CASE PRESENTATION

RECCURENT PULMONARY
EMBOLISM

 Abdul Karim 48 Years old Non Smoker Teacher from

Kabul Afghanistan presented to Out Patient
Department with Chief complaints of Difficulty in
Breathing , Chest Pain and lower Leg Swelling from
Past 20 Days.
On History Of Presenting Illness: Onset of Dysnea
was sudden, was not related to any Trauma ,
aspiration of foreign body. Patient complain of
waking up at night gasping for breath when he slide
down the pillows( Paraoxysmal nocturnal
Dyspnoea ).
No history of Atopy or any Seasonal Allergy.

 The Dyspnoea did not relieved on

sitting Up right.
It was associated with Dry Cough
It was not associated with hemoptysis.

ON EXAM
INSPECTION:
Clubbing Grade 3

 Abdul Karim 48 Year old male from Kabul Afghanistan presented

to OPD with complains of Shortness of Breath and Constipation
from past 20 days.
History of Presenting Illness:
The patient was in his normal state of Health 20 days ago when
he gradually started to have Shortness of Breath on mild Exertion
but over a period of One week the symptoms aggravated and he
experienced breathing Difficulty even on Rest.
It was associated with Sharp Chest pain of Moderate intensity
Typically which increased
with deep respiration and coughing.
It was also associated with Palpitations on and off.

On asking about previous similar

episodes he revealed that 05 years
ago he had Similar symptoms for
which he was Hospitalize in India and
was discharged on Home
medications but patient quit taking
medications after he got symptom
free.

 Patient denied any history of Wheez, Fever,

Hemoptysis , Night sweats or weight loss.
Medical history:
Patient was initially managed in Govt hospital where
Rt. Side chest intubation was done.
No history of DM , HTN, TB.
Cancer, immobilization, DVT, pregnancy, use
and tachycardia of oral contraceptives or other
estrogencontaining
drugs, recent surgery or
hospitalization

 Social History:
Primary School Teacher and lives in
well constructed House with his Wife
and kids.
Medications:
No History Of any medication at
Home.
Sy

 Systemic Review:
Neuro: Depressed
Cardio: Chest Pain,Palpitations On/off
, Pedal Edema
Resp: Shortness of Breath,
Tachpnoea , Dry Cough.
G.I: Constipation, Anorexia.
Rest Of the systems Normal.

EXAMINATION
General Physical Exam:
Ill looking middle Aged man having Nasal
Prongs Lying in Bed with Head End Elevated
Vitals:
BP: 110/80
Pulse: 120/ Minute
Temp: 98.9 F
SPO2: 88 %
R/R : 20/Minute

 CNS: NAD
CVS : JVP RAISED, TACHYCARDIA ,
B/L
PEDAL EDEMA
CHEST: CLUBBING ++
B/L CRACKLES
DECREASED BREATH SOUNDS
ON
LEFT

Rest of the Examination was Normal.

 Summary:
Gradual Onset and Progressive SOB
with Sharp Generalize Chest Pain on
Inspiration, Cough,Raised JVP,
tachycardia, tachypnoea, Pedal
Edema and B/L Crackles with
Decrease Breath Sounds on Rt with
Low Oxygen Saturation.

 Differnetial Diagnosis