8. Tachypnea, tachycardia, hypoxia, hypocapnia, and respiratory alkalosis was observed, PTE was considered and diagnosed by CT pulmonary angiography. 50 mg Alteplase was applied to the patient. After administration of alteplase, general condition was improved (pH:7.37, PaO2:85.1, PaCO2: 38.9,SO2:98.5%, HCO3:20.3). Conclusion:Pneumonia, may mask the diagnosis of PTE and should be considered in patients with dyspnea, hypocapnia, hypoxia, and hypotension