ABSTRACT:
Pulmonary Embolus (PE), in association with Deep Vein Thrombosis (DVT), is one of the three major cardiovascular causes of death. There are several risk factors for PE but still many cases are idiopathic. Cavity, bullae, and lung abscess formation are unusual findings in PE. Right Ventricular (RV) thrombus secondary to PE itself is also rare. Here, we present a case of a young male patient with no prior risk factors, who came to us with large bullae and cavitation in the lung which was secondary to PE. Later he developed RV thrombus and saprophytic fungal colonization of the affected lung which was all attributed to PE. The patient was managed conservatively with anticoagulation and his repeat echo after two months showed clearance of RV thrombus.
Case Report:
A 23-year-old previously healthy adult male presented with complains of cough since 5 days which was insidious in onset, gradually progressive in nature; with muco-purulent expectoration often blood tinged and non foul smelling. He described that 1 day prior to these symptoms he had an episode of sudden onset choking and breathlessness which lasted in 5 minutes after taking rest. There was no history of pain or swelling of lower limb, trauma, recent surgery or prolonged immobilisation, drug intake and significant weight loss. He had no previous medical illness. There was no history of any illicit sex or intravenous drug abuse. None of his family members had similar illness.
Clinical Examination:
On examination he was febrile with a temperature of 99.4 F, pulse rate was 120/minute, regular and all peripheral pulses were felt. B.P- 130/70 mm Hg, respiratory rate of 32/minute and pulse oximetery saturation was 89%. On cardiovascular examination, Second heart sound was loud in pulmonary area and a Grade 2 pansystolic murmur was present in tricuspid area. Respiratory system examination revealed a central trachea with grossly diminished air entry on right side with fine crepitations in right axillary and mammary area, left side was normal. Central nervous system examination was normal.
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